Yoga Therapy in the United Kingdom
by Tim Naylor, Ph.D. Coordinator, British Council for Yoga Therapy
Yoga therapy has been practiced and developed in the United Kingdom for well over twenty years, both by inspired individuals and by groups such as the Yoga for Health Foundation and the Yoga Biomedical Trust. Compared with other complementary therapies, however, such as acupuncture or osteopathy, it has not developed as far or as fast. This is not surprising, as yoga therapy is a relatively new practice, even though yoga, like acupuncture, is an ancient discipline.
It is interesting to explore why yoga therapy has not yet become well established in the West. Perhaps in order to understand why, one must recognize that acupuncture was well codified in China many years ago and has been practiced there for millennia. Despite its introduction to the West relatively recently, it had this good foundation of past history and established efficacy upon which to build. Its alternative explanation of how the body works through the flow of energy, however, has taken conventional Western physicians some time to grudgingly accept, and even now it is still viewed with suspicion in some conservative quarters.
By comparison, osteopathy has had a long history in the West, having been formulated and developed over the last 150 years. Yet despite this, within the United Kingdom, it is only within the last 15 years or so that it has gained official recognition and status within allopathic medicine.
One problem with the acceptance of yoga therapy is the lack of a well-established set of practices with a proven track record of efficacy for particular ailments. Another problem has been that of defining "yoga therapy" (or whatever term one prefers), since it is generally accepted that Yoga is by nature therapeutic and that all who practice it will benefit. This has been known through the ages, and thus it can be argued that all yoga teachers are therapists in some way!
Within Ayurveda, yoga practices have been prescribed as part of an overall treatment program for many years. Western medicine, however, has been slow and sometimes reluctant to accept Ayurveda, or even to acknowledge it as a complementary treatment. Consequently, its storehouse of knowledge has been dismissed or overlooked until very recently.
It was only in the 1920s in India that research into the effects of various yoga practices was begun in order to demonstrate that yoga exerts measurable physiological effects on the body. Consequently, at least from a conventional point of view, yoga therapy may be considered to date only from this time. In addition, a somewhat narrow-minded Western view coupled with the "not invented here" syndrome have tended to minimize the significance of some of this work.
While there is now much evidence regarding the efficacy of yoga practices, it is scattered and a lot of it is non-standardized, which makes comparisons difficult. In addition, a lot of the research fails to meet Western standards for medical trials. Consequently, an accepted "reference manual" with a recognized level of efficacy does not exist that could be utilized to promote the cause of yoga therapy.
Perhaps one reason for this lack of a "reference manual" is that it would require us to fit practices meant for the whole person to Western symptomatic interpretations of disease. In yoga therapy, the goal is to treat the whole person to help resolve the underlying problem rather than treat just the external symptoms. This in turn generally means that each presenting client brings a unique set of problems that requires a unique set of practices. For example, even though it has been found that for asthma a certain sequence of practices will be of general benefit to all presenting asthmatics, a closer examination usually reveals that each individual would derive even greater benefit from a slightly different (or individually tailored) set of practices.
Yoga therapy thus initially has been promoted and subsequently developed by only a few individuals. Within the United Kingdom, perhaps the foremost of these is Howard Kent who established the Yoga for Health Foundation (YHF) in 1976. Through YHF's pioneering efforts, it has now reached the point where YHF's yoga therapy work is highly regarded and accepted in some areas of the conventional medical establishment.
Paul Harvey, who had studied with Desikachar in India, founded the Centre for Yoga Studies in 1982 and started to train people to teach yoga therapeutically as well as in the more general sense.
The Yoga Biomedical Trust (YBT), established by Robin Monro, Ph.D., in 1983, also pioneered the development of yoga therapy in the United Kingdom, but through an alternative route. YBT's focus has been designing and carrying out controlled clinical trials, with the aim of making the results more easily acceptable to the allopathic medicine community.
As a result of these pioneering efforts, yoga therapy in the United Kingdom is a relatively young practice with a very small (but growing) clientele and a very small, but also growing, band of enthusiastic practitioners.
