use of appropriate tools (heya-hetu and hana-upaya).
• The first and foremost step in this comprehensive template of yoga therapy is to try and understand as completely as possible the nature of the problem/issue/challenge/manifest suffering (heya). It is important to focus on how long the problem has been in existence, how severe it is, and how it impacts the client’s daily life. We need to assess together with the client the physical, emotional, mental, social, financial, and spiritual aspects, to have a holistic picture of the current “state” of the individual who is seeking our help.
• The second step attempts to find the possible causes of the problem (hetu). This must not stop at a superficial level of symptoms but try to unravel the potential root causes that are causing the manifest signs and symptoms of disease. It is important to make a complete search for internal causes, which could include genetic predisposition, maladapted stress responses, energy imbalances, distorted perceptions, as well as negative emotions and self-image. On the other hand, external causes could be infective, accidental, environmental, or traumatic in nature. Finally, we need to address in detail the role of an unhealthy lifestyle, as this is often the main cause of the whole problem. An example would be two clients with the same symptoms—both obese and both depressed. However, one may be depressed because they are obese, and the other one may be obese because they are depressed.
• In the third step, a joint understanding is developed between the client and the therapist towards setting the target goals for the therapeutic process (hana). The client may have a certain goal in mind while the therapist has another. These goals may be different and hence a joint discussion and collaborative and realistic plan needs to be made to avoid disappointment later. An example would be a cancer patient seeking yoga therapy to enhance energy, improve sleep, reduce fatigue, and deal with pain while the therapist may be more focused on “preventing an occurrence of” the cancer.
• The final step in this process is the adoption of concrete concepts and practices that then contribute to the development of a comprehensive individualized protocol (upaya). This is the stage where the actual tools are determined in order to achieve the goal set in the third stage. This may include a combination of any or all of the techniques in our therapeutic armory including counseling, shifts in attitude (bhavana), lifestyle modifications, and practices of Ashtanga Yoga, Kriya Yoga, Hatha Yoga, mantras, yoga nidra, and most importantly, relaxation. It is only during the relaxation phase that healing truly manifests, and hence we should never forget the importance of this often-neglected aspect in yoga therapy.
Understanding the issues that brought the client to us
In order to properly understand the client and their problem, we need to make sure that we keep our ego in check and that we are conscious of any projections or transference that may occur as the result of our own experiences. Our own history affects our judgment and we need to be very aware of this fact in order to prevent mis-assessment. Very often we have “blind spots” around our own issues, and it is always good to have some kind of supervision set up to be able to verify our own projections getting in the way of assessment.
In Lee’s case this manifested in a peculiar way. She noticed that after finishing a three-week intensive retreat, Beyond Cancer, she would be completely depleted of energy and had to spend two to three days resting in bed to slowly regain her vitality. One day she was discussing the retreat with a friend—a yogi scholar and psychotherapist—and she mentioned her affliction. He listened carefully and then said, “Most likely you have unresolved issues around the work you are doing with cancer patients.” It took only a second to realize that she had never grieved the death of her father from lung cancer when she was 15. That night she let it all surface and had a deep release. Since then she tends to be tired, which is to be expected after leading three weeks of an intensive retreat, but never so depleted as before.
Here are a few suggested check points for yoga therapists before they face a client:
A SUGGESTED PERSONAL CHECKLIST FOR YOGA THERAPISTS
1. Do not bring your personal problems into the assessment process.
2. Let go of your prejudices and do not let that influence the assessment.
3. Patience and perseverance are key qualities if you are to do justice to the assessment process.
4. Intelligence and empathy guide an objective and logical assessment.
5. Do not judge the client, and never condemn them for choices they may have made. Remember, it is their life!
6. Always remember that your role is limited to facilitating their inherent healing mechanisms and not to impose your will on them.
7. This should be a bidirectional interactive process and their choices should be accepted and respected, even if they are contrary to your own personal views.
For the purpose of assessment it is always useful to use the five-layered existential model (pancha kosha) as it enables us to develop a thorough understanding through processes of observation (darshanam), touch (sparshanam), detailed interview (prasnam), and assessment of energy flows (nadi pariksha) the issues that may be of a physical, functional, psychological, intellectual (frustrations and conflicts), or even spiritual nature.
Evaluating physical or structural (annamaya) issues
Yoga therapy evaluation of physical wellbeing starts the moment the client enters the office, as keen observation can provide immense clues about many aspects of their health. We look at the body type (endomorphic, ectomorphic, or mesomorphic) and deposition of body fat (apple, pear, or hourglass body forms). This enables us to have a better understanding of the constitutional aspects of the individual (dosha), and helps in the selection of practices as well as the adaptations that may be required for different body types. Taking it even further, body mass index (BMI) may be evaluated by measuring weight and height and calculating it in kg/m2. This objective measure is always useful as it gives a clear baseline for pre and post comparisons, and also gives us a clue to metabolic and cardiovascular risks that increase proportionately with BMI.2 Medical practitioners are always more comfortable with yoga therapists who speak their language and use standardized metrics. So it is always better to indicate BMI rather than just saying, “My client is overweight,” “They have a huge tummy,” or worse, “They have a huge stomach.”
The need to obtain consent for physical examination is something that cannot be stressed enough, as no yoga therapist should ever touch their client without clear verbal or even preferably written consent. This should be obtained in the initial stage itself, as later it may take a nasty turn, especially if the client is not satisfied with the results of their therapy. This warning percolates into the practices and hands-on assistance that may be given by the therapist in the sessions. Many people are very sensitive of their personal space, and we need to respect this.
During the focus on the physical aspects of the client, it is important to create a constitutional (dosha-based prakriti) analysis by an inferential approach. Individuals with a movement-predominant constitution (vata) usually have a thin and light frame. They often complain of sudden bouts of fatigue. They typically have dry skin and hair with cold hands and feet. When this becomes imbalanced, they may complain of weight loss, constipation, joint pain, muscle weakness, restlessness, and indigestion.
Individuals with a metabolism-predominant constitution (pitta) are usually of medium size and weight and complain of early greying, baldness, or thinning hair. They claim that they can eat anything and usually have a warm body temperature. When in balance, a lustrous complexion, abundant energy, and a strong appetite manifest, but when out of balance,
