Carlin Francis

The Integration of Yoga Practices into Therapeutic Work:

A Look at Social Workers and Psychologists

CARLIN FRANCIS

Lesley University; Yoga: Theory, Practice and Culture; Laura Douglass

INTRODUCTION

While yoga began as a religious and philosophical practice in India, it is generally recognized in the United States as a fitness-oriented practice. A growing interest in yoga has led to a better understanding of the psychological benefits that come along with yoga practice. Recognition of yoga's potential as a healing power has caught the attention of various medically based professions. For example, social workers and psychologists are beginning to view yoga as a complementary practice to more traditional psychotherapy techniques. Recent scientific interest in yoga has resulted in increasing evidence of yoga's benefits exceeding improved physical strength and flexibility (Sisk, 2012), and clinicians are beginning to consider yoga as a complement to psychotherapy (Novotney, 2009).

In my own personal exploration of yoga, I have recently been introduced to a variety of practices and alternative means of healing such as Ayurveda treatments and meditation practices. These nontraditional methods are once again becoming a trend in the United States today. Curious as to the onset of the recent trend, I began looking at the acceptance of yoga as medicine within counseling professions. I suspected that the nation's growing interest in the ancient practices of yoga would allow for some experimentation and inclusion of nontraditional healing methods for mental disorders. Because the healing power of yoga is primary recognized in our culture as a physical activity, yoga's potential for aiding in psychiatric disorders is not typically a central focus.

HEALING AS MEASURABLE?

The importance of scientific validation is crucial in Western medical and scientific fields today. Shannahoff-Khalsa addresses this right away in his book Kundalini Yoga Meditation: Techniques Specific for Psychiatric Disorders, Couples Therapy, and Personal Growth. He explains one of the primary purposes of the book as giving the reader “enough evidence to consider this knowledge as an important ancient science, which today is perhaps best described as an 'ancient technology of the mind'” (Shannahoff-Khalsa, 2006). It is quite difficult to fully explain yoga's ability to achieve such measures, for establishing tangible first steps toward understanding the complexities of the power of the mind is a challenge. Although many studies have been conducted in regards to yoga as a complementary therapy, very little quantitative evaluations have been recorded (Selman, Williams & Simms, 2012).

“Social work is currently resting in a paradigm where evidence based practice is all the rage” says Smart, a graduate student of the Simmons School of Social Work, in regards to the fixation on rigorously tested therapeutic methods. She continues with discussing the trend of “many clinicians are using interventions like cognitive behavioral therapy or dialectical therapy” for these approaches are easily measured (Smart). Dr. D.L. Bhusan labels yoga as the science of the mind: “Yoga, therefore, is not only a science of mental diseases but a complete science of mental health. It is both preventative and curative of mental disorders and at the same time capable of producing mental peace and cosmic consciousness” (Bhusan, 1994). Because these therapeutic approaches stem from the core of one's being, it is difficult to solidify a concrete experiment due to lack of adequate controls (Germer, Siegel & Fulton, 2005). The possibilities of “altering states of consciousness, achieving states of transcendence and enlightenment, and wielding the mystical abilities of the saints” are familiar territories to many Eastern cultures, for exposure to such practices has been repeated throughout their history. Generally speaking, Americans find these acts to be exotic and somewhat untouchable. This general unfamiliarity with yoga teachings can result in a hesitation of the uninformed to engage in yogic practice, for as with many other religions the fear of the unknown or mystical tends to be avoided. Because medical or therapeutic figures work to earn their clients trust, their guidance into the unfamiliar world of yoga can help a newcomer to adjust.

MINDFUL PRACTICE

Trust within therapeutic practice is a crucial part in the success of the patient's healing. Usually driven by their suffering, patients surrender a certain amount of control to their therapists when asking to be guided through therapy. Experienced therapists are ideal when dealing with specialized therapies; “Direct experience by the therapist with each technique or protocol leads to the best source of motivation for the patient” (Shannahoff-Khalsa, 2006). If the therapist has an understanding of yoga culture and theory, those ideas/beliefs will naturally carry over into their practice even if yoga-specific practices are not prescribed. Their views on healing, health, happiness and life in general will inherently affect the tone of their sessions. “Mindfulness and yoga help me be able to sit with difficult or over emotional clients with a bit more ease...that doesn't mean I don't have strong reactions - but I am mindful of my reactions,” said Smart. She spoke about the importance of her personal yoga practice and how it informs her approach when working with clients saying such practices allowed her to be “better attuned to the clients subtle emotional states and gestures” (Smart, 2012). Weintraub expresses the importance of finding a psychotherapist yoga teacher, especially for teachers of yoga themselves. She highly recommends this guidance when working with students, especially those suffering from depression or mood disorders (Weintraub). In regards to her personal guidance from her mentor she says, “It’s important, I think, that we stay open for a continuing inquiry into our own emotional triggers so that we are as clear as we possibly can be in the moment when we sit with another” (Weintraub).

