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Transforming Women's Body

Image
a a a
Mary Bergner , Pam Remer & Charles Whetsell
a
Faculty, College of Education, University of Kentucky
Published online: 18 Oct 2008.

To cite this article: Mary Bergner , Pam Remer & Charles Whetsell (1985) Transforming
Women's Body Image, Women & Therapy, 4:3, 25-38, DOI: 10.1300/J015v04n03_04

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 Transforming Women's Body Image:
A Feminist Counseling Approach
Mary Bergner
P a m Remer
Charles Whetsell
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The negative self-view that many women have toward their own
bodies has been identified as an important issue for feminist thera-
pists and researchers (Gilbert, 1980; Hutchinson, 1983). In a study
by Hutchinson (1983), nearly all of the 122 women sampled had
held or currently held a negative body image. Very little research
has been done on women's body image and most counseling in-
tervention approaches have focused on changing the body itself
(through exercise or dieting) rather than helping women learn to ap-
preciate the bodies they have.
Prior research on body image has had a primarily androcentric
orientation because it has failed to give adequate weighting to the
unique socialization women undergo (Brodsky & Hare-Mustin,
1980). One important aspect of a woman's social learning is the
equation of physical attractiveness with self-worth, with attractive-
ness being culturally derived and determined by others in the envi-
ronment (Greenspan, 1983).
The different perspectives of men and women in relating to their
bodies is illustrated in a study by Gold and Berger (1978). They
found a positive correlation between physical attractiveness and
popularity for elementary school-aged girls while for same-aged
boys popularity was linked to athletic performance. Similar findings
have been obtained in research on adolescents and young adults
(Lerner & Brackney, 1978; Morse, Gruzen & Reis, 1974; Musa &
Roach, 1973). These studies concluded that a lack of attractiveness
is a social liability for females significantly more than for males in
this culture.

Mary Bergner. Pam Remer and Charles Whetsell are faculty in the College of Education
at the University of Kentucky.
Women & Therapy, Vol. 4(3). Fall 1985
O 1985 by The Hnworth Press. Inc. All rights reserved. 25
 26 WOMEN & THERAPY

Feminists believe that women have been over-identified with their

bodies, i.e., "Women as Body" (Greenspan, 1983, p. 161). Self-
worth has ohen become contingent upon the prevailing norm for
physical attractiveness which is in turn a primary factor inherent in
most traditional female roles (wife, mother, gal Friday). For ex-
ample, appearance becomes important in catching a husband or
pleasing a boss. Consequently appearance can become a survival
issue for the traditionally sex-typed woman.
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Thus, body image, the value laden thoughts and feelings about
one's body (Hutchinson, 1981), is derived from cultural influences,
and as such is an internalized representation of cultural norms
(Wooley & Wooley, 1980). From a social learning theoretical
perspective, the individual woman internalizes these social values in
the form of self-statements and cognitions which she believes
originate within herself and which she experiences as objective reali-
ty. Negative self-evaluation and feelings arise from what may ap-
pear as individual problems, but which actually originate from the
socio-political environment of the woman. Feminist writers such as
Hutchinson (1981, 1983) and Greenspan (1983) argue that this is the
etiology of negative body image since the vast majority of women in
our culture are at odds with their bodies.
Hutchinson (1981) has researched the efficacy of a visuo-kines-
thetic imagery intervention in changing the negative body image in
physiologically and psychologically healthy women. The majority
of the women in her study saw themselves and their bodies in a sig-
nificantly more positive way as a result of the treatment.
The .investigators of the present study sought to improve female
subjects' self-esteem and body image through three different group
counseling treatments (Visual, Kinesthetic and Visual-kinesthetic)
based on the cognitive restructuring principles of Rational Behavior
Therapy (Maultsby, 1984) and on social-learning principles (Ban-
dura, 1977). In the present study body image was defined as the
mental representation of embodiment which encompasses feelings,
attitudes and beliefs about the body (Hutchinson, 1981). These
thoughts and feelings are value laden and tend to cluster into a total
body cathexis which describes the degree of satisfaction or dissatis-
faction with the body (Jourard & Secord, 1955).
The purpose of this present paper is to describe these group
counseling interventions for negative body image in women and
outline the more salient body and sex-role issues that emerged for
the women in the groups. In addition, results of the differential im-
 Bergner, Remer, and Whetsell 27