Given the different approaches to developing yoga therapy, it is not surprising that there are a number of different views as to what exactly constitutes yoga therapy and how it differs from yoga. In fact, opinions vary across the entire spectrum. One example would be a yoga teacher in a general class who simply advises a student who is recovering from a herniated disc to do backward bends in preference to forward bends. Another example would be someone who diagnoses a patient's back condition and then prescribes appropriate yoga practices. There are also those who feel that one should treat the whole person and not his or her symptoms. In addition, there are those who think the term "therapy" should not be used and prefer the word "remedial" and have the view that yoga therapists do not "treat" patients. Some also feel that a high level of medical knowledge is required, and others think this is not so relevant.
One common thread that unites all, however, is that we firmly believe that yoga can be of immense benefit to people in all stages of their lives and that there is great scope for the further application of yoga. It is this belief and a strong desire to be of service to the public that have drawn us together to initiate the creation of a homogeneous community that respects the diversity of views and that can cater to the different demands made on us in a professional and caring way.
The Need for Patient Protection
Within the United Kingdom, the rapidly spreading use of complementary therapies by the public over the last few years led the U.K. government to commission a report by the House of Lords Select Committee on Science and Technology on issues related to protecting the public when using these treatments. Over a 15-month period it examined a large range of complementary and alternative therapies and reported back in November 2000. The committee classified the therapies into three groups: those that are professionally organized disciplines with their own diagnostic approach, have some scientific evidence of effectiveness, and have recognized systems for training of practitioners (e.g., acupuncture and osteopathy); those that lack a firm scientific basis and are not regulated to protect the public, but which give help and comfort to many people (e.g., yoga, meditation, and shiatsu); and finally those that perform diagnosis and treatment, but for which the Committee did not find convincing evidence of efficacy (e.g., Ayurvedic medicine and Chinese herbal medicine).
The Main Conclusions of the Report
- In order to protect patients and the public, better regulation was found to be essential, which meant single voluntary regulatory bodies needed to be developed for each profession.
- Training courses varied unacceptably in content, depth, and duration. Hence it was recommended that training courses become standardized, accredited, and validated; that continuing professional development be made a core requirement; that every therapist should have a clear understanding of the principles of evidence-based medicine and health care; and that training should define the limits of competence. These recommendations were accepted by the U.K. government in March 2001.
Concurrently, The Prince of Wales's Foundation for Integrated Health, a charity created to improve the quality of health care in the United Kingdom by bringing together complementary and conventional practitioners, began to take a more active role in promoting these aims and assisting the various complementary therapies in forming the relevant national bodies. Two of the Foundation's aims are:
- to encourage the establishment, development, and maintenance of a single voluntary regulatory body for each therapy and profession
- to encourage each therapy to ensure that its practitioners are educated to an agreed level of competence, and where appropriate to register practitioners with that body
As a result of a £1 million grant obtained from the King's Fund, The Prince of Wales's Foundation for Integrated Health has initiated an extensive program of work with the United Kingdom's main complementary therapy practitioners and organizations and has supported setting up their fledgling regulatory bodies.
Origins of the British Council of Yoga Therapists
I attended, along with Bill Feeney of the Yoga for Health Foundation, a series of meetings organized by The Prince of Wales's Foundation for Integrated Health at which the above points were raised and discussed. This was seen as an ideal opportunity to set up yoga therapy as a fully professional and well-regulated body, which would help to raise its profile among the public and the other health professions.
The idea for The Yoga Therapy Forum thus arose, although its name was not agreed on until the first meeting. Letters were sent to all organizations involved - or potentially involved - in training yoga therapists and a notice was placed in the yoga press alerting people to the forthcoming event and seeking their input and involvement.
We set ourselves up as The Yoga Therapy Forum, as our first aim was to try to gather together all the organizations or individuals who felt they might be involved in training yoga therapists. Our next aim would be to try to decide just what we meant by "yoga therapy," whether we should use a different term, and how to determine if we were different from yoga teachers in the first place! In other words, our goal was to create a forum open to all interested parties and to openly discuss our views and see if we could arrive at a consensus.
