Gary Kraftsow On Yoga Therapy
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Gary Kraftsow on Yoga Therapy
Sandra Anderson

Yoga therapy is hot these days. Every teacher I know wants to know what to do with this student who has a lower back problem, that student with intractable pain in their shoulder, this student with NIS, that student with heart disease, this one with depression. The yoga community is scrambling to keep up with the demand for specialized services. There is a growing awareness in the healing professions and the general public that yoga may help with many conditions not otherwise easily addressed. Having failed to find relief with conventional treatments, patients make the rounds of alternative modalities, and yoga is one of them. And then, as a broader range of the public becomes interested in yoga, those showing up for classes are not necessarily the ones who are in good health. They may have taken up yoga as exercise because they are not fit enough for conventional exercise, and they hear that yoga is gentle and safe.

In answer to these demands, yoga teachers have reached into many other healing modalities—those that were familiar to them, or readily available—and wedded them to hatha practice. This kind of yoga therapy is well-intentioned and may be effective, but there is a sophisticated and powerful tradition of ancient yoga therapy which is rooted in Sankhya philosophy, one whose viewpoint is radically different from that of yoga as a fitness movement with a modern therapy of some sort tacked on the side.

“The yoga star is rising: this child of the East is becoming a citizen of the world,” Gary Kraftsow writes in Yoga for Wellness. One aspect of full citizenship is defining just what yoga therapy is relative to yoga, and in the process, defining yoga as well. Gary Kraftsow has been studying and practicing yoga from many angles for many years, in the renowned Vinivoga lineage of T. Krishnamacharya and T. K. V. Desikachar. The Viniyoga system is noted for its therapy aspects (which stem from the ancient tradition) and for its adaptation of yoga technology, as the author calls it, to individuals and the unique circumstances of their lives. He spends much of his time traveling and teaching these days, with time out for retreats in Italy and Hawaii, where he lives with his wife and son. He also trains teachers in the Viniyoga and yoga therapy tradition.

Yoga International interviewed Gary Kraftsow in Palm Springs at the Southwest Yoga Conference.

It seems that yoga itself is inherently therapeutic, so how is yoga therapy distinguished from yoga?

Traditionally, yoga is a path of self-transformation, self-realization, and transcendence. In my book Yoga for Wellness I used the image of a launch pad to explain that kind of yoga. Therapeutically, yoga is more like a life raft. When you’re drowning, yoga therapy gets you back up and integrated into yourself. Traditional yoga sadhana [practice] is a spiritual discipline, not a system of health and fitness as it has become in the United States today.

In the West, yoga has been reduced in the public eye to asana practice, and yoga therapy has been reduced to a kind of glorified physical therapy Some practitioners have added other techniques such as gestalt-like counseling or massage therapy to this structural therapy; there are psychotherapists who love asana practice and integrate it into their practice; there are all kinds of synthetic, mixed traditions. These approaches may all be useful in helping people, but there is an ancient tradition in yoga therapy that is not a combination of Western psychotherapeutic techniques, massage therapy, physical therapy, and asana practice. The ancient therapeutic adaptation of yoga was a synthesis of yoga and ayurveda that was often combined with jyotish (Vedic astrology). The application of yogic technologies in this therapeutic model is called yoga chikitsa.

The idea in this traditional yoga therapy is that the practices are adapted to suit the condition of the individual to help them with duhkha (suffering) at the level of the physical body or at the psycho-emotional level. Traditionally the masters were well-versed in a wealth of Vedic sciences—including the use of amulets, the prescription of mantra, the consideration of diet, how to work with family deities, and of course, the appropriate use of asana, pranayama, self-reflective meditation, prayer, and ritual activities. So that’s the ancient idea of yoga therapy and therapy and it’s very different from its modern evolution.

I would imagine that this caliber of yoga therapy is hard to find these days.