pact of the treatment groups on self-cathexis and body cathexis are

reported. The counseling interventions were based on feminist
therapy tenets (Gilbert, 1980) and the research was conducted from
a feminist research perspective (Brodsky & Hare-Mustin, 1980).

METHOD
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Subjects
Three eight-week-long small groups were run concurrently
wherein women were given the means to restructure their sex-role
stereotyped thoughts and feelings about their bodies in ways that
were more personally useful to them. All the subjects joined the
groups voluntarily in response to posters which wereentitled "Trans-
forming Body Image," and all subjects perceived themselves as
having negative body images. Four-fifthspf the subjects fell within
the desired healthy range of weight for their height (National Center
for Health Statistics, 1980). Four subjects (less than one-fifth) were
not within their weight range and were more than 20 pounds over-
weight. The 24 subjects were Caucasian women ranging in age from
21 to 63 with a median age of 36. Twelve were married and 12 were
employed outside the home. The subjects were randomly assigned
to one of the three treatment groups or to a waiting list control
group.

Instrumentation
All subjects were given the Jourard-Secord Body-CathcxislSelf-
Cathexis Scale (BCISC) (Secord & Jourard, 1953) two weeks prior
to the start of the groups and again during the last week of treatment.
The BCISC scale consists of 110 items. The 54 body-cathexis items
measure the degree of satisfaction with aspects of physical appear-
ance and performance. The 56 self-cathexis items measure satisfac-
tion with self. The instrument yields body-cathexis, self-cathexis
and total cathexis scores.
Treatments
All three groups were co-led by the first and third authors. One
leader was a female counseling psychology graduate student who is
training to be a feminist therapist and has had special training in Ra-
 28 WOMEN di THERAPY

tional Behavior Therapy. The second leader was a male counseling

psychology graduate student who has had special training in body-
centered therapies. A female leader was seen as important as a sup-
portive role model who could empathize with and validate the group
members experience as women in this society (Gilbert, 1980). It
was hoped that the presence of a non-traditional, androgynous male
group leader could provide an alternative model who did not re-
spond to the women primarily on the basis of bodily appearance.
The tools of rational restructuring provided the foundation for the
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treatments. A cognitive restructuring approach allowed the women

to access how their internalized, culturally derived self-statements
led to personal feelings of worthlessness. More importantly, they
learned to change these self-defeating statements into more per-
sonally self-enhancing and accurate statements.
The three treatment groups were alike in their use of cognitive
restructuring methods, homework assignments, journal keeping and
group processing of content, but differed in their approaches towards
both accessing and reframing cognitions. One group (Visual) ac-
cessed and reframed thoughts and feelings primarily through a
visual 'processing system, a second group (Kinesthetic) through a
movement-sensation processing system and a third group (Visual-
kinesthetic) through combining these two processing systems. For
example, in an exercise used in the first treatment week, the Visual
group accessed self-talk about their bodies by looking at themselves
in a mirror while the Kinesthetic group accessed their thoughts and
feelings by walking around.the room during a guided movement ex-
ercise. In the Visual-kinesthetic group, the subjects walked in front
of a camera and then watched video-tape playbacks of themselves.
(Subsequent weekly treatment descriptions will focus on the
similarities among the groups. Detailed treatment descriptions for
each group can be obtained from the second author.)
The journal-keeping option was given to all women across groups
as a structure for them to record their reactions, impressions, or
questions regarding each group session. If they so desired, the jour-
nal could be turned in to the group leaders who would read and then
respond in writing to each entry. Homework assignments, however,
were mandatory for group membership and gave participants a
chance to practice skills or to focus awareness on certain issues
which had been central to the prior group session. The homework
was designed as a means to strengthen group interventions in the
real world outside of group.
 Bergner, Remer, and Whetsell 29

Based on this cognitive-behavioral model, there were three major

therapeutic goals across all three treatment groups. They were:

1. T o help group members build a sense of stewardship and nur-

turance towards their bodies. Implicit in this goal was the need
to challenge the ways in which women relinquished ownership
of their bodies to others. Cultural norms which defined one
particular physical appearance as better than another were
challenged as were norms which labeled female bodily func-
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tions (menstruation, menopaus-,, etc.) as dirty.

