for Therapist Resilience
By Sarahjoy Marsh, MA, E-RYT 500
Clinicians from many different fields of study and practice are referring patients and clients to yoga and starting to incorporate the tools of yoga therapy into their own practices. With such confidence in yoga therapy, how might clinicians incorporate yoga therapy tools into our daily work for our personal and professional resilience?
Being a Lighthouse
A lighthouse provides a steady, radiant beacon that calls ships back to shore. Regardless of how lost a ship has been or how stormy the ocean, the lighthouse continues to beam its light on behalf of ships looking for a safe harbor.
As a yoga therapy practitioner for the past 20 years, with foundations in mental health and art therapy, one of my primary therapeutic tools is the regulation of my own nervous system, on my behalf and my clients’. When we cultivate our personal equanimity, compassion, perspective, and presence, we are less likely to face burnout or compassion fatigue.
With such self-care we are more likely to see the potential in our clients,
even those struggling with the most tenacious of their addictions and coping strategies. We become better clinicians, with greater access to our intuition, and more patience with the frustrations, fears, or resistances of our clients.
Yoga regulates our nervous system toward the ventral vagal parasympathetic response, our compassionate “lighthouse” nervous system. The vagus nerve—the 10th cranial nerve—regulates multiple functions on behalf of our well-being. Higher vagal tone is associated with compassion, altruism, benevolence, and resilience. Vagal tone is both changeable and interpersonally influenced. Maintaining our vagal tone as clinicians nurtures our resilience, our relationships, and our capacity to provide a lighthouse of possibility to those who seek safe harbor, empathy, or refuge in our presence.
Lower vagal tone is associated with anxiety, increased sensitivity to physical and mental stimuli, restlessness, and difficulties with self-soothing. Regulation of brain and body states, and distress tolerance are also impaired. Low vagal tone may show up as resistance, fear, or apprehension about the therapeutic process. Many clients with disordered eating patterns, PTSD, addictions, anxiety, depression, or difficulty with affect regulation will evidence low vagal tone when they come into therapy. Aspects of vagal tone can be noted in newborns, and seen as the result of adverse childhood experiences, or the repetition of coping mechanisms that disregulate, though they were intended to self-regulate. Disordered eating behaviors, such as purging, are one such self-regulation strategy. It’s often a revelation for my clients when they discover that purging temporarily regulates their vagus nerve. Of course they feel better after purging. To be clear: purging isn’t a strategy I recommend, though it is helpful to acknowledge the intelligence meant in the repeated use of such a strategy. A nervous system can only tolerate so much disregulation before its instinct is to do something to numb the pain, ease the angst, or shift the intensity to that which feels more manageable.
Improving Vagal Tone
Empathy increases vagal tone. Robust singing, vigorous gargling (three to four minutes, several times a day), and the release that comes with a good cry also increase vagal tone.
When practiced mindfully, a regular yoga practice raises baseline vagal tone. Vagal regulation occurs through use of tools such as stretching muscles, reawakening diaphragmatic breathing, and releasing the held tensions and patterns of unresolved fight-flight-freeze-submit reactions. These tools serve to down-regulate (soothe) or up-regulate (energize) your nervous system. Unresolved fight-flight-freeze-submit reactions accumulate in the body as tight muscles, inefficient breathing (chest breathing, frozen breathing), and nervous system disregulation. On behalf of your professional resilience, these tools can be incorporated into a daily rhythm for renewal (e.g., you’ve had several sessions in a row and need a lift), solace (e.g., you’ve had a difficult client with painful circumstances), or transitioning from one client to the next.
We can begin with stretching the secondary breathing muscles, those that stimulate chest breathing, intended for fight or flight. Chronic chest breathing stimulates your sympathetic nervous system and can promote states of anxiety. Repeat these exercises with each side.
Pectoralis Minor Stretch With Doorframe
Place your right forearm up on the doorframe at about shoulder height. Lift your collarbones. Step your right foot forward. Stabilize your pelvis. Breathe with your diaphragm (into your belly) while relaxing your right upper chest.