Most yoga people in the United States today don’t have a clue about any of the ancient teachings or sciences. Even my own teacher, T.K.V. Desikachar, who is a master therapist, would probably not consider himself a master in either ayurveda or jyotish. His teacher and father, T. Krishnamacharya, was an ayurvedic master and a yoga master. He knew jyotish, as well as all the religious traditions of India, and so does Desikachar. There are very few like him, and probably none in the United States. Still, there is much we can do working with asana, pranayama, meditation, prayer, ritual, chanting, and lifestyle counseling, without having to be an expert in ayurveda or jyotish. We also need to know something about allopathic medicine and pathology to understand the kinds of diagnostics that patients come with and the effect of some of the medicines they are taking. If someone is on antibiotics, or undergoing chemotherapy, or taking HIV cocktails, for example, we have to be careful about our methodology

The primary perspective of the yoga therapist is different from that of a Western physician, or even an ayurvedic physician. An allopathic doctor’s job is to work with disease and cure it. Our approach is to work with the human beings who have the disease—to help them develop a better attitude and get a better perspective on themselves and basically to help them with their mind. That doesn’t mean that we don’t work in a curative direction with certain conditions. But if we’re working with somebody who has cancer, we encourage them to see a doctor; we don’t say, “Why don’t you stop using chemotherapy and try pranayama instead?” If somebody is undergoing chemotherapy, I’ll work with them to improve their digestion, help their sleep, stimulate the immune system, or help them feel better about themselves. So yoga therapy is complementary, not primary for conditions like cancer or AIDS.

What kinds of conditions respond well to yoga therapy?

The first thing most yoga teachers who move into the therapeutic application of yoga will be confident with, if they get good training, is structural problem—low back pain, and chronic neck and shoulder tension. We can do good work with sciatica or sacroiliac problems, and some shoulder conditions. That’s the beginning. But as teachers get more deeply trained, they can work effectively with conditions such as asthma, high blood pressure, diabetes, irritable bowel syndrome or inflammatory bowel disease, reproductive disorders, chronic fatigue syndrome, and serious hormonal challenges. There is a science of training teachers to adapt practices that will either benefit patients with these conditions or allow them to exercise without harming themselves.

The point of yoga therapy is to reduce patients’ suffering, to develop a practice for them without aggravating their condition, and to build confidence that they can improve their condition through their own actions. But this is not a substitute for medical attention, especially in the case of more serious or acute conditions. A lot of yoga teachers hold a negative view of modern medicine. But we must be realistic. If you were a survivor at the World Trade Center you’d want to get to the hospital as quickly as possible; you wouldn’t want somebody standing over you with a pendulum or saying, “Well, let’s try garlic.”

It’s also important to point out that the best yoga therapy takes place one-on-one. If you are working with someone with diabetes or cancer or depression or anxiety, you have to be one-on-one with them. In a group of heart attack survivors, one person might have thoracic kyphosis, another might be obese, and still another might be emaciated. One might have hypermobile ligaments. One might have asthma. Everybody’s symptoms are unique, and the prescription must be unique if you’re going to do effective work. As yoga therapists, we help patients develop a practice that they can do on their own. In a group of twenty, we can’t create individual practices for everyone.

You also mentioned yoga therapy as treatment for emotional problems.

On another level we work with psycho-emotional problems. In our society we have an epidemic of depression and anxiety, and there is a way to adapt yogic technology to help someone suffering from chronic depression, chronic anxiety, manic conditions, or low self-esteem. We do very well with what I like to call normal neurotic minds—people who are reasonably well-integrated in their life, but have typical insecurity problems, or are suffering over a relationship, or have blind spots, or an excessive sense of self-importance, or self-pity, or mild depression. These are not pathological, not biochemically based, clinical depression or schizophrenia.

How do you treat the normal neurotic with yoga therapy?

Again, we almost never work with just the back or just the blood pressure or just the emotions. We’re working with the whole human being. So when I do the intake interview I’ll find out if there’s a tendency toward anxiety. If there is chronic anxiety I try to find a way of engaging the person in activities that will help them stay calmer. For example, sometimes someone is agitated mentally but sedentary physically—the state of mental agitation and the level of physical activity are disconnected. In order to calm down the mental agitation we have to increase the physical activity and integrate the mind and the body. Then, having done that, we’ll develop practices to calm the whole system. On the other hand we might do the opposite for someone who’s depressed: their paradigm is that they don’t want to get off the couch.