The inaugural meeting was held in July 2002, and by December 2003 we had made excellent progress due to the dedicated efforts and good will of all our members. We had gathered together virtually all the different groups involved in yoga therapy in its different guises, and thanks to a grant from The Prince of Wales's Foundation for Integrated Health had identified and elected an independent chairwoman for our group. This was an important step, as we all felt it would be best if no one group was seen or perceived as gaining an upper hand for any reason whatsoever.
Our achievements thus far include:
- a working definition of yoga therapy
- identification of how yoga therapy differs from yoga
- development of aims and objectives
- development of ethical guidelines and a code of best practice
- creation of a web site
We have established a series of working groups to look into and report back on the following topics: Education and Training, Codes of Conduct and Ethics, Working Practices, Research and Development, Pregnancy and Therapy.
We are now starting to address the issue of setting some minimum levels of training. Given the varying approaches of our members to the application of yoga therapy, this is an important issue requiring much thought and consideration. In view of the considerable rapport that has been built up over the last year, however, we are confident we will succeed.
Definition of Yoga/Yoga Therapy
Yoga has many aspects, but in essence it aims to help a student reach his/her full potential and thereby blossom fully as a human being. It has many tools, including postures, breathing and relaxation techniques, and meditation.
Yoga therapy occurs when a yoga therapist works with a student or group of students with the primary aim of addressing a health issue, be it physical, emotional, or mental, specific to the needs of the individual student or the group.
A therapist works with students, choosing the appropriate techniques for each one and encouraging each one to establish a personal practice embracing these techniques. This enables each student to be more autonomous, practicing in his or her own time and space, fully participating in the journey to well-being.
Our website (currently www.yogatherapyforum.org.uk) lists all our member organizations, and it shortly will be updated to include a listing of all therapists trained by our member organizations and links to their websites. This will serve the dual purpose of:
- informing the public about therapists in their area
- enabling members of the public, via the websites of the training organizations, to inform themselves about the nature of the different training organizations and their particular approach to yoga therapy
In order to reflect the growing professionalism of our group, we recently felt it was time to change our name (which was initially intended to reflect the need for discussion and consultation) to one that represented our newfound position. We thus selected "The British Council for Yoga Therapy."
We fully recognize it will take time to define and inaugurate all the procedures and standards we have planned. We feel, however, that we have begun to establish a solid foundation on which to build a sound, professional organization that will serve both the public and yoga therapists by offering a well-regulated and professional body that fully represents all practitioners and sets out and maintains the best standards for all.
Since our inauguration, one thing has emerged that has surprised all of us, especially considering our diversity of views, and that is how much our desire to see the benefits of yoga therapy spread out to the general public has enabled us to work with a spirit of openness, collaboration, and understanding. We consequently feel strongly motivated to work through any difficulties that may emerge and resolve them in a way that reflects our love for yoga. With this orientation we are bound to succeed.
The author would like to acknowledge the help and assistance of colleagues in The British Council on Yoga Therapy in the preparation of this article.
About the author: Tim Naylor, Ph.D., has been practicing yoga for nearly twenty years and teaching for twelve. He qualified with Friends of Yoga International (FRYOG) in 1992 and taught part-time for the next ten years while working as a full-time research scientist. He then took the Yoga Biomedical Trust course in Yoga Therapy, qualifying in 2001, and started working as a yoga therapist and teacher at the Yoga Therapy Centre in London, where he runs classes for HIV/AIDS and asthma and sees individual clients with a variety of disorders. He uses yoga-nidra extensively, as he finds it to be a very powerful technique, and recently took a course in yoga-nidra from the Bihar School of Yoga in the UK. He feels fortunate to have been in the right place at the right time to help initiate the founding of The British Council of Yoga Therapy. Contact: firstname.lastname@example.org.