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Yoga Therapy In Pediatric Hospital--featured article in the Spring 2013 issue of Yoga Therapy Today

Yoga Therapy In Pediatric Hospital--featured article in the Spring 2013 issue of Yoga Therapy Today

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Published by Michelle Fury
my article on our yoga therapy program for kiddos at Children's Hospital Colorado
my article on our yoga therapy program for kiddos at Children's Hospital Colorado

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Published by: Michelle Fury on Mar 08, 2013
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YogaTherapyToday| Spring 2013 www.iayt.org
FeatureArticle
Yoga Therapy in a Pediatric Hospital:
A Mental Health Approach
Pioneering a NewBranch of IntegrativeMedicine
Working with kids in thissetting has taught me moreabout the power of yogaand its application thanany other experience.
    P    h   o   t   o   c   r   e    d    i   t   :    R   a   n    d   a    l    l    S   t   r   e    i    f    f   e   r   t ,    C    h    i    l    d   r   e   n    ’   s    H   o   s   p    i   t   a    l    C   o    l   o   r   a    d   o
Jake doing fire hydrant poseas part of a Psychiatric DayTreatment class.
Photo credit: Tia Brayman,Children’s Hospital Colorado
 
By Michelle Fury 
Introduction
The combination of yoga therapy andmental health is gaining traction in thepublic eye. In a 2009
Time 
magazine arti-cle, licensed clinical social worker JoanStenzler spoke of the natural union ofyoga and psychotherapy. She is quoted assaying, “The goal and intention in psy-chotherapy is to support a patient to bewho they always were. And that’s yoga!”(Kornfeld, A.B.E. [2009]. Psychotherapygoes from couch to yoga mat.
Time 
. Retrieved fromhttp://www.time.com/time/health/arti-cle/0,8599,1891271,00.html.)Stenzler is describing what I do atChildren’s Hospital Colorado (Children’sColorado). I am both a licensed psy-chotherapist and a seasoned yogateacher. Though it has been a challengeto get here, I know it is possible, becauseI have been doing it for over seven yearsand with great results. So in this article Iwill describe what I do, the current settingin which my position exists and how it wascreated, and the qualifications necessaryto fill it. I will also review the compellingevidence that yoga therapy can andshould be used for mental health benefits.
Keep Calm, Carry On
Recently a girl attending my weekly thera-peutic yoga group for adolescents lostconsciousness when it was her turn to“check in.” The group was part of the Ado-lescent Psychiatric Unit (APU) at Chil-dren’s Colorado. My primary role in thisgroup is to use yoga therapy as a psy-chotherapeutic intervention, and this par-ticular APU yoga session serves as agood example of how I do this.As soon as the girl slumped over, theother staff in the room and I sprung intoaction: staff called for a nurse who arrivedquickly and assessed the girl’s health.Meanwhile, the other staff and I escortedthe teens back to their unit. Once in theunit’s day room, I led the group in a slowflow of gentle yoga poses that empha-sized forward folding, followed by deepbreathing. During check out, I asked eachparticipant to share how she or he felt. Allteens reported a change in their affectfrom the beginning to end of group. Forinstance, one teen checked in as “blah”and checked out as “relaxed.” Anotherteen checked in “irritated” and checkedout “refreshed.” Though this APU groupstarted off unusually, the unusual circum-stances highlight something importantabout the teens’ response: that is, theydidn’t respond much at all. This particulargroup of teens presented with the bluntedaffect that is common in depression. Thepsychotherapist in me allowed me tonotice the teens’ nonreaction and to pointout to them that something extraordinaryhad just occurred, while the yoga therapistin me knew what yoga poses and breath-ing techniques could enliven and regulatethe participants. This example alsodemonstrates the combination of modali-ties in action.
Developing a Yoga Therapy Pro-gram in a Hospital that is Pediatric
and 
Psychiatric
I am a full-time yoga therapist in thePonzio Creative Arts Therapy Program(PCAT) at Children’s Colorado. Pediatricpsychiatrist Marianne Wamboldt, MD, co-founded PCAT in 2005 with a grant fromthe Craig Ponzio family. PCAT offers art,dance/movement, music, and yoga thera-pies, and is composed of master’s-levellicensed therapists. I have been part ofthis team since I joined it as a psychother-apy intern in the fall of 2005. Now, I runweekly therapeutic groups for almost allunits within the Department of Psychiatryand Behavioral Sciences at Children’sColorado. These units have inpatient andtransitional day-treatment programs. I alsosee individual outpatients on a semi-regu-lar basis. My remaining time goes to theIntegrative Headache Clinic (IHC), where Iconduct a bi-monthly yoga class for ado-lescents with chronic headaches.
(continued on page 12) 
Like my fellow PCAT therapists, I use mymodality (yoga) as a psychotherapeuticintervention. We meet weekly to discussour teams’ policies with the units weserve, to provide one another with peersupervision on difficult cases, and to dis-cuss the training of our interns. My PCATteam as a whole has formally recordedthe check-in and check-out process via ameasure called FACE pages (FastAssessment of Children’s Emotions) overtwo years. Because good psychotherapyinvolves looking at one’s negative emo-tional states as well as the positive states,sometimes we care less about whether anadolescent’s state is positive or negativeand more about whether he or she noticesa change. Two years of collecting FACEsheet data has shown us that teens over-whelmingly report a change in their affec-tive state from the beginning to end of allthe PCAT groups. More informally, I haveconsistently noted improvements in moodand emotional regulation in the teens, aswell as receiving positive reports fromtheir healthcare team.The work that I (and my fellow PCATtherapists) do with children and adoles-cents does not happen in a vacuum.When I see an individual patient I commu-nicate with his or her primary psychologistor psychiatrist on a weekly basis to coordi-nate care. Before I see each of my regu-larly scheduled groups, I speak with staffon the unit to determine what interven-tions and techniques to use for that partic-ular group. Being clear about the scope ofone’s practice is vitally important in anenvironment like Children’s Colorado. Forinstance, while I must be familiar andtrained in the use of the DSM-IVR (the
YogaTherapyToday| Spring 2013
 
11
www.iayt.org
Feature Article
continued
Three teens takepart in the filmingof Children’sHospital Colorado’sinstructional yogavideo for teens inSeptember 2011.
Photo credit:Randall Streiffert,Children’s HospitalColorado
 
Revised Diagnostic and Statistical Manual for Mental Disorders 
), I do not diagnose.In addition, while I am a co-investigator ona few studies at Children’s Colorado, myrole is to develop and deliver yoga therapyinterventions.Unlike the art, dance/movement andmusic therapies offered through PCAT,there is not an academic master’s degreeassociated with yoga therapy for mentalhealth. Yet. We are working hard at Chil-dren’s Colorado to create the structureand the alliances foundational to a formalyoga therapy education. To that end, I cre-ated a yoga therapy internship that mirrorsthe other PCAT modalities’ internship pro-grams, which I have implemented for thefirst time this academic year of 2012-2013. I am currently supervising an internstudent who is enrolled in Naropa’s Mas-ters in Contemplative Psychotherapy Pro-gram (MACP), the program from which Igraduated. The difference between herinternship experience and mine is that Ihad to do two separate internships to sat-isfy the requirements of MACP. This wