Yoga Therapy in Practice

Healing and Transformation through a Yoga and Mindfulness Psychotherapy Group

By Lisa M. Mountain

Yoga scholar Stephen Cope, MSW, states, “It’s through remembering who we really are that we are liberated. The transformation of the self is not about adding anything. It is about finding what was already there.”1 Yoga, mindfulness, and group psychotherapy are each pathway to self-discovery, but they are also a natural and powerful combination. Ideally, participation in all of these practices increases connection to one’s authentic self and strengthens it through a community of support, empowerment, and containment. Yoga and mindfulness can add depth to psychotherapy through the facilitation of calm, insight, and physical and mental awareness. Psychotherapy and group support can bring safety, grounding, and regulation to the strong emotions that often emerge in yoga and mindfulness practices. Jon Kabat-Zinn summarizes the potential of the combination of these practices in Wherever You Go, There You Are: “When we are in touch with being whole, we feel at one with everything. When we feel at one with everything, we feel whole ourselves.”2 I feel honored to witness this deepened connection to self, others, and the world by the participants in my Transformations: A Yoga and Mindfulness Psychotherapy Group™.

The rationale for the development of this group was based both on extant research and my experience with group therapy, mindfulness, and yoga. I have been practicing psychotherapy for over twenty years, specializing in trauma and addictions, and have found group therapy to be an especially effective modality. As a result of my own yoga practice over the past six years, I have become increasingly interested in integrating the therapeutic and healing qualities of yoga into my work. There is a growing awareness in the field of psychology that the practice of mindfulness, i.e., bringing nonjudgmental attention to present-moment experience, can greatly improve quality of life. As a result of these factors, I completed a 1000-hour Yoga Teacher Training program with D’ana Baptiste at Centered City Yoga in Salt Lake City, as well as a training in Teaching Trauma-Sensitive.

Yoga with David Emerson, ERYT, and Jennifer Turner, MA, RYT, at the Kripalu Center for Yoga and Health, and a training in Mindfulness-Based Stress Reduction with Vicki Kennedy Overfelt, MA, and Dawn Jackson, PhD. Bringing yoga and mindfulness theory, research, and practice into my work as a psychotherapist has resulted in a dramatic and transformative effect on the depth and rapidity of progress in my clients. Specifically, I have observed that the implementation of yoga and mindfulness skills often serves to significantly decrease symptoms of anxiety, depression, substance abuse, disordered eating, and post-traumatic stress.

A solid body of research demonstrates the effectiveness of group therapy in the treatment of a variety of mental health issues, including depression,3; child-hood sexual abuse,4; and chronic trauma-related stress.5; Irvin Yalom, MD, one of the founders of the group psychotherapy movement, has found over his extensive clinical and research career that certain therapeutic conditions such as universality (the recognition of shared experiences), instillation of hope (inspired by the progress of other group members), cohesiveness (the feeling of belonging to and acceptance in a group), and interpersonal learning (practicing social and relationship skills in a safe environment) are unique healing factors that occur in a group therapy format.6 New research indicates that yoga and mindfulness are helpful in the treatment of trauma,7 depression,8 anxiety,9 eating issues,10 and substance abuse.11

Yoga has been found to be especially helpful for people with a history of trauma experiences who are struggling with post-traumatic stress disorder.7 I have been facilitating Transformations: A Yoga and Mindfulness Psychotherapy Group™ in my private practice since May of 2013. This group combines gentle yoga, breathing, meditation, and mindfulness exercises with the empowerment and support of group therapy. No prior yoga experience is necessary and the practice is suitable for all body types and most abilities. The group is offered weekly for ninety minutes as a ten-week session and has a maximum of eight members. Participants are welcome to continue in the group for as long as they like and new members are added at the beginning of the next session. The group is designed specifically and only for women in order to increase feelings of safety, shared experiences, and empowerment. I include women working on recovery from anxiety, depression, trauma, substance abuse, and eating issues, because many of my clients are dealing with multiple issues. In my observation and according to the very positive evaluations of the group experience by clients, this format has worked very well. I meet with potential group members individually to ensure that the group is a good fit for them. In this meeting, we discuss the format of the group and what the client hopes to attain from her participation in it. I also explain the rules of the group, the most important of which is maintaining confidentiality, and each person who joins the group signs a form indicating her agreement to the group rules. Since its inception, the group has been full and I have had a waiting list of people who want to join when an opening becomes available.