Relatable experiences with yoga and mindfulness practices, such as breathing exercises at the beginning of a session, put the therapist and patient on the same level simply as human beings. Rather than the relationship resembling a doctor-diagnosis dynamic, the shared practice allows the two to interact and relate as equals. Shannahoff-Khalsa speaks of the therapist's role of identifying the obstacles that stand in the way of healing, and inspiring the patient to overcome the hardship (Shannahoff-Khalsa, 2006). In this way it is the job of the therapist to introduce and educate the patient, leading them by practicing together. When trust is instilled within the created safe environment of practice, a space for “space for grief and depression and fear and anxiety” is held allowing for practitioners to release any emotion (Weintraub).

THE POWER OF THE GROUP

Generally, it is easier for most to stick with a practice if working within a group setting. Shannahoff-Khalsa outlines a few reasons as to why the group dynamic proves successful. He claims that “the patient is a little less self-conscious” when surrounding by others doing the same thing (Shannahoff-Khalsa, 2006). Also, the “comparison with others' progress” can lead to a healthy competition and serve as a great motivating factor. Being surrounded by a group helps to validate the patient's choice of therapy, as well as help to find comfort in social interaction. Group yoga practices not only “increase cooperation and collectivism among group members” (Shannahoff-Khalsa, 2006), but allow for individuals to look within while surrounded by the comfort of others. The simple act of synchronized breathing, for example, can “really help with giving people that sense of belonging, of being part of something bigger” (Novotney, 2009). Amy Weintraub, author of several yoga books and director of the LifeForce Yoga Healing Institute spoke of her own personal experience with feeling comfortable within the classroom environment saying she felt “safe enough to be okay with whatever was showing up on my mat, including negative emotions” (Weintraub).

FINDING INNER PEACE

Using breathing, focus, and meditation techniques of Kundalini yoga, Shannahoff-Khalsa's book outlines an approach to dealing with mental issues. A review of Shannahoff-Khalsa's book states, “the working hypothesis behind the approach is that the Kundalini Yoga practices balance the circadian rhythms of the body-mind system, as the distorted rhythms can be a part of the etiology of the symptoms” (Louchakova-Schwartz, 2011). Even suggesting simple techniques such as encouraging clients to get comfortable and take notice of their breath can change the mood of a session (Novotney, 2009). Directing attention to the breath or repetition of a word or mantra, for example, can bring on relaxation responses that help to “reduce physical arousal and stress”, allowing the body to ease and focus on the mind (Germer, Siegel & Fulton, 2005). While the ultimate goal of psychoanalysis is typically to “resolve the conflicts and strengthen the ego” in hopes of the individual being able to better adapt to the demands of a given situation, yoga's intentions differ in that mental strains are to be removed as well as “transcend the ego-consciousness so that spiritual consciousness may dawn” (Bhusan, 1994). Approaching an internal issue with the agenda to conquer or derail the problem can become a distraction, however.

Simply directing a client's attention to the here and now helps to settle the client into the present moment. Focusing on the present limits the distractions and burdens that come along with thoughts of the past, as well as worries and fears that shape thoughts of the future. These types of emotions can cause resistance to acknowledging one's present needs. The goal is to release “compressed or constricted” areas of the body, whether the blockages are “lymphatic, muscular, energetic, or emotional” (Weintraub). Especially when working with individuals dealing with depression or anxiety, it is crucial to center the client in the now in order for them to find peace within themselves. Without an inner calmness and willingness, change is extremely difficult. Because the power of these practices resides purely in the hands of the practitioner, there are limitations to the therapist's role. The practitioner must be willing to engage in such practices if any progress is to be made. The trust in a non-traditional Western healing method such as yoga is hardly a guarantee, especially with paying customers. Without scientific validation or previous experience, individuals seeking therapy may be hesitant in working with a therapist in this way.

YOGA-BASED TREATMENT

One example of a yoga-based treatment is with recent studies done in regards to PTSD among different social groups including soldiers. A yoga Nidra inspired nine-week restoration program designed by psychologist Richard Miller, PhD, was used in 2006 by the Department of Defense to aid returning soldiers from Iraq and Afghanistan (Novotney, 2009). The soldiers resulted with fewer PTSD symptoms including “insomnia, depression, anxiety and fear” and were said to have an overall higher sense of control (Novotney, 2009). Yoga Nidra centers around relaxation through sleep-oriented visualization techniques where desire for action is suppressed in turn slowing the body's functions. The decreased blood flow throughout the body results in a separation from one's executive control, allowing the individual to explore the inner-workings of the mind in a completely relaxed state (Kjaer, Bertelsen, Piccini, Brooks, Alving & Lou, 2002). Such treatment plans as Miller's focus on applicable skills that can be used in real life, daily situations to work through tough circumstances. The participants were introduced to a set of tools to rely on in times of need. Ritu Sharma, PhD of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts also has constructed yoga therapy research. Working with women with PTSD, Sharma states “body-oriented techniques such as yoga help them increase awareness of sensations in the body, stay more focused on the present moment and hopefully empower them to take effective actions" (Novotney, 2009).