2. To facilitate a sense of self-worth that is independent of body
image. Specifically the women were encouraged to own other
sources of power available to them, while at the same time
learning to appreciate and enjoy their bodies.
3. To validate each woman's experience, including her feelings
of anger and rage, as important and worthy of respect.

Interventions

Week One. The first group session opened with each woman shar-
ing her hopes and expectations for the group. Common themes were
poor self-esteem based on negative body image, anger at the media
for its continued message that worth equals physical attractiveness,
lack of bodily confidence, and sexual dysfunction related to poor
body image.
A didactic section ofs each group included information-giving
regarding the nature of self-talk, how it arises in response to specific
events, and how it leads to particular emotional states (Maultsby,
1984). The group then did an exercise which focused group atten-
tion on the self-talk elicited when their bodies were under observa-
tion either by themselves or by others. This was accomplished dif-
ferently for each group, depending on their representational system
focus, through the use of mirrors (Visual), stage performance (Kin-
esthetic) or video-recording equipment (Visual-kinesthetic).
Week Two. The group sessions began with a processing of the
homework assignments. The didactic portion focused on how choice
of language (i.e., thinking) can shift attributions from inside to out-
side, thus effecting a change in perceived locus of control from in-
ternal to external. Next, each member imagined herself in several
different life situations (e.g., nursing mother, young athlete, busi-
nesswoman, old woman) and noticed what assumptions arose about
 30 WOMEN & THERAPY

the life-style and daily experience of each. These awarenesses were

discussed as internalized and learned sex-role stereotyped messages
regarding women's bodies, rather than as being innate realities.
Beliefs which members thought were maladaptive for them were
worked with by restructuring self-cognitions.
Week Three. At this point in the group process the women were
challenged to focus on their own personal body image issues and to
specify behavioral and cognitive changes they would like to ac-
complish. Group members shared what their target behaviors were
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and the leaders modeled rational reframing (Maultsby, 1984). Time

was also allotted for emotional processing and support-giving
among group members.
Week Four. This group session was devoted entirely to working
with Rational Self-Analyses (RSA) forms (Maultsby, 1984) that the
members had completed as homework. Using the RSA format, each
woman had identified an antecedent event, her ensuing self-talk, and
her emotional reaction to that event vis-&is her body image issue.
She then attempted to restructure her thinking rationally in order to
achieve her desired emotional state.
~ h e ' ~ r leaders
o u ~ worked with each woman systematically to en-
sure that all group members had accurately identified their self-talk
and had refrarned it in a way that had a positive emotional effect.
The concept of habitual cognitive/emotive patterns was discussed,
as was the importance of regular practice in forming new behavioral
habits. Group members expressed relief and a sense of freedom at
the idea that their thoughts and feelings were learned rather than in-
nate and that new behaviors could be chosen and worked toward.
Week Five. Part of this session was spent assessing how the group
experience was meeting individuals' personal needs and goals. In
accord with guidelines for feminist therapy (Gilbert, 1980), the
group process had been presented and maintained as a collaborative
effort between members and leaders. Thus at this mid-way point in
the treatment, feedback was elicited and utilized in planning the re-
maining groups. In general, feelings of trust for each other and hope
for personal change prevailed, with most members expressing satis-
faction with the ratio of time spent in didactic, experiential and pro-
cessing activities.
The women were guided through an imagery experience which
had been designed using Maultsby's (1984) script format for Rational
Emotive Imagery (REI). In this imagery they imagined themselves
behaving, thinking, and feeling congruently with their desired body
 Bergner, Rerner, and WherseN 31