Each week the session begins with a guided meditation that includes a body scan, mindful focus on the present moment, and pranayama exercises such as increasing the length of the exhalation to allow people to bring their focus inward, calm their nervous systems, and bring increased awareness to their experience. We then move into a gentle yoga asana practice in which the focus is on staying connected with the breath and their interception, that is, how they feel in their physical bodies in the present, particularly when they experience anxiety or trauma triggers. We work to develop witness consciousness so that participants can move toward observing rather than immediately reacting to their experiences. David Emerson and Elizabeth Hopper’s principles of trauma-sensitive yoga13 are implemented in a variety of ways. The practice is done quite slowly, with invitational language, such as “You are welcome to…” and “If you like… .” Personal choice is emphasized throughout the practice. Clients are encouraged to modify the poses or to not do them if they do not feel comfortable. I do not give physical assists. I stay on my mat in the front of the room so that clients know where I am at all times, and client mats are arranged in a semi-circle so that no one has anyone behind them.

I choose a theme for each session related to yoga teachings and philosophy that I intertwine into the practice and the process portion of the group. An example of a group theme is the root chakra with a focus on grounding poses such as child’s pose and mountain pose during the yoga practice followed by a discussion of these and other grounding strategies that the women find to be helpful during the process portion. Another example of a group theme is the Yama (guideline for yogic life) of Satya, or speaking your truth, with a focus on throat-opening poses such as camel in the practice and a discussion on what speaking their truth means to them in the process portion. I also read a poem related to the theme as we move into the guided meditation at the beginning of the group and again as we move into Shavasana at the end of the yoga practice. I have outlined a typical yoga practice for this group in Table 1 on the next page.

After Shavasana, for the second half of the group, we move into a seated circle and begin the processing portion with each person sharing something that she noticed in her yoga practice and how this applies to life outside of the group. The focus is on how the women can support each other in eventually transferring into their daily lives the calm, the focus, and the connection with themselves and others that they experience during the yoga and mindfulness sessions. The group discussion provides a safe container in which people can make sense of, articulate, and integrate the experiences that have come up in their bodies during the yoga practice. This serves to decrease feelings of isolation; helps people to remain grounded in the here and now; and provides feedback, support, and shared experience. I often ask what reactions group members have to the theme of the yoga practice. For example, “Did you notice anything that helped you to feel grounded during your practice?” or “How did you feel in camel pose and how do you feel about the idea of speaking your truth in your life? What would support you in being your true, authentic self?” In a recent group session, we discussed what warrior poses feel like and symbolize for them, and how this applies to their everyday lives. One group member said that she “likes feeling grounded and open at the same time in the warrior poses.” This moved into a discussion about ways that group members can be assertive, set boundaries, and stand their ground in their lives while also being open to their experiences rather than reactive.

I will share some other examples of client group experiences, with identifying information changed to protect confidentiality. Holly is a woman in her early sixties who had struggled with alcoholism for two decades. She was referred to me for individual therapy when she was newly sober after completing an intensive outpatient treatment program. We discussed ways that the yoga and mindfulness psychotherapy group could increase her ability to remain calm and centered and to tolerate and move through her triggers to drink. She was eager to join the group, and it became a cornerstone of her recovery program. She stated that the yoga, mindfulness, and support of the group helped her to learn healthy ways to calm herself, live in the present moment, and have some space from her stressful job. She received feedback from other group members that her wisdom, insight, and recovery experience was very helpful for them, and this helped to build her self-esteem. After her participation in the group for nearly a year, I continue to work with Holly on an individual basis and she has now maintained her sobriety for almost two years. She also recently completed a yoga teacher training and is teaching yoga for others in recovery.

