Yoga Therapy in a clinical setting by Yasmin Zaman, CNHC registered for Yoga Therapy
I am registered with CNHC as a yoga therapist, however I refer to the yoga portion of my work as therapeutic yoga - and myself as a therapeutic yoga teacher. As a discipline, the evidence base for therapeutic yoga is steadily increasing, suggesting a wide range of benefits that support a person’s overall system. It is not intended to address specific symptoms, but rather to apply a whole person approach to healing and recovery and to supplement the main interventions which, in the context of psychiatric and mental health, is psychiatry and psychotherapy.
I teach therapeutic yoga, Mindfulness-based Cognitive Therapy and Stress Reduction (MBCT and MBSR) within a psychiatric hospital and a wellbeing centre for mental health. I receive referrals for patients and clients to complement the work of other professionals within the Therapy Services team. The team I work with consists of psychiatrists, psychologists, mental health nursing staff and psychotherapists, among others. I also see private patients within my own practice.
When providing therapeutic yoga sessions, I clarify the benefits and bring decades of experience along with my full awareness of the physical and mental health condition of the patient. I also ensure I manage their expectations by not making any medical claims and reassure them that this intervention complements the main treatment they are receiving.
In the clinical context, the patients referred to me are assessed by the psychiatric and psychotherapy teams who, together with the patient, create a care or treatment plan for a specific period of time. Then depending on the patient’s mental state, they are then referred for NICE (National Institute for Health and Care Excellence) recognised interventions in the treatment of psychiatric and mental health disorders – of which mindfulness and yoga are included. Sometimes a member of the team will request that I assess a patient for suitability for my sessions, if they are uncertain about the patient’s suitability for therapeutic yoga or mindfulness at that time.
The patients attend regular group sessions and, perhaps, on the advice of members of the medical team, one-to-one sessions. The work is complex as patients often present not only with a range of mental health disorders, for example, anxiety, depression, a range of personality disorders, PTSD, psychosis, trauma, addictions and eating disorders but also with co-morbidities largely due to, but not exclusively limited to, an inactive and sedentary lifestyle. Often patients are prescribed specific medication to alleviate their symptoms which effects physical movement. In addition, many patients and clients have experienced, or are in the midst of, extremely difficult life situations adding to their vulnerability.
It would not be possible to deliver therapeutic yoga and mindfulness meditation in this context without the continual, daily briefing and de-briefing about patients’ progress between team members. It is this that is crucial when it comes to planning the delivery of my sessions with the utmost care of patients’ physical, mental and emotional state together with awareness of potential outcomes – positive effects that can bring patients into an embodied, calm awareness more able to explore their state in talking therapies, as well as issues arising during sessions that could potentially traumatise and unsettle them.
The actual delivery of the sessions involves very careful attention to use of language so that guidance is clear but also sensitive to patients’ situations thereby mitigating any potential alarm or deterioration of their mental health. For example, traumatised or eating disorder patients can benefit from a process of mindful enquiry, which ensures that patients stay present in therapeutic yoga/movement or meditation, so they can be aware of not only discomfort but also signs of wellness in their body and mind. The sessions usually include a period of enquiry where the patients can share their observations of their physical, mental and emotional state during and after movement and meditation. In this way, I can help patients explore the interrelationship of mind and body in a way that helps them open to their specific issues and explore them further in talking therapy sessions.
Teaching regular yoga classes and therapeutic yoga sessions require a good amount of planning with the intention to enhance the overall wellbeing of students and clients. However, they are very different in that the therapeutic approach is usually undertaken with it being an adjunct to another intervention that serves as the main therapeutic modality – talking therapies and medication within my working context.
Also, most importantly, another medical health professional has clinical responsibility for the patient in a therapeutic context e.g. GP, psychiatrist, physiotherapist etc. Nonetheless, in a general class, I require students to complete a health questionnaire that informs the class planning so that specific individuals and their physical issues will be catered for. In regular yoga classes, the teacher is not targeting individuals as the class outcome is more general. There is no need for a system where clinical responsibility is necessary, unless the classes are part of a GP Referral Exercise programme. In class situations where issues may arise, I suggest students seek the support of appropriate professionals rather than try to solve their physical or mental health conditions in the class.
While working within the hospital, I am required to write clinical notes for each patient which will be read by other team members as well as input into reports on patients’ progress with recommendations for consideration during ward rounds and other medical panels. Working within this context requires me to have regular clinical and personal supervision. They ensure my teaching adheres to the Best Practice Guidelines for Mindfulness Teachers, and being CNHC registered it is also important that I adhere to The Code of Conduct, Ethics and Performance. Supervision also gives me the opportunity to raise any concerns regarding patients and seek advice to enhance my teaching. I also work as a supervisor for other teachers mentoring and guiding those who specialise in psychiatric and mental health, young people and workplace therapeutic yoga and mindfulness delivery.
Therapeutic yoga and mindfulness are rich areas of work and there is a growing need for experienced teachers who undergo regular supervision to ensure patient safety and high professional standards. It is important not to over promise on what it can deliver to those members of the public interested in exploring the benefits it can bring to their health and wellbeing. The CNHC and other similar bodies play an important role in ensuring quality control as well as helping to spread the word about the value of therapeutic yoga and mindfulness.