With over twenty years of experience as a clinical psychologist, Penny Kokot Louw has long been passionate about research. In 2020, she took on the challenge of pursuing her Doctor of Health while continuing to work full time.
Her research has shed light on an issue that is often overlooked in psychological care— unconscious bias against people of size. Despite training to avoid bias, Penny’s findings reveal that clinical psychologists can still carry implicit prejudices—highlighting a critical area for improvement in the field.
“It's almost taken for granted in the health field, that to be healthy you must be thin. Of course, this is not true. Knowing this, I was very curious to understand how this might play out in the mind of a psychologist working with a person who presents for anxiety, depression, or relationship difficulties.
“How does a psychologist’s perception of a person's body, shape the way they think about their problems? Or even shape the way they think about their solutions? This hasn’t been explored in New Zealand before.”
Another crucial element of Penny’s research is the importance of decolonising psychological practice. “The antecedent of bias against fat bodies goes back quite a long way. It has roots in colonial ideas around sexism, racism, and classism.
“Discrimination and bias based on body size is pervasive in the health field. My research shows that psychologists are often unaware that they hold bias, or that their bias may impact negatively on the therapy they provide to clients.”
Penny also found that many psychologists are uncomfortable talking about their clients’ bodies, especially if their clients are living in large bodies. This is problematic, Penny explained, because trauma is not solely confined to the mind—it is experienced in the body as well. This concept, which aligns with more holistic and indigenous understandings of health, calls for a new, integrated approach to considering the body in therapy.
“Nobody walks into therapy without their body,” she says. Importantly, Penny notes that where there is bias, there is often stigma. “We're doing harm. And of course, our first job is to do no harm.”
Through her own years of clinical training and supervision, Penny has become aware of the lack of support to develop accessible psychological care for fat people.
“The topic just never came up. In society, fatphobia is so entwined with colonised physical health concepts, it could be described as the ‘last acceptable form of bias’. It feels as though I’m exploring uncharted territory.”
After interviewing participants for her research, Penny feels a sense of responsibility to share her knowledge. “They were generous enough to share some very raw, honest impressions, which I think are meaningful to the profession as a whole.”
Returning to study was a big decision for Penny. With a family and a busy career to take care of, Penny had attempted to begin her PhD twice before, ultimately putting her plans on hold.
“In the end it was for the best. I couldn’t have done the same study if I started earlier. I didn’t have the lived experience as a therapist, and the observations of people around me and how they’ve been discriminated against—especially women and ethnic minorities. I think this lived experience has brought a lot to the study.”
Despite the challenge of juggling work and study, Penny expressed her gratitude for the support she received upon starting her professional doctorate. “You get a lot of initial support to find your feet in the academic world again. You’re encouraged to ask for help and check in with your peers.
“As an experienced professional, you think, ‘I’ve got a lot to offer people, but I haven’t been a student for years.’ In reality you’ve been training your whole life for it. You’ve learned to persevere and to prioritise. Those are skills that translate really well to research.”
Penny feels passionate about encouraging others to pursue postgraduate study. “Many of the people in my cohort were coming back to study later. For women especially, I think we’ve started to realise that your life’s not over when you turn 50.”
Through the long weeks of study, the passion from her fellow researchers kept her motivated. “They love what they do and it’s infectious. That kind of energy just keeps you going.
“I’m looking forward to seeing what the rest of my cohort did with their own research.”
Penny's work promises to make a lasting impact in the field of clinical psychology, fostering a more inclusive and respectful approach to mental and physical health in Aotearoa and globally.
Read Penny’s thesis: The Framing of Fatness in the Profession of Psychology in Aotearoa New Zealand