image. Guidelines were then taught for writing rational-emotive im-

agery scripts and suggestions were given for implementing daily
RE1 practice.
Week Sir. Group members read their imagery scripts to one
another and shared the experiences they had in daily practice of the
imagery. The women who had written successful imagery scripts
reported powerful effects related to practicing their desired thinking
and feelings. They were aware of real bodily changes as their affect
changed in the imagery. Sharing these experiences with one another
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was very moving and empowering for all present. Experiencing

change in cognition, affect, and behavior was exciting and consis-
tent across groups at this point.
By the end of this session, all the women had designed a workable
imagery script based on their individual body image issues and had
been instructed how to practice. At this point in the groups, our
leadership roles had become less directive, group cohesion was
strong, and the women were taking increased responsibility for both
their own growth and the running of the group.
Week Seven. This week's groups were devoted to a relaxation and
imagery exercise guided by one of the leaders. Once the women had
achieved a deep state of relaxation, they were given the suggestion
that as various body parts were named by the leader an image or
symbol would spontaneously emerge. Slowly parts of the body were
mentioned (i.e., feet, thighs, stomach, genitals, hands, etc.) for a
total of nine body parts. Without talking to one another, the women
were instructed to choose one of the symbols which had emerged
with which they would like to converse. They then began this
discussion with the symbol by using a free-associative writing style
suggested by Progoff (1975). These dialogues were then shared in
the group.
This exercise was designed as a way to access self-talk through
the use of symbols. Each woman had encoded different types of ex-
periences in specific areas of the body. Each woman's chosen body
part had its own needs and its own wisdom to share with her. The
final portion of this group was spent in grounding this exercise by
relating it back to each woman's body image issue. Members were
given some information about the use of symbols in imagery and
suggestions for dialoguing with the remaining symbols they had ac-
cessed.
Week Eight. In the final session members were first given the
post-test instruments. Time was then provided for saying goodbyes
 32 WOMEN & THERAPY

and reaching some degree of closure. Each member was asked to

evaluate and then share how successful the group had been for her in
dealing with her particular body image issue(s). Opportunity was
provided for each woman to address her group as a whole as well as
each group member individually. The group leaders asked for sug-
gestions for improving future groups, explained the research model,
and let the group members know that they would receive the
research results in the mail. Additionally, the women were given in-
formation describing sources for both individual and group counsel-
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ing available in the area should hey choose to continue their work.

RESULTS

Emergent Body Issues

Throughout treatment, body image issues continued to emerge

that were both common to group members and consistent across
groups. Because these issues may be typically found in clients with
negative body image, and because negative body image is so com-
mon among women, an understanding of them is pertinent to all
counselors of women.
At the core of the problem of negative body image in woman is
the total cultural identification of woman with her body, so that in a
very real sense, perceived self-worth is equal to perceived body-
worth. Greenspan (1983) argued that in patriarchal cultures where
women are so often dependent on men for survival and/or approval,
the body becomes the woman's primary source of power. The more
physically attractive a woman's body is, the more likely she is either
to snare a successful man (and thus ensure her economic security),
or to be successful on her own in a world where men control access
to fame or fortune.
Furthermore, women believe they should be able to control how
they look. Research suggests that most women believe they weigh
too much, even when their weights fall within a medically defined
normal, healthy range (Hutchinson, 1983; Wooley & Wooley,
1980). The popular myth prevails that overweight people are simply
out-of-control, weak-willed, and have no self-respect, even though
recent studies indicate that there may be little difference in the eating
habits of the obese and normal weighted persons (Wooley & Wooley,
1980). Thus, not only do women believe they have to look a certain
 Bergner. Remer, and Whetsell 33

