You Are Not A Doctor Or A Counsellor

These were the opening words from Bill Feeney, former Director of the Yoga for Health Foundation (YFHF), as I began my remedial yoga training, today more commonly referred to as yoga therapy. His words have steered me through the increasing complexity and sometimes blurred parameters of teaching regular Hatha yoga and mindfulness courses for the public, and in the clinical settings where the majority of my work is undertaken with vulnerable populations - local authority GP Referral and Psychiatric Hospital in and out-patient  programmes and also in schools.

In 1989, I arrived at the YFHF’s residential centre at Ickwell Bury in Bedfordshire to begin nearly two years as a resident volunteer learning from the remedial yoga teacher trainers, specialist health professionals and nursing staff working with a wide variety of people and their health conditions for 51 weeks of the year: M.S., cancer, respiratory conditions, arthritis, Chronic Fatigue, Parkinson’s,  heart issues, stress, disability, pregnancy as well as some rare health disorders.

Managing Expectations

Due to the complexity of health conditions, my experience leads me to believe that it’s imperative to have as much experience of not only teaching but also, if possible, in a volunteer assistant role under the watchful eye of experienced professionals before committing to yoga therapy training.

Howard Kent, the founding director of YFHF and producer of the Yoga for Health TV series with Richard Hittleman in the 1970s, had a very clear vision of Hatha yoga as a way of life supportive of the whole system of a human being.  He emphasized that therapy has specific parameters whereas yoga ranges widely and although its effect is extremely therapeutic, it is not therapy designed to alleviate specific symptoms. I return to this definition to manage expectations – my own as well as the client’s. 

With this understanding, the YFHF’s seminal work moved beyond addressing symptoms to support over 3,000 people seeking remedial yoga to look at their whole way of life and gain an understanding of the lifestyle and psychological underpinnings which may have contributed to their health condition. He saw remedial yoga as putting a whole life back in balance by fostering self-compassion, reflection, togetherness alongside the typical elements of asana, pranayama and meditation.

In this way, disabled and able bodied visitors to Ickwell Bury not only practised together but also ate vegetarian meals and learned and played together with remarkable and positive results until the YFHF closed its doors in 2006. Staff and volunteers worked tirelessly to ensure that there was no separation between able and disabled visitors except in the use of adjustments, adaptations and assistants to support those who needed them.

Defining Yoga Therapy Parameters

Today, I work as part of a clinical team of medical and therapy services professionals who refer patients or clients to me and with whom I can discuss the broader elements of an individual’s case. Thus, each patient has a team of professionals with each one working within clear parameters of their particular discipline and an understanding that their provision is only one part of a wider recovery programme. In addition, I am required to have regular personal and clinical supervision, which is an enormous support and resource. As a supervisor myself, I advocate for all yoga therapists working within these contexts to have supervision available to them, if they don’t already.

Working in my private capacity, I often recall Bill Feeney’s wisdom as I encounter clients who look to me as a yoga therapist/teacher to either help them process their psychological issues or seek my opinion on a medical condition.  Thirty years since I began my journey in yoga therapy, I understand that whether yoga therapist or teacher, the role is complex and based on teachings and traditions that straddle both health and psychology and are, hopefully, delivered with compassionate care.

Therefore, it’s not surprising that clients would seek advice from the yoga professional. At those times, I recommend that the client speak to their doctor or seek counselling and I remind them, if necessary, that although they are seeking to work on a specific area/issue, yoga therapy ultimately helps by bringing the body and mind into an overall state of wellbeing. 

Balancing Hard and Soft Skills

This is the tricky edge between having the hard knowledge and skills one requires as a yoga therapist and teacher - creating a professional relationship with the client to address a symptomatic issue - and the softer skills of the yoga teacher as an embodiment of compassionate care that often encourages clients to overstep the boundary and expect more than yoga therapy may be able to deliver.

Recently, a young patient with eating disorders told me how shocked they were that a yoga teacher at another hospital was teaching headstands, shoulder stands and an athletic style of yoga to patients on an eating disorders ward. The risk to patients with osteoporosis, medical complications and very often an eagerness to expend as many calories as possible, makes this too frightening to contemplate.

Clearly, this is an issue of hospital recruiters not understanding that there is a range of yoga available and, perhaps, ignorance or confusion about who exactly governs the standards applied to yoga therapists and training schools. It would, therefore, be helpful to create one alliance from the few governing bodies, so that organisations interested in utilising yoga therapy have one place to go to for information on standards to help them recruit suitable teachers offering appropriate and safe sessions.

In recent years I’ve had to redress the relapse and psychological harm experienced by some clients in my clinical work: those who’ve used online yoga videos or courses for anxiety and depression created by well-meaning and enthusiastic teachers using the latest marketing and technological savvy.

Not all people experience anxiety, depression or stress in the same way. While yoga is holistic in its understanding of what creates health, people with existing mental health conditions need specialist and experienced professional care and not simply a stretch class or relaxation.

I strongly advocate for teaching experience before one embarks on yoga therapy training as well as for a unified governing body to sign post teachers to accredited specialist trainers, especially in the high risk area of mental health. 

The National Occupational Standards of the government regulated Complementary and Natural Healthcare Council (CNHC) recommends that:

...A Yoga Therapist should be able to provide …appropriate practice for anyone from the normally fit to the terminally ill and dying.

If yoga teaches us anything, it is to look at life, particularly our own, through a wide angle lens and recognise when we have limited expertise so we know when to seek professional support and guidance, in spite of any compassionate or competitive urges to the contrary.  The professional reputation and future of Yoga Therapy depends on it. 

This article has been taken from the 4th issue of Amrita Yoga Magazine released in 2018. Buy your copy here!