Working with Cultural Differences in Therapy

As the above cases illustrate, anorexia and bulimia are also problems among many young women of color. Eating disorders of all types exist among people of color. Therapists must attend to the full spectrum. This means noticing obesity as well as anorexia and asking questions about feelings and attitudes about weight. It is helpful to formulate questions that reveal information about cultural norms around food and weight. Therapists can ask, "Is weight a concern for you?" "What are the weight norms in your community/ethnic group?" "In what ways are your concerns about weight or body image (or lack of concern) similar to and different from white women, or from the the dominant groups in society?"

If the therapist is white, these questions may need to be rephrased and repeated as the therapeutic alliance develops. It can be difficult to discuss the concerns with women of another racial or ethnic group, particularly when the norms around food and weight are so different.

I have yet to meet any woman of color who did not have some concern about food intake and body image. Yet there are some differences between the weight concerns of white women and women of color. Healing for black women and other women of color must be culturally and emotionally in harmony with one's environment. To facilitate healing, therapists should explore the role of culture. In addition, therapists must be cognisant of the vast international variety among racial groups. The culture of people of West Indian heritage, for example, differs from African American culture.

This awareness is also extremely important in working with vastly different cultures that comprise the so-called Asian peoples. The impact of racism and class oppression must be uncovered as well. A full understanding of the personal and cultural meanings of weight and food will facilitate the process of healing among women of color suffering from eating disorders.

By: Patricia Romney Ph.D