So you have to strategize (this is called upaya) the right means to help someone move their energy in the right direction. There are different methodologies—it depends upon the nature of the person. Certain strategies of communication will help them feel more empowered and feel better about themselves.

Once I asked someone to drink coffee in the morning for a period of time just to give herself a lift. That’s an extreme prescription, but it worked. So our idea about upaya is to use whatever helps somebody feel better about themselves. This boosts their immune system, helps them sleep better, improves their digestion, and helps them have healthier relationships. A big piece of our work is measured in healthy relationships. Dysfunctional relationships are symptomatic of something else, and one of the means of healing is to help people transform these relationships and create healthy ones. Sometimes it’s a matter of encouraging them to stop relating to certain people in their lives—or, conversely to start relating to certain people in their lives.

In the tradition in which I was trained, the foundation for practice for most adults is to create stability at every level—structural stability, physiological stability (which could be equated to immunity, perhaps), and psycho-emotional stability, which is essential given the volatile nature of the external world. The next goal is to help them to awaken slowly and appropriately to a deeper dimension in life—the spiritual dimension—and then help them find a way of linking to that dimension through their heart in a way that’s not counterfeit. You must find an authentic link, something that inspires them. For example, I might ask somebody, “Do you remember what inspired you when you were five or six? Did you go to church? Do you remember the joy?” The point is to reconnect to something they felt in childhood, and to go back to that. Help them return to something deeper inside themselves that gave meaning to their life.

Would it be fair to say that stability at all levels is the goal of yoga therapy?

That’s a good starting point. Again, we’re talking about therapy. We’re talking about the life raft. What you want to do is get out of danger and reach a stable place. Then if something else awakens we can think about the launch pad to help people elevate to another dimension. I had a powerful epiphany, which I wrote about in my first book. I was watching PBS interview the man who developed the rocket science to launch the Voyager out of the solar system. It was a tricky thing because this satellite was quite small and couldn’t hold enough fuel to propel itself out of the solar system. So this man figured out how to use the “gravity well” of the planets to ricochet the satellite to its next destination. If you shot it too close to the planet, the satellite would crash into the planet. If it was close but not too close, it would go into orbit. But if it was just right it would swing around the planet and pick up momentum from the gravity of the planet and go on. I was watching this and suddenly a light bulb went off in my head.

I thought about the normal neurotic who’s in orbit around the planet called me. It’s me, me, me. It’s all about me. (The seriously ill people have crashed into themselves.) Now, we all have challenges, and what I’ve learned in my own life is that when I’m suffering, if I get caught in the loop I just circle around the suffering and I don’t get anywhere. But if I sit with it and relax into it and let myself feel it, I can gain momentum from it and it can propel me forward. That for me is helpful diagnostically. I can watch someone and I see where they’re preoccupied with this neurotic thing, with themselves. Then I figure out how to apply what we call pratipaksha bhavanam, a reframing of a person’s perspective on their own challenges. Pratipaksha is a key idea in yogic theory, not only for working with psychological problems but also for someone who has cancer or diabetes. What we’re trying to do is reframe their way of dealing with emotional challenges.

Is the concept of pratipaksha bhavanam part of traditional yoga?

Patanjali uses the word twice in the Yoga Sutra. One sutra [2.33] says, “Vitarkabadhane pratipaksha bhavanam.” That’s a very simple sentence. It means that when we have afflicted thinking, then “Pratipaksha bhavanam”: Contemplate and take another view—look at the situation from another perspective. In another sutra [2.34] Pantanjali says if you have negative thinking that comes from anger, greed, or delusion, whether you’re actively in it or just thinking about it, the fruit will be unending suffering and ignorance. Therefore, “Pratipaksha bhavanam”: Take another view, reframe your perspective on the situation.

