Why "Gentle" Doesn't Always Mean Therapeutic in Yoga

I’ve offered yoga therapy for 25 years. I’ve also taught both gentle and vigorous hatha yoga for 35 years in education centers, studios, fitness centers, and hospitals. Through it all, I’ve learned a lot about the nature of yoga therapy—namely, that there is a difference between classroom asana and yoga therapy. Teaching in a classroom setting, I became aware that students come to their mats with every conceivable physical and emotional quandary. Generalized safe movement and breath practices may help to address some of  these, but more focused time spent looking at how all the pieces of yoga fit with attention to individual needs provides deeper and more direct benefits. 

When scheduling private therapy sessions, people often assume they will receive the same set of practices that are offered in a gentle yoga class. Yoga therapists, however, are not simply teachers or personal trainers, but rather trained therapists offering specific techniques in breath, physical movement, sound, and sometimes mudras and meditation practices to assist healing. Yoga therapists look at how you walk, sit, and stand—and even how you eat—helping you create healthy new patterns and allowing you to take charge of your own well-being.

When scheduling private therapy sessions, people often assume they will receive the same set of practices that are offered in a gentle yoga class.

Below are some common assumptions (and clarifications) to assist in differentiating between yoga classes and yoga therapy.

Assumption #1. People must be able to get up from the floor and lower down to the floor to practice yoga.

Mobility issues often prevent people from attending yoga classes. Knee, hip, and lower back problems may make lowering to the floor painful and embarrassing. An injured or weak shoulder or wrist can also make getting up from the floor challenging. A class that requires students to lower their bodies to the floor may keep an individual from returning, even if the class is truly needed. Private yoga therapy can help a client assess her abilities and limitations in a setting free from rush or embarrassment.

Of course, there are chair-yoga classes. I love them, and I love to teach them—but not everyone can attend these classes, as they may be offered at inconvenient times or inaccessible locations. Teachers for such classes are less likely to be available because yoga teacher trainings often don’t offer components for instructing those with mobility issues. Chair-assisted classes are also often held during work or school hours and seem intended for those who are retired. As a result, even when chair yoga is available, younger students may feel self-conscious about attending classes marketed toward an older crowd, and students of all ages often have the misconception that chair-based yoga is not "real yoga."

A yoga therapist can help make the call about whether chair yoga or other types of practice will benefit the student, and how yoga can be adapted for home practice. A yoga therapist focuses on healing rather than specific poses or positions, understanding that there are all kinds of ways to accomplish that end. While a student may want to be able to get up and down off the floor easily, the therapist recognizes that it may not be a rapid process after injury or surgery. But if fielded into an all-levels class (even one offering modifications), the student may feel a need to push too hard when seeing others practice. Even in private yoga sessions, many teachers without therapeutic training may assume that a student is there to gain access to harder yoga poses rather than find ease in daily movement. 

Assumption #2. We must start and end each class by closing our eyes and centering.

Having worked in trauma therapy for many years, I have seen the discomfort created for students who are expected to close their eyes or lie facedown in a yoga practice. Traumatized individuals often exhibit "hypervigilance," which is defined in Merriam Webster Medical as “the condition of maintaining an abnormal awareness of environmental stimuli," and can lead to great stress when one is asked to “relax" or "surrender” (even outside of a group setting). 

As seen in Zen meditation practices, we can learn to breathe and center with eyes open, and therapists and some classroom teachers offer this as an option. However, often in a yoga class the teacher makes suggestions (like starting in a facedown position like child's pose or crocodile pose) that may serve a majority of students but may cause physical or mental stress for others. Yoga therapy allows for something more of an alliance between therapist and practitioner, creating a conversation about readiness. If the time comes when the client is ready to rest the eyes in relaxation or centering, the client makes that call.  

Assumption #3. Young people need a vigorous class and don’t have health issues.

We all experience illness and dysfunction at different points in our lives. For some, it may be in youth. Younger students often feel pushed to achieve athletic and even gymnastic feats when practicing anything with the "yoga" label attached. Injuries, disorders, and emotional and mental disturbances are not uncommon in younger students, and young people are often quite uncomfortable coming to a "gentle" yoga class filled with students many years their senior. For these individuals, private yoga therapy may be a more comfortable option after (for example) a sports injury or car accident, and it gives young people without current illnesses or injuries the opportunity to deal with individual concerns and develop personal strategies for wellness. This could include tutorials on specific yoga postures that may benefit their healing, or alternatives for practices that need to be avoided or modified.

I’ve also taught many therapeutically focused group classes to individuals in their teens and twenties. In these types of classes, a yoga therapist with additional training in mental and behavioral health issues, or a psychotherapist with yoga training, assists participants in addressing addiction, depression, trauma, or eating disorders, and utilizes breathing and movement specifically designed to help. 

Young people are no less vulnerable to the difficulties of life, and we all need nurturance, understanding, and an occasional boost. Yoga therapy can address complex issues at many levels—physical, hormonal, emotional, mental, and spiritual—and may help in identifying a common thread between a physical issue (back pain, for example), and how that relates to emotional stressors (such as school worries or lack of self-confidence). 

Assumption #4.  Slow means gentle, and gentle means therapeutic.

I was not available one week to lead the yoga therapy class in the hospital in which I practiced, and another yoga teacher was sent in to work with a group of orthopedic patients, many of whom had knee and hip replacements or spinal fusions. The teacher offered a regular fitness-based yoga class, but at a very slow pace. Anyone who has held a balance pose or a warrior stance for over a minute would recognize this as a bigger challenge than a short hold. Needless to say, the hospital staff heard many complaints. Fortunately, no one was hurt, as these long-term students knew their capacities and modified accordingly.

Is all of yoga therapy slow paced? Not at all. There are times when vigor is helpful, especially when dealing with certain types of depression, addiction, edema, and anxiety. It is case by case. There is no set pace, but yoga therapy is always mindful.

Assumption #5. You can assess a student's level of ability and mobility by watching them walk into the class.

Years spent in the fields of yoga and yoga therapy mean years spent observing people. If I see a person who is thin, young, dressed in athletic wear, with no limp or external indicators of pain, I still cannot assume that they can move comfortably. I have also been surprised at the overall easy movement of people with visible evidence of disability or injury.

At the start of a class, many good teachers ask their students if there are health issues to be considered. Even then, students may not inform the teacher of a personal problem due to embarrassment or limited time before class, hoping to “do what they can.” In private yoga therapy, clients are more likely to open up about injuries, surgeries, and chronic conditions and can expect the therapist to offer a broad array of healing possibilities beyond conventional poses.  

There are also times when even the most fit among us may find themselves injured or immobilized by a life event. In a group yoga class, it's outside of the teacher's scope of practice to root out trauma or shame, and it would be insensitive to attempt to do so. This is a private matter.

A yoga class—even a gentle yoga class—is not a therapy session. This is not to say that a yoga class is without therapeutic value, and many people may not ever need a one-to-one yoga therapy session to heal. But yoga therapy addresses issues that traditional group classes cannot. Yoga therapy is an invaluable way of learning to bring healing to where we personally need it most.