Yoga is an ancient practice that originated far away. It has made its way around the globe in a wave of both physical healing and spiritual awakening, while simultaneously becoming a multi-billion dollar industry in the US.  Some of the yoga teaching in the west has been simplified to a mostly physical practice by this commercialization and popularization, however yoga's philosophical foundation as a way to live a good life endures as well. These days, yoga is practiced not just in affluent studios, but also in schools, prisons, hospitals, and apparently on aircraft carriers (love this picture.)

Thanks to modern science and research, we also know much more about how yoga impacts physical and mental health than ever before. Let's explore some things we know about how yoga helps, and then describe how this knowledge can be incorporated into a traditional talk therapy session. 

From Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative & Complementary Medicine, 16(1), 3-12. doi:10.1089/acm.2009.0044 

Physical Effects

• Powers down the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) stress response which leads to disease
• Decreases cortisol, blood sugar levels, heart rate, blood pressure, inflammation
• Increases immunoglobulin A and immune response
• Decreases sleep disturbance
• Increases strength and flexibility
• Depending on type of yoga, may or may not improve physical fitness

Emotional Effects

• Decreases symptoms associated with anxiety, depression, schizophrenia
• Increases sense of well-being
• Decreases fatigue and experience of physical pain

Psychosocial Effects

• Increases social and occupational functioning
• Increases quality of life

Here's a description of how I combine yoga and counseling. Other therapists/yoga teachers may do it differently, and chances are, my own style will keep evolving the more I learn from my clients what works best.

Individual Sessions

Individual counseling sessions can include yoga, if and only if, the client thinks it will be helpful. Yoga in session can range from simple seated stretches, to intentional work with the breath, to standing and seated poses on the floor. In the intake and beginning phases of counseling, personal goals are identified, and as we explore these goals through talk therapy, I will be thinking about how certain yoga postures or sequences may be helpful. We will talk about using yoga in this way, then plan a time to incorporate it, or go ahead and use it at that moment. The way that yoga is used in counseling is always up to the client, and my suggestions as counselor are just that... suggestions.

For instance, a client who is struggling with self-image may be asked to try a yoga sequence that feels familiar and accessible, and notice their self-talk during the movement. How compassionate are their thoughts toward self? Are thoughts about self-image coming up? Are they critical? Then the client may be cued to work through a more challenging sequence and notice how the self-talk changes. After a few minutes of yoga (usually 15-30 minutes during an hour counseling session), I will sit with the client either on our yoga mats in an adjacent studio or back in the counseling office to discuss their experience, share what internal self-talk arose, describe how their physical or emotional state changed in response to the movement, and so on. 

Another example is a client who is experiencing social anxiety. The client may have a goal of learning new ways to manage anxiety so that it doesn't stop them from going out with friends. The client may notice a tightness in the chest or throat when thinking about going out with friends. So to address it, I might ask a client to imagine that they are about to go out with friends, notice in detail the sense of constriction or tightness they are experiencing in the chest and throat, then use some guided breathwork and throat opening stretches, while seated in the counseling room to work with the sensations. 

Group Sessions

We can also work with yoga in group sessions. My ideal way to combine yoga and counseling in a group is to use a mixture of both physical yoga postures and discussion and/or personal reflection. My experience of vinyasa flow sequences is that often emotional "stuff" will come up as we move the body. As we work into the creaky, rarely accessed parts of our joints and tissues, an emotion may arise. Then from that emotion, a chain of thoughts may arise: memories, anticipations, judgments, regrets, etc. Taking time after a yoga practice to reflect on these emotions and chain of thoughts can help to move through them, put them away, or take more time attending to them. This can be accomplished through internal self-reflection, group discussion, or both. 

​In this upcoming group yoga workshop, we will practice a one hour vinyasa flow class, then we'll take a short break and come back together to process our experiences. I will provide some paper and pencils to help participants process their yoga experience through writing or drawing. I will provide some prompting questions to help participants explore their wellness in several core areas shown below. I like this "Indivisible Self" model because it prompts us to think globally about what impacts wellness. (Myers, J. E., & Sweeney, T. J. (2005). The indivisible self: An evidence-based model of welIness (reprint). Journal of Individual Psychology, 61(3), 269-279. )

After we've processed internally, I'll offer a chance for participants to share and discuss their self-reflections. This part is absolutely optional, as some might prefer to keep their reflections private. A very important component of using yoga with group counseling is that all members agree to keep one another's shared thoughts and feelings confidential.  Maintaining confidentiality is a key guideline and expectation for the participants in this type of group.