Alicia, who is in her mid-thirties, is a survivor of childhood sexual abuse. She joined the group to gain a source of support, to help her to learn coping strategies, and to increase her connection with her body. During the yoga portion of one group session, she experienced a flashback related to the abuse she had experienced. She initially became tearful, excused herself from the group, and went into the rest-room for several minutes. She then returned to the group and was able to finish the yoga practice. During the process portion, she shared that although she initially wanted very much to leave that group session, but that the breathing and grounding tools she had learned enabled her to stay present. Other group members were very supportive, shared some of their experiences with flashbacks, and offered additional coping strategies that they have found helpful. Alicia and other group members expressed that as a result of being able to talk about these experiences in a safe environment, they felt less isolated, better equipped with tools, and more understood and supported.

Table 1.

Example of typical yoga practice for Transformations: A Yoga and Mindfulness Psychotherapy Group™

Opening — Explain yoga theme such as one of the chakras, yamas, or niyamas
Seated Guided Meditation — present moment focus, poem, body scan, pranayama
Seated Poses — ex.: hands to the sky then heart; forward, side, and backbends; twists
Hands and Knees — ex.: cat/cow, thread the needle, child’s pose
Downward Facing Dog to Basic Sun Salutes — forward fold, monkey, mountain
Mountain Pose — ex.: feet grounded to earth, moving side to side, and re-centering
Balancing Poses — ex.: tree, eagle, dancer, warrior III, half-moon pose
Return to Mat — ex.: move into boat, bridge, reclined pigeon, reclined twists
Finishing Poses of Choice — anything we did not get to or they would like to revisit
Shavasana — I read a poem related to the theme once again, then silence
Closing — move to the fetal position, then seated, hands to heart, group om and namaste

Becky is in her early twenties and was in early recovery from a history of disordered eating when she began the group. At first, Becky was very disconnected from her body and from other people. Over the seven months in which she participated, she was increasingly able to describe more connection with, caring for, and feeling in her body, particularly in her core, and she connected this to her search for her authentic identity. She also became more comfortable sharing with people on a much deeper level and described how this experience transferred into her relationships outside of the group. Since she ended the group, I have seen her periodically for individual sessions. She reports that she continues to be able to cope with stress without engaging in disordered eating behaviors and that her confidence and healthy connection with her body continue to strengthen. Participants in the group complete evaluations of their experience toward the end of the ten weeks. The most consistent theme that has emerged from the evaluations is that group members especially appreciate the nurturing connections that they have made with themselves, other group members, and their physical bodies in a safe and supportive environment. They also frequently mention the benefits of the tools that they have developed to calm and ground themselves and cope with trauma triggers in healthy ways outside of the group. Several people have shared that they plan to practice yoga for the rest of their lives. In the fall of 2013, I was asked to facilitate this same type of group at the Utah Pride Center for female-identified clients. The themes from the evaluations from this group were similar to those from my private practice group, with the addition of many comments by participants that they found being in a safe place with others with similar experiences and struggles to be especially beneficial.

I am so grateful to be part of the evolving discipline of yoga therapy and to share it with those with whom I work. I encourage other mental health professionals to learn and implement yoga and mindfulness skills, and I encourage yoga teachers to engage in mental health training, as the combination of these disciplines is so effective, powerful, and therapeutic. My group is just one example of the myriad ways that yoga can be used therapeutically. The field of yoga therapy will continue to benefit from the development of creative interventions tailored to a variety of populations. My hope is that sharing my experience provides information and inspiration as the field of yoga therapy continues to develop, grow, and move toward reaching its full potential to bring healing to individuals, groups, and the world.

Published in Yoga Therapy Today by the International Association of Yoga Therapists.