When Joanne Spence first accepted a job teaching yoga at a psychiatric hospital, she had no idea there was such a thing as a yoga therapist. Since then, as yoga has become a nearly ubiquitous form of self-care and the mental health field has paid closer attention to the physical manifestations of trauma, the title yoga therapist has become an accredited designation. Spence, a social worker turned yoga therapist and author of Trauma-Informed Yoga: A Toolbox for Therapists, talked to Psychotherapy Networker about how therapists of all kinds can incorporate yoga into their work treating trauma. Yoga can offer immediate relief, Spence says, and therapists don’t have to become yoga experts to use its practices to help their clients.
Psychotherapy Networker: What’s the difference between a yoga teacher and a yoga therapist?
Joanne Spence: Yoga therapists tailor yoga practices for a specific person and the mental and physical health issues that they’re presenting. That's nearly impossible when you're teaching a group class at a yoga studio.
After years of swimming in the water of mind-body movement— as I have while working through my own healing and working every day with patients— it seems like the work of a trauma yoga teacher is to state the obvious: My job is to encourage people to notice their breathing, to join in and see what the present reality is, to expand their sense of awareness of the present moment. But, in fact, not everybody does know that the breath-body connection is integral to mental and physical health.
For therapists, we all know why the breath-body connection is important. If it was only a matter of knowing, we’d all be doing lots of yoga and meditation. We’d all be fit and healthy. My goal in writing Trauma-Informed Yoga was to make the practices simple enough so that crossing the bridge to doing these practices could be as easy as possible. The book is for therapists who don’t have the time or inclination to go become a yoga teacher or yoga therapist but want to use some of these tools with their clients. I think of it as a toolkit that can expand their capacity to provide trauma-informed care.
PN: How did you transition from being a social worker to a yoga therapist?
Spence: I worked as a clinical social worker in many different settings for about 10 years. After I was injured in a car accident and experienced two years of chronic pain, I discovered yoga. Because of my own traumatic childhood, my struggle with the chronic pain and resulting depression, I was disconnected from my body. As I started learning about yoga for my own healing, I wanted to show other people how they could find a path to health.
I started a yoga studio, which I still have, and after several years, I felt a restlessness about who I was teaching. I knew there were people that didn’t have access to classes, so that led me to form a nonprofit, Yoga in Schools, and I started teaching yoga in school settings.
Then, in 2007, I was offered a job running therapeutic yoga groups in that large psychiatric hospital setting. I became their first yoga therapist. Honestly, at the time, I didn't even know what a yoga therapist was. But I thought, Well, of course, it makes sense that they’d ask me. I know how to teach yoga, and I'm a social worker by training. I have clinical experience under my belt.
I learned pretty early on at the psychiatric hospital that I didn't have even a cursory understanding of the autonomic nervous system and how breath and movement might interrupt trauma. Of course, a very high percentage of people seeking inpatient treatment in the psychiatric facility have experienced trauma. I started looking around for skills on treating trauma with yoga, and found a book called Yoga for Depression written by one of my teachers and mentors, Amy Weintraub, but there weren’t many resources at the time.
If I’d ever felt that there was a division between me and the people that I was serving, that all dissolved after my injuries, and because of my felt experience and personal enthusiasm, I was more able to navigate the therapeutic space in the hospital. Teaching yoga to people with chronic mental illness was very, very satisfying, and still is. I stayed at that hospital for 10 years, and 20 years after starting there, I now predominantly work with veterans.
PN: In what scenarios do you recommend that clinicians consider integrating yoga into their practice?
Spence: As we know from the work of Bessel van der Kolk and others, trauma is stored in the body. That knowledge means we have to come to grips with the limits of talking, although of course talk is important.
When you start to practice breathing techniques, you realize that there's a lot of information in our nervous systems that we just block out.
I’ve found that people are hungry to have simple things that they can do to increase energy if they’re depressed or to help them down-regulate if they’re anxious. We've heard a lot about walking and getting outside in nature. Yoga is another tool. How you breathe and how you move has a big impact on one's energy. I’ve seen significant shifts in the moment, when working with patients. It’s not always the case, but I’ve seen people get immediate relief, at least for a few minutes. When you’re in the acute phase of a psychiatric illness, a few minutes of relief is huge.
For patients with trauma, for example many veterans I’ve worked with, getting into a still peaceful place might be triggering. We have to be careful. It’s important to be invitational, not pressuring.
PN: Can you say more about being invitational?
Spence: Being invitational is really important with someone who has trauma. And because you usually don’t know if someone has trauma, being invitational should be a universal practice.
To a client I’ll say something like, “I can see that you are feeling upset right now. Would you like to try this breathing practice?" Then I'll give a little explanation in not too many words, and then I'll just be quiet and let the person decide.
Being invitational also means we have to let go of our own agendas. I nearly always arrive at a class or a session with an idea in mind of what I‘d like to try. That seems like reasonable professional preparation. At the same time, I have to trust that I’ll completely let go of the agenda, so that we're only doing things about which the client has said, "Yes, I want to try that." Otherwise, we're undermining the very thing that we're trying to build— consensual agency, the capacity to say yes and no because of what the person wants and how it feels. In the therapeutic setting, I’ve seen doing yoga moves something forward so that someone has been able to either keep moving and doing the yoga, or they decide there’s something they want to talk about. They often decide they want to practice yoga again, because they want get back that feeling— that sense of relief with a little bit of energy— so they don't have to prop themselves up with caffeine or alcohol or drugs.
Of course, we therapists have to do the work ourselves and practice these skills ourselves, so that that the part of us with our own agenda doesn't dominate.
PN: How do these ideas apply to clinicians taking care of themselves?
Spence: Being with people that have just unimaginable things happening in their life, day in and day out, is very hard work, so we have to have ways to protect ourselves so we don’t become callous and lose our ability to be compassionate and present. I think using these tools for ourselves and in teaching them to our clients not only gives us that growth mindset and resiliency, but it helps us remain present and compassionate and prevents us from becoming cynical and judgmental.
They’re called yoga “practices” because they’re ongoing work, and we have to do them regularly. I used to think, "I'm going to arrive, and I'm not going to need to go into therapy anymore, or I've done enough yoga." It's not the way of our humanity. Understanding that our limitations are part of our humanity means our work is an ongoing process. I think as soon as we come to grips with that as truth, the happier that we will be with ourselves and the work that we're doing.
This has been especially true during the pandemic and its aftermath. People fall into several categories during the pandemic: Those who lost their livelihood and are wondering what to do with their time or how to survive, and then those who got busier. Therapists and healthcare workers have had this overload and overburden and have been seeing more patients and clients than may be healthy.
The hurting, dare I say trauma, that comes from holding that space for so many—there’s a breaking point. It's not a hidden agenda, because I think it's pretty overt and obvious, but I consider my books a self-help book for therapists that they can also use with their clients. Therapists have been so overburdened, especially over the last year, and so, without begging, I’m urging people to take time for themselves.
Meaghan Winter is the former content editor at Psychotherapy Networker.
Photo © iStock/PeopleImages