You include the notion of personal ritual as therapy. I’m intrigued. There is so much misunderstanding in the yoga community about what ritual is and how to use it. What do you mean by personal ritual, and how do you use personal ritual in a therapeutic context?

Ritual activity is designed to bring another level of consciousness to daily activity. Its purpose is to bring a dimension of the sacred into the profane, to elevate the profane daily activities to the level of the sacred. The most common kind of communal rituals we have in our secular Western society are probably shopping and football and CNN and CNBC and watching the stock market. Of course, within our general American culture there are subcultures such as practicing Catholics, Jews, Muslims, and Buddhists, all of whom have traditional sanctioned rituals that the community celebrates. So that is communal ritual.

Personal ritual is different. A personal ritual could be saying grace before you eat, or washing your hands before you eat. But when I talk about ritual in the context of yoga therapy I mean integrating personal practice into ritual. It might be asana, but adapting the asana in the service of some breathing. It might include pranayama, but adapting the pranayama in the service of meditation or chanting—and selecting the chanting in the service of a meditative quality. That opens the heart.

The idea is that ritual integrates many elements. It doesn’t have to include all of them. It doesn’t have to include any one in particular. But it integrates many different elements and organizes them and points in a certain direction to lead the person to a sense of deeper connection. In traditional yoga therapy, or at least in my approach to yoga therapy, I consider the five mayas (dimensions), which you probably know as the five koshas.

Annamaya is the physical structure and asana is a primary tool. But we want to bring the structure back into balance, so for us yoga therapy doesn’t necessarily mean asana. It could mean going for a walk. Then there is pranamaya, the vital system, the physiology—and pranayama is the primary tool, but diet is also very important.

Manomaya, which is often overlooked in the yoga world, has to do with the mind that learns from the outside via the senses. We take in information from the world around us via the senses, and with that information we learn more about ourselves and can thus make more intelligent choices about, for example, our diet, or which asana is good for us. So we’re always encouraging people to continue their education. If you have heart disease, you might want to study food. Or the topic you choose may be unrelated to your health: it may just be an interest that stimulates you. Often as people age, they lose enthusiasm. They are so overwhelmed with the responsibilities of family, mortgage, taxes, and so on that when they have any free time they choose entertainment such as drinking, which dulls the senses. And so the curiosity, the hunger to learn that youth has, which is very healthy, goes flat. We often just encourage those people: “What are you interested in? What didn’t you do when you were younger that you’ve always wanted to do as a hobby?” That’s manomaya.

Then vijñanamaya, that’s the character or the personality. This is where svadhyaya (self- reflective meditation) comes in, and maybe counseling, and having good friends that are healthy and can influence you in a positive way. Finally there is anandamaya, the emotions in the heart. There we work through relationships and singing, prayer and ritual, chanting. So the idea is to develop a personal ritual that integrates practices for all five dimensions.

Patanjali in the first chapter of the Yoga Sutra offers contemplations to help the mind remain in a state of what he calls chitta prasadanam (tranquil mind). So these dimensions are a kind of pratipaksha to help us cultivate a balanced mind. If you want to do it pragmatically, try to see the same situation from a different perspective. But that requires more than sitting down and doing it intellectually. That would be working only on manomaya, the intellectual level. To have that reflection penetrate to a deeper level, to vijñanamaya, we use asana or pranayama or different chanting techniques to help us access a deeper place within us from which we can then do a reflection.

And so the first step in effective yoga therapy is careful and holistic assessment of the individual’s condition. We do this by examining these different dimensions, recognizing their manifest symptoms, and working toward identifying their causes. And then we determine the right strategy for the practice, considering what elements should be included, when it should be done, and for how long. The clearer we are about the needs, the tools available, and how to adapt and apply them, the more effective the practice will be.

Founder of the American Viniyoga Institute and author of Yoga for Wellness and Yoga for Transformation, Gary Kraftsow conducts seminars and retreats throughout the United States and Europe, working with students and training teachers and therapists. He makes his home in Maui, Hawaii.

Reprinted with permission from Yoga International, April/May 2002.