We would like to welcome guest blogger Deborah Lubetkin, Psy.D., RYT-200, LFYP Mentor. Deborah is a Licensed Psychologist with a private practice in NJ for 18 years. She became certified as a LifeForce Yoga practitioner, Level 1 in 2009, returning to complete her Level 2 certification in 2011. Deborah’s practice incorporates Eastern philosophy with the challenges of Western living to create a forum for her patients to develop an integrative plan to address a wide variety of mood related imbalances. Visit Deborah’s website at: www.drdeborahlubetkin.com.
LifeForce Yoga is about meeting the mood as it arises, and it is an approach that de-pathologies mood states and works toward helping our clients to develop a compassionate, non-judgmental self-appraisal.
So how can we find a way to help our clients meet their mood, while at the same time taking care to fully understand their specific symptoms and the way mood expresses itself within their mind and body?
We do need organizing frameworks to help define mood symptoms in order to safely treat our clients, whether we are Yoga Teachers or Mental Health Practitioners (MHP). We cannot delve into the mind or the body of our clients without first doing a careful and comprehensive assessment of mood. In this article, we will look at the Western and Eastern approaches to the understanding and classification of mood.
With that said, all Yogic approaches begin with the understanding that imbalances occur as a natural part of life, and we work to regulate these imbalances through the practice of Yoga and Ayurveda. Healing comes from the inside, and resources needed for healing are innate-we have all that we need. In Yoga and Ayurveda, we measure our state of being on a spectrum, divided into 3 dimensions. Our anxious states are known as rajasic states, and our slower and at times depressed energy states are known as tamasic states. A balanced state is called the sattvic state. As LifeForce Yoga Practitioners, our goal is to help our clients achieve this balanced, sattvic state.
Assessment – Yoga Model
From a yoga perspective, we can do an assessment of our clients by observing how they are functioning at each level of their existence—physical, energetic, emotional, mental and their sense of connectedness or bliss. In yoga, this is the kosha model. We might ask ourselves, for instance, at which of the five layers (Koshas/sheaths) does a client show their symptoms, and how can we help that client awaken to the presence of equanimity and bliss in each layer? Each layer informs and is informed by all the others, so when the Koshas are out of alignment, energy stagnates and symptoms erupt. When they are in alignment we experience life more authentically as what we think, feel, say and do are consistently manifested.
Here are the Koshas and the practices that most bring them into balance:
Annamaya-physical body (supported by asana)
Pranamaya-breath body (supported by pranayama)
Manomaya-Thoughts/Feelings (supported by nondual self-inquiry, an exploration of polarities within the whole, focused concentration/meditation)
Vijnanamaya-Intuition/Wisdom (supported by meditation practices like chanting, mudra, mantra, and other meditation practices that cultivate witness consciousness and greater access to intuition)
Anandamaya-Soul/Bliss (supported by Tantric meditation practices, yoga nidra)
Assessment – Medical Model
The medical model is a problem-focused model, it views healing as coming from outside of ourselves, and the goal is to get rid of or compensate for a problem or symptom. Western approaches use Diagnostic Assessment for the primary purpose of 3rd party payment and, also to evaluate for medication. Insurance companies will not pay for services without a diagnosis code. The DSM-5 is the manual that lists all possible, recognized Diagnoses for the purposes of billing and medicating. Regarding medication, diagnosis is very important because, for example, one would not use medication for a depression related to uncomplicated grieving, which might look very similar to a Major Depression. You might say, well if I am not a MHP or physician/psychiatrist, why would I need to know this? I will share a case anecdote- a friend of mine was on medication for depression for several years. She then started to take Vinyasa yoga classes very intensely and became manic-one day I was talking to her on the phone and noticed racing speech and an inability to slow down and self-regulate. She was clearly out of balance and in an intense rajasic state. I suggested she speak to her prescribing physician about her symptoms and her yoga practice. Fortunately for my friend, her doctor is an Integrative psychiatrist who understands how yoga affects the brain and mood. The Psychiatrist knew that the answer was to actually LOWER her SSRI to regulate her mood, where most Western Psychiatrists would likely have increased or changed her medication to control the mania.
The above is one good example of how the DSM helps with the issue we call Differential Diagnosis-for instance, how do we know if our clients have a Depression reactive to a loss versus a chronic depression that is exacerbated by a loss? And what does it mean for treatment? The more we can be clear about our clients’ symptom constellations, the more we can guide them to meet the mood as it exists for them, and help them to create their own practice to achieve balance. Also, there is so much comorbidity (overlap) between diagnoses, that we are often dealing with more than one clear-cut diagnostic picture.
Be a Team Player
Issues of diagnosis are one of many wonderful reasons to develop integrative partnerships with professionals in your community. None of us knows it all or are equipped to manage issues outside the range of our expertise. In my practice, I have an extensive network of colleagues to whom I refer for everything from psychiatry to homeopathy, nutritionists, marital therapists, Reiki practitioners, and Ayurvedic practitioners. Imagine, for instance, what would have happened to my friend who became manic if her treating psychiatrist was not someone who understood the neurophysiological effects of yoga on the brain: Instead of recognizing that her manic symptoms were triggered by the additional neurotransmitters (serotonin, norepinephrine) being released from the yoga, she would most likely have been put on heavier medication, and may have even been hospitalized! Developing these relationships with supportive, like-minded colleagues is, for me, part of establishing a safe container, both for me as a clinician and for my patients. We are far too complex as human beings to have only one “magic bullet” treatment, be it yoga, psychotherapy or medication. I have a commitment to the team approach. Not only do I have my own therapist, but although I myself am a yoga teacher, I also maintain a list of yoga teachers from different schools of yoga to whom I can refer my patients and feel that I’ve made a good match. I may also refer a client to an Ayurveda practitioner, and I continue to seek out clinical supervision and LifeForce Yoga mentoring. I can happily, and with a big breath say to myself, “I am not alone, and I don’t have to be the only specialist on this case.”
Here are some questions to ask yourself as a yoga or mental health professional integrating yoga into mental health treatment:
- What is my own self-appraisal related to my own mood?
- Do I have a daily practice to clear my koshas, so that I am open to supporting my clients without a personal agenda?
- Who makes up my client population, and do I have the collegial support network to make necessary referrals?
- What steps do I need to take to create a fully safe container for my own self-care and for that of my clients?
Let your own yoga practice remind you that we are not the body, we are not the mind, we are not the diagnosis!
Dr. Lubetkin is on the faculty for the LifeForce Yoga Practitioner Training. This article is based on a section of the curriculum delivered by Dr. Lubetkin at Kripalu, 7/2013.
Join Amy Weintraub and other esteemed faculty at the LifeForce Yoga Practitioner Training in Tucson January 12-19, 2014 . This is a certification training for yoga teachers and health professionals. Learn and practice simple Yoga tools to empower your clients and students to manage their moods. To learn more about the training and to register online please click here.