way, they also believe they should be able to control how they look
and often experience the profound guilt and depression inherent in
the double bind of "I have to but I can't ." This phenomena was
observed in our group members across several issues, including
body weight, body height, aging, sexuality, and physical perfor-
mance.
Many group members found it difficult or impossible to actually
focus on themselves in a mirror or on a video tape. They experienced
a marked inability to describe objectively what they were seeing and
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were not able to dissociate from their subjective negative self-

attributions. The majority of women described looking at them-
selves as a painful experience accompanied by negative self-talk
regarding their bodies and their worth, arising from the disparity
between perceived appearance and the cultural ideal. It is critical to
note that this was as true for the younger more slender women as it
was for those who were older or overweight.
A second consistent issue throughout the groups was a sense of
having been betrayed by the body, especially as the body changes in
pregnancy and childbirth and as a function of aging. Thus, a
woman's greatest source of power becomes her own worst enemy
(Greenspan, 1983), as men lose interest in the body bearing stretch
marks or wrinkles. Group members expressed much bitterness and
anger in discussing this issue, and because female anger toward men
is not socially sanctioned, their rage was focused on their own bodies.
One of the older group members, for example, was very hurt by the
fact that her husband was having an affair with a younger (and pre-
sumably more attractive) woman. Rather than focus her attention on
the marital relationship, however, she seemed to accept that it was
natural that he would not want her anymore and directed her bit-
terness towards her own body. She felt that something was wrong
with her because she was depressed and could not come to terms
with her aging process.
Several group members worked on the issue of mindlbody dis-
connection as described by Hutchinson (1983), wherein there is a
dissociation from and denial of the female body. These group
members were bright and had worked hard in their lives to achieve a
sense of intellectual competence. However, they felt that in order to
do so they had traded off their sense of connection to their bodies. In
general they described themselves as "not very feminine." They
had been socialized to believe that they could have a mind or a
female body, but not both. For one woman this issue manifested as
 34 WOMEN 8; THERAPY

sexual dysfunction, and for another, as bingelpurge eating behavior.

One of the highlights of the groups was a session wherein the latter
woman experienced herself as "female," a part of her identity she
had denied since adolescence. She worked toward a realization that
she could be in her body and still experience intellect, power, and
worth.
A shared experience among group members who were married or
involved with men was that they had relinquished ownership of their
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bodies. Several mothers reported experiencing their bodies as

utilitarian machines that gave birth to and nursed children and which
sexually serviced their husbands. Additionally, all of these women
discounted their experiences of resentment at not owning their
bodies as silly, trivial, or selfish. Implicit here are belief systems,
based on socially learned stereotypes, that good women put them-
selves last and seek to please others at all costs. Their bodies, then,
become a functional tool toward this end and lose their function as a
source of self-information and pleasure.
Sexual double standards wherein the female body is experienced
as bad,, ugly, or dirty, and masturbation or enjoyment of sex is viewed
as sinful, was a fifth issue for group members. Unger (1979) re-
ported that women tend to masturbate less than men, are expected
not to have as strong a sex drive (despite research evidence to the
contrary), and are taught that they will enjoy sex less. Additionally,
she argued that female genitalia is considered to be ugly and smelly
and proposed that these attitudes about the most specifically female
body parts carry over to poorer general body image. Among our
group members we found these attitudes to be present and con-
tributing to negative body image as well as to sexual problems. One
group member specifically joined her group in order to work on her
inability to orgasm or to even touch herself sexually.
Meinbers raised the issue of competition between women as
primarily a body image problem. They found that they made judg-
ments about other women, as well as about themselves, based on
preconceived beliefs connected to appearance. Thus, women defined
as attractive by cultural standards were perceived as threatening to
marriages, conceited, and as less likely to make good friends. The
double bind for women is explicitly clear: unattractive women are at
risk of not attracting men, and attractive women are at risk of being
seen as competitors and suffering from the rejection of other
women. Besides suffering loss of female friendships, at least one
group member felt that because she was attractive she was only be-
ing related to by men because of her looks. In any case, all group
 Bergner, Remer, and Whersell 35

members had experienced feeling discounted by being related to

first as bodies and secondly as individuals.
Underlying each of the aforementioned issues was a shared feel-
ing of rage among group members that this culture offers them no
valid sources of identity beyond their bodies. Greenspan (1983)
pointed out that personhood is culturally defined in male terms, so
that traditionally, women can obtain personhood only vicariously as
bodies for men.
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Treatment Groups' Comparisons

