Yoga in the Therapy Room

Q: I’ve taken yoga classes for several years and know there are many physical, mental, and emotional benefits associated with the practice. How can I use yoga techniques to enhance my work as a therapist?

A:You can offer your clients many yoga-based practices to help them focus, relax, and access their feelings more readily during the session, as well as self-regulate at home. As you may know, the physical postures, known as asanas, are only one aspect of traditional yoga practice. A variety of no-mat yoga practices and rituals can help quiet mental chatter, reduce bodily tension, and promote a heightened awareness of oneself and one’s surroundings. All these techniques are perfectly suited to the consultation room.

The work of therapy can’t begin in earnest if the client’s mind is racing or fogged by depression at the beginning of the session, or if tension is so great that bodily awareness is lost. Offering a simple yoga practice as a portal into the session can enable your client to experience a shift in attentiveness and mood. Having moved into a state of heightened awareness, she or he may then be able to bring newfound clarity of mind to the issues looming throughout the session.

Carol, a woman in her mid-forties with a history of trauma and bulimia, was referred to me for yoga therapy by her psychotherapist. She entered our first session in a highly agitated state. Her shoulders were tight and drawn up toward her ears, and her breathing was rapid and shallow. She was fairly new to yoga and nervous about our work together. After two rounds of a tense-and-release exercise and a brief check-in, I guided Carol in these simple, yoga-based practices: mudra, the use of a hand gesture; pranayama, a simple yoga breath; bhavana, locating an image of sanctuary or peace; mantra, a soothing universal tone; and kriya, a cleansing breath. This series of practices, which took under two minutes, respected Carol’s revved-up state while helping her self-regulate.

Tense and release. To begin, I said to Carol in a calm voice, “Take a moment to tighten as many muscles as you can. Draw the shoulders up to the ears, squinch up your face, make fists with your hands, and sustain your breath. Compress all the getting-here-on-time anxieties and all the judgments you have into a little ball, and place it at the back of your neck. Squeeze the ball, and then let it roll down your back as you let the breath go. Beautiful! Let’s do that again. Inhale and tighten as many muscles as you can. Squeeze whatever is keeping your heart and mind from being completely open. Squeeze, squeeze, squeeze. Now, let it all go . . . beautiful!

Carol was visibly more relaxed after this exercise. Although her breath remained shallow, her face was softer and her eyes more focused.

The use of image. At this point, Carol agreed to try a simple practice we could do in our chairs to bring her current state of mind into balance. I asked her to think of a soothing image. “It could be a place,” I prompted, “real or imagined, where you’re relaxed and at ease. Or maybe,” I said, “a face comes to mind that makes you feel peaceful. It could be a human friend, a precious four-legged friend, or even a deity.”

Carol closed her eyes. After a few moments, I asked her to raise her finger if she’d found an image. When she’d located an image and had opened her eyes, I asked if she’d feel comfortable sharing her image with me. She said she saw her favorite beach in Hawaii. (If your clients can’t find an image, you can ask them to simply think the word peace.)

Notice that as I guided Carol in forming an image, I didn’t use the word safe, as this might have triggered Carol’s mind to think of the opposite, putting her back in a position of fear and anxiety. I also didn’t suggest a specific image, but guided her to create her own. That way, she felt ownership of the image, and her sense of self-efficacy and empowerment was bolstered.

Arm movement, breath, and mudra. Because her breath was shallow and in her upper chest, I didn’t ask Carol to breathe deeply at this stage, since that might have been too difficult. Instead, I chose a breath practice to work with the short breaths she was already taking. I call this practice Stair Step, but it’s actually an ancient technique known in Sanskrit as Anuloma Krama. I demonstrated how to open her arms wide to the sides, raise them up over her head, and then interlace her fingers with her index fingers extended toward the ceiling. This hand position is a mudra.

Mudras engage many nerve endings that activate various regions of the brain. In addition, by asking her to raise her arms over her head, I helped her increase body sensation and body awareness, which is important because many trauma survivors feel unsafe in their bodies. They often say they feel as though they live from the neck up. At the end of the exercise, you’ll see how, through my cuing, I made use of her heightened body awareness to allow her to reoccupy her body safely without ever having to use the word safe.

As we began the practice, I invited Carol to close her eyes or, if that didn’t feel comfortable, to lower her gaze to the floor. I kept my eyes open, so I could see how she was breathing. As a clinician, you want to keep your eyes open while leading a practice, unless your client requests otherwise, so you can monitor the effect of the practice.

As she was lifting her arms, I instructed her to inhale little sips of breath through the nostrils, as though she were climbing a mountain with her breath. When she arrived at the top of the mountain, I cued her to pause and imagine the beautiful scene on the beach in Hawaii she’d chosen as her image—sky, waves, sand, everything. After just a heartbeat or two, I guided her to lower her arms to the side, knowing that from this final position, she’d let her breath out slowly on her own. “Beautiful,” I said.

Adding the mantra. We practiced the Stair Step exercise twice, and then I told Carol that we’d add the mantra so-hum, a soothing sound that I explained means “I am that” in Sanskrit. From my intake form, I already knew that Carol’s religious beliefs wouldn’t be in conflict with a simple, nondeity mantra in Sanskrit. Had this been otherwise, we might have used shalom, amen, or soob-hahn-all-ah to meet her religious beliefs as a Jew, a Christian, or a Muslim, respectively.

We practiced the Stair Step exercise three more times with the mantra. Using the sound helped her slow her breathing even more. Research has shown that mantras are effective because an extended exhalation stimulates the parasympathetic nervous system, relaxing the body. In addition, a soothing sound like so-hum or om deactivates the limbic brain, which is often hyperaroused in individuals with a history of trauma.

Body sensing. As we finished the practice, I invited Carol to sit with her eyes closed and observe the sensations in her arms, palms, and fingertips. “Sense deeply into your palms,” I said. “The mind is a time traveler, but the body is always present. Sensing that feeling in the palms is like having a window into the present moment.”

Notice that I didn’t ask her to feel the sensation in her body in a global way. A client with a history of trauma similar to Carol’s may carry a belief that it isn’t safe to live in her body, or that she’ll be overwhelmed with emotion if she lets herself feel her body. But when we’re specific in our cues to feel sensations in the palms or fingertips, for example—places where there are a lot of nerve endings—we give the client the gift of reoccupying the body in a manner that feels safe.

When we finished these simple exercises, I could see that Carol’s belly was expanding as she inhaled, meaning she was naturally breathing more deeply. Her exhalations came slowly, and her eye contact was steady as well. She said she felt relaxed and a little excited about how easy it had seemed to shift her mood. I told her that the image of the beach in Hawaii was on the altar of her heart, and that she could go back to it any time she felt stressed. She could add the Stair Step breath and the brief pause, for no more than four counts, at the top of the mountain. Since she liked the so-hum mantra, I invited her to use that whenever she felt agitated.

At this point, we rose to move to the yoga mat. However, if Carol were your client, you could begin the work of talk therapy with greater clarity and a deeper sense of connection between the two of you.