Teaching such techniques and directing a patient's attention inward can inform the individual as to how to handle unbalanced emotions in the future without the guidance of a therapist. The misconception that derailing or repelling these negative thoughts as a means to healing is a common tendency, for sometimes it is far more difficult to sit with painful or frustrating emotions than to ignore their presence. Recognition of the present moment through pranayama or meditation practices encourages the practitioner to welcome thoughts rather than fight them, and simply let them pass. When working with a particularly troubled individual Weintraub says she encourages the consideration “of their mat as a safe and sacred space, where whatever shows up is an honored guest”.  If patients can become comfortable with simple exercises and techniques within their therapy sessions, they are more likely to recall the techniques in times of need. A learned ability to observe pain without the insistence on identifying it can help to ease tension and allow more room for other emotions (Weintraub).

CONCLUSION

A common theme of healing versus curing came up within my research. The general structure of Western therapy is a 1, 2, 3... step model to fixing the problem at hand. There is a desire to eliminate the immediate problem, pushing it away, rather than embracing the issue and allowing that to become a part of the healing experience. The therapeutic techniques that directly or indirectly employed yogic theory looked at suffering as a gateway to somewhere else. However negative the issue at hand, it was generally confronted, welcomed, and treated as a route to the next level of enlightenment. Although there was little scientific evidence to support specific yoga-based therapies, there are enough sources to make a case for the power of mindful practice when dealing with mental ailments. I also found that although in many instances there is a recognition of yoga and mindfulness practices within therapeutic training, but it comes more as an afterthought or side note to the more concrete methods being taught.

My hope would be that the increasing interest and urge to know more about the power of yoga will spark new experiments and discoveries. Although the world of modern medicine and science has become extremely industrialized, the answers to some problems, big or small, may still be found through organic, simpler pathways.

References

Bhusan, D. L. J. (1994). Yoga and mental health. Yoga Magazine, Retrieved from http://www.yogamag.net/archives/1994/ajan94/mental.shtml

Germer, C. K., Siegel, R. D., & Fulton, P. R. (2005).Mindfulness and psychotherapy. (pp. 220- 230). Guilford Press.

Kjaer, T. W., Bertelsen, C., Piccini, P., Brooks, D., Alving, J., & Lou, H. (2002). Increased dopamine tone during meditation-induced change of consciousness. SciVerse, 13(2), 255-259. Retrieved from http://www.sciencedirect.com/science/article/pii/S0926641001001069

Louchakova-Schwartz, O. (2011). Book review: Kundalini yoga. doi: Ebscohost

Muktibodhananda, S. (1985). Hath yoga pradipika. (pp. 605-636). New Delhi: Thomas Press (India) Limited.

Novotney, A. (2009). Yoga as a practice tool. American Psychological Association  (APA). Retrieved from http://www.apa.org/monitor/2009/11/yoga.aspx

SELMAN, L. E., Williams, J., & Simms, V. (2012). A mixed-methods evaluation of complementary therapy services in palliative care: yoga and dance therapy. European Journal of Cancer Care, (21), 87-97. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365- 2354.2011.01285.x/abstract

Singleton, M. (2010). Yoga body: The origins of modern posture practice. New York: Oxford University Press.

Sisk, J. (2007, April). Yoga and social work: Mantra meets mental health. Social Work Today, Retrieved from http://www.socialworktoday.com/archive/marapr2007p30.shtml

Shannahoff-Khalsa, D. S. (2006). Kundalini yoga: Meditation for complex psychiatric disorders. (p. 366). New York, London: WW. Norton & Co.

Smart, J. L. (2012, April 10). Interview by C Francis [Personal Interview]. Simmons school of social work: Mindfulness.

Smith, Ph.D., E. N. (2012). Journey to well-being: New light on yoga for depression and anxiety.YogaUOnline, Retrieved from http://www.huffingtonpost.com/eva-norlyk-smith- phd/yoga-depression_b_1412506.html?ref=mindful-living

Weintraub, A. (n.d.). Interview by K McGonigal [Personal Interview]. Lifeforce yoga: A conversation with amy weintraub. (IAYT) The international association of yoga therapists, Retrieved from http://www.iayt.org/publications_Vx2/ytip/aug06/weintraub.aspx