The means and standard deviations of the pre and post outcome
measures for the four groups are given in Table 1. Analyses of
variance comparisons were conducted on the pre-post gain scores
for the self-cathexis, body cathexis and total cathexis scales for the
three treatment and one control groups.
The pre-post gain score comparison for the body-cathexis scale
yielded a non-significant F value of 2.23 (df = 3,18, p.>.05). Thus,
the treatments did not have a significant impact on the subjects'
perceptions of their bodies. The pre-post gain score comparison for
the self-cathexis and total cathexis scales yielded significant F
values of 4.06 (df = 3,18, p.< .05) and 3.65 (df = 3,18,p.< .05)
respectively. Tukey's studentized range test was then performed on
the self-cathexis and total cathexis means to determine where the
significant differences occurred. The Visual group and the Visual-
kinesthetic group both had significantly higher mean gain scores on
the self-cathexis scale than the control group. The Visual group had
a significantly higher mean gain score than the control group on the
total cathexis scale. Thus, the Visual and Visual-kinesthetic treat-
ments had a significant impact on subjects' satisfaction with self and
the Visual treatment had a significant impact on subjects' total
satisfaction with self and body.
There were no significant differences on any of the dependent
variables among the three treatment groups (Visual, Kinesthetic,
and Visual-kinesthetic) indicating no treatment was significantly
better than anothcr.

DISCUSSION
Congruent with Hutchinson's (1983) finding that a majority of
her sampled women had or had had a negative body image, 80% of
the subjects in the current research were within the desired weight
Downloaded by [University of New Hampshire] at 15:47 04 March 2015

Table 1
Means and Scandard Deviations for Cachexis Inventory Across Treatment GroupS

d
Visual Group a Kinesthetic Group Visual-Kinesther ic Group Control Group
Pretest Posttest Pretesc Posttest Pretest Posttest Pretest Posttest
Measure M SD H SD M SD M SD I4 SD M SD M SD H SD

Body Cathexis 3.01 .32 3.67 .34 3.03 .38 3.29 .23 2.89 .49 3.27 .50 3.09 .14 3.23 .41

Self Cathexis 2.85 .59 3.61 .64 3.09 .09 3.41 .51 2.97 .73 3.62 .51 3.31 .42 3.04 .45

Total Cathexis 2.94 .45 3.64 .43 3.06 .22 3.35 .35 2.93 .46 3.45 .43 3.2 .28 1 .38
 Bergner, Remer, and Whetsell 37

range yet still perceived their bodies negatively. Because of the

cultural identification of woman with her body, the problem of
negative body image is a core factor in women's mental health
issues, including depression, eating disorders, sexual dysfunction,
agoraphobia, and marital relationship problems. Thus, developing
counseling interventions that help women gain a more positive view
of their bodies (rather than trying to change their bodies through diet
andlor exercise to conform to the cultural ideal) is important for
feminist therapists. Moreoyer, these interventions need to enable
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women to challenge their sex role stereotyped body messages.

The cognitive intervention approach to negative body image used
in this study was determined to have a significant impact on self and
total cathexis in a group format of relatively short duration. Skills
were learned which group members could generalize to situations
outside of the group. Equally important was the sense of group sup-
port and validation for each members' experience.
Additionally, members came to realize that their thoughts and
feelings were products of their specific cultural learning histories
rather than innate characterological defects. This was a crucial shift
in outlook for these women, many of whom had spent years im-
mersed in self-blame and self-hatred. Most members expressed feel-
ings of empowerment and excitement upon learning how to replace
habitual, learned patterns of thinking and behaving with new ones,
and thus became active, informed participants in their own growth.

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