Chest Stretch at the Wall
Facing the wall, stretch your arm out sideways at shoulder height. Turn your chest, hips, knees, and feet to move into the stretch. Breathe with your diaphragm while softening the muscles of your upper chest.
Sitting in a chair, hold the seat of the chair with your left hand. Tip your right ear toward your right shoulder with your chin slightly tucked into your throat. Breathe with your diaphragm while relaxing the left side of your neck.
Disarming chest breathing paired with returning to diaphragmatic breathing effectively adjusts vagal tone. These are positions that automatically promote the diaphragm.
Table Top Pose
Place your hands on the tabletop, shoulder-width apart. Step back into a stretch for your upper back (and possibly your legs). This position disarms chest breathing and promotes the diaphragm.
Hands Behind Back Breathing
Sitting or standing, bring your hands together at the small of your back. Tip your head slightly forward. This position disarms chest breathing and promotes the diaphragm.
Hands On Head Breathing
Place your hands on top of your head. Relax your shoulders. Start your inhale in your lower belly and slowly expand through your trunk. Exhale from your lower belly and gently tone your abdominal muscles. This position can promote a full trunk breath, initiated from your diaphragm.
Our nervous system has another potential response to perceived threat or stress. This is the dorsal vagal parasympathetic response. Physiological effects include profoundly reduced heart rate, respiration rate, and internal housekeeping functions such as digestion. These are also referred to as “freeze” or “submit” responses. If we find ourselves slipping into heaviness, hopelessness, or stagnation, yoga suggests reviving the nervous system. At times, these responses may be part of our therapeutic process with a client. Our body gestalt may register their nervous system, and we may use this therapeutically. But, we don’t want to get stuck in those responses when transitioning to the next client, or to our own lives.
Shaking Off Cobwebs
Shake your limbs thoughtfully yet vigorously, for 30 seconds each. Take several deep breaths into your belly, lengthening your exhale like sighing.
Swing your arms back while making fists of your hands. Inhale strongly through your nose. Exhale vigorously while swinging your arms forward with fingers spread. Briskly repeat for two minutes. Finish with arms hanging and a deep cleansing breath.
The mammalian part of our brain enables us to engage in relationships for healing. Through mindful breathing of the therapist, the therapist-client relationship can regulate vagal tone. Like an antenna, our mindful breathing transmits this possibility for clients. (Conversely, our tense breathing does the same.)
Additionally, when we are mindful of our breathing patterns, we have access to information about our relationship to our client, and their process. Mindful diaphragmatic breathing lessens the likelihood of our brain getting unskillfully triggered, and increases our ability to maintain perspective and empathy. Empathy reminds us that both our clients and ourselves are experiencing a shared human condition. In the presence of daily suffering or struggle, mindful breathing paired with mentally reciting the word “empathy” can buoy us toward our own lighthouse of presence, skill, and capacity.
Empathy, when experienced with frequency and duration, improves vagal tone. Self-empathy helps us to navigate the turbulent seas of our shared humanity with clients. If our personal lighthouse feels less than robust, we may practice self-empathy in the form of tenderness, and appreciation for ourselves and the efforts we’re making on behalf of suffering in the world. Self-empathy includes perspective, context, and an acknowledgement of our inherent goodwill. We hold a recognition that our nervous system (not just our clients’) feels some pains more poignantly. At times such as this, self-empathy, articulated as follows, is our lighthouse for coming back to shore:
Breathing in, I offer myself tenderness.
Breathing out, I offer myself appreciation.
Breathing in, I honor my goodwill.
Breathing out, I hold myself with empathy.
Integrating Yoga Into Therapy
— Yoga Therapist Sarahjoy Marsh, MA, E-RYT 500, has been training yoga teachers, yoga outreach volunteers, and mental health providers in yoga therapy tools for 26 years. She is the author of Hunger, Hope & Healing: A Yoga Approach to Reclaiming Your Relationship to Your Body and Food.
This is an exciting collaboration, meriting much consideration (to be addressed in my next article). To start simply, consistently remember that nurturing vagal tone increases the likelihood of compassionate, courageous, and integration-oriented therapy.