Whether you are a psychotherapist, registered dietitian or physician working in the eating disorder treatment arena, you are well aware that meeting your client where they are at is the first step to gaining their trust and forging a healthy, recovery-oriented relationship. As a former owner and operator of a comprehensive eating disorder treatment center, that used to integrate Yoga with treatment, I have found that Yoga therapy is no different than psychotherapy, nutrition therapy or medication management when it comes to meeting the client where they are at, including engaging in their resistance.
But what is Yoga therapy anyway? An outsider such as an insurance company or the media may have a preconceived notion about Yoga that includes fun and games, jumping around all day long, sweating and dripping and/or filling time with meaninglessness.
The International Association of Yoga Therapists defines Yoga therapy as, …The appropriate application of these teachings and practices in a therapeutic context in order to support a consistent yoga practice that will increase self-awareness and engage the client/student’s energy in the direction of desired goals. The goals of yoga therapy include eliminating, reducing, or managing symptoms that cause suffering; improving function; helping to prevent the occurrence or reoccurrence of underlying causes of illness; and moving toward improved health and wellbeing. Yoga therapy also helps clients/students change their relationship to and identification with their condition. The practice of yoga therapy requires specialized training and skill development to support the relationship between the client/student and therapist and to effect positive change for the individual.
While this sounds like what you may be experiencing at a Yoga studio or in fact your center/clinic, under the guidance of your Yoga teacher, there is a fine line that is greater than it appears. In addition to completing at minimum a 200- hour yoga teacher training, ideally credentialed through Yoga Alliance, a Yoga therapist has also completed at least an additional 800 hours of Yoga therapy training, through an International Association of Yoga Therapists (IAYT) Accredited Program.
Yoga therapy requires a foundational understanding of yoga theory and practice, biomedical and psychological foundations, teaching and therapeutic skills, yoga therapy tools and their application, along with professional practice that includes legal, regulatory, ethical issues pertaining specifically to Yoga therapy.
How is this translated into practical application in an eating disorder treatment center or outpatient clinic?
The Yoga therapist will start by building a recovery plan together with the client. This starts with a thorough assessment including current healthcare information relevant to the work of a Yoga therapist treating the eating disorder population, including pathologies, co-occurring disorders, drugs, surgical procedures, along with an evaluation of the physical, energetic, mental, emotional, and spiritual dimensions of well-being. With this assessment, the Yoga therapist applies knowledge of how to combine this intake, evaluation, observations, and working assessment to develop an appropriate practice or session strategy for individual clients with eating disorders as well as group classes, taking into consideration the individual make up and needs of the client.
For your client with an eating disorder, the benefits of yoga can be a powerful tool to uncover attachments and move these individuals forward with awareness. By observing and recording body language, including the client’s resistance, the Yoga therapist can become in tune to what is going on with the client in the moment and consult with the treatment team. Here are some of the observations and benefits:
- Yoga can help delay impulses. Through Yoga, clients may find themselves in postures that are difficult or awkward. Learning to stay within the poses and work through these postures can help the client, who feels an urge binge or practice unhealthy food behaviors, delay acting on this urge. In our society, there is a natural tendency to want to escape anything that causes psychological or physical discomfort. Clients tend to escape by bingeing, working too much, getting caught up in unhealthy relationships or by drug/alcohol use. In Yoga, individuals are encouraged to observe rather than react to their discomfort by breathing and listening carefully for what his/her body/mind is conveying.
- Clients learn to tolerate uncomfortable emotional states without running toward food for comfort, for which they truly may not be hungry or numbing out by turning away from food. When in various Yoga poses, postures are held for a certain length of time while maintaining the breath. Often, clients with eating disorders tend to want to “run away” from uncomfortable situations and/or ambivalent about treatment. Practicing Yoga can help maintain discipline, help clients to feel and accept uncomfortable emotions and avoid eating and other impulsive behaviors.
- Clients begin to enjoy their body for the first time. They start to define their body in terms of “what it can do” versus “what it is.” They learn that they are not mere extensions of their body, but possess beautiful internal qualities. In this way, Yoga can improve body image concerns and self-esteem.
- For many clients, part of weight homeostasis is learning to tune in to the body’s signals of hunger and satiety. For clients with eating disorders, particularly those who struggle with binge eating disorder, eating only when hungry and stopping when the body is satisfied will result in the body slowly return to its natural weight. Unfortunately, most clients who have attempted to control their weight through dieting are fearful of allowing themselves to decide when and how much to eat. Yoga can help those with weight and food issues trust their body and understand the messages given to them by their own body.
- The physical discomfort of overeating and under eating becomes more obvious as greater awareness learned in the regular practice of Yoga makes all sensations more apparent. This can make it easier for clients with eating disorders to choose to stop eating before the point of physical discomfort as well as honor hunger and nourish the body.
- Yoga also emphasizes mindfulness. Clients learn to experience the taste, texture, and other sensual qualities of food. They also learn to begin to make thoughtful vs impulsive choices related to eating behaviors and daily life decisions. Mindful awareness, which emphasizes “observing” vs. “reacting” to daily stresses in life also comes into play for clients who are repulsed by food.
- Staying present is another important concept learned in Yoga, whereas the mind starts to wander, clients are taught to draw their attention back to the breath. Although many poses are uncomfortable, others are also meant to be enjoyable, thus teaching clients how to engage into life and “let go” of whatever they are holding on to that is hindering them from untangling the hold of their addiction.
- Clients are taught to look inward and focus on inner qualities versus the body’s outward appearance. Clients are encouraged to let go of competition with themselves and others. Yoga teaches self-acceptance in this way.
- With Yoga, clients are taught to find their physical edge meaning working at a pace of intensity that is not too extreme where breathing is compromised—and this may be simply sitting on one’s mat and breathing if they are nutritionally and weight compromised – but also challenging themselves and taking balanced risks. This is an important concept in life as clients begin to “take their Yoga off the mat” and find their edge in everyday life. Finding their physical edge can help peel away layers to tapping into an emotional and spiritual edge.
In the next three articles of this four-part series, we will explore an individual client, across the eating disorder spectrum, in relation to what a Yoga therapist may observe on the mat in order to bridge with the treatment team how this translates to behaviors and experiences and off the mat.
BEVERLY S PRICE is a certified eating disorder registered dietitian and iaedp supervisor, experienced registered yoga teacher and IAYT certified yoga therapist. Beverly is recognized for bringing mindfulness-based yoga to the eating disorder treatment community along with yoga therapy training programs in eating disorders for professionals. For more information www.beverlysprice.com
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders and not intended as endorsement by iaedp Foundation or its Board of Directors.