In summary, we know that a regular yoga practice is helpful for many different conditions, ranging from chronic illnesses, to mental illnesses, to adjustment-related problems, to general stress and anxiety. We also know that talk therapy is helpful for these conditions. Combining yoga and counseling involves, first and foremost, respect for the client's autonomy and ability to choose the direction of therapy, along with gentle reminders toward self-compassion, self-acceptance, and an attitude of self-exploration in both body and mind. 

-Kambria 

There are so many experiences of work that are negative, and many that are positive. Sometimes we are so caught up in the tasks at hand, we don't notice how we feel about them at all. Here's a chance to step back away from the work you do and see it more clearly.

First, consider what is work? (As a quick aside, did you know the counseling field developed from the work of career counselors in the early 20th century? Because of this, all of us who get an advanced degree in counseling must take an entire course on Career Counseling. In this course, we are asked to define work. It turns out to be a worthwhile question!) So work is... the hours of the day in which you are at your place of employment. Right? Or when you work at home? Like reading emails after hours? Or working in a home office? Or worrying about your day at the office tomorrow while you're trying to relax at home? Is that work? What about stay at home moms or caregivers for older family members? They aren't paid but they are working, aren't they? They do all their work at home, but it's still work right? What about doing chores on the weekends when you're "off" work. Don't chores still feel like work? What about volunteering? You're not getting paid, but it's still work, yes? Wow, ok, maybe it's not that easy to define work. 

After much reflection in Career Counseling 101, I came up with this conclusion...Work is any way in which we use our energy to accomplish a goal that will benefit both ourselves and others. Work is getting out of bed, making a meal, taking care of your children or your pets, doing your chores, going to your job, doing the tasks of your job, paying your bills, working out (notice how we use the word "work" here but for most of us, it isn't a job!) What do you think? The point is that sometimes our thinking about work is misleading, like it's a certain set of places or activities that are discretely different than the rest of life, when actually, it is in many ways inseparable. 

It may help to identify some of the elements of satisfaction or dissatisfaction at work. 

Then mark them on a scale like pictured here. Make a bunch of these lines and put a tally mark there on the line for each of the different elements we identified. You may be highly satisfied with some aspects of work and dissatisfied with others. Some of these elements may be more important than others, so take that into consideration, then you can rate your overall satisfaction with your work based on the elements that are most important to you. 

In order from most restrictive to least:

1.      Medically Managed Inpatient

• Supervised detoxification and stabilization under the care of 24/7 medical staff
  
• Provides safety when detoxing from substances like alcohol, benzodiazepines, opioids
• Helpful when clients have complicated medical conditions and co-occurring substance abuse and mental health conditions

2.       Inpatient or Residential (IP)

• May or may not include 24/7 medical care
• Involves a stay at the facility or hospital while receiving treatment.
• Can last from overnight, a few days, weeks, or in rare cases a month or more.
• Usually receive medical care, individual counseling, group counseling, family counseling, recreation, all meals
  

3.       Partial Hospitalization (PHP)

• Involves spending most all of the day at the facility or hospital, but evenings and nights are spent at home
• Usually receive medical care, individual counseling, group counseling, family counseling, some meals
• Removes you from your everyday environment without the added cost and time of spending nights
• Must have a stable and healthy home environment
  

4.       Intensive Outpatient (IOP)

• Involves 3-6 hours per day at the facility or hospital
• Involves group, family, and individual counseling, might share a meal
• Appropriate for those who need a high level of care to support a change in everyday living but need to maintain their work or school schedule
• Must have a stable and healthy home environment
  

5.       Outpatient (this is what Flourish provides)

• Weekly counseling sessions for family, individual, or group
• May or may not involve collaboration with physicians for medication management
• Focus may be on abstaining from substance use or problematic behaviors, and preventing relapse 
• Focus may be on “harm reduction”, or decreasing the amount or frequency of substance used
  

6.       Prevention and Early Intervention

• Information is provided to the general public about mental health and substance abuse
• May be used with  individuals experiencing life stress that may lead to substance abuse or mental health diagnosis

Health care professionals can help you make the best decision for what level of care is most appropriate. The first step is reaching out and letting us know what you're going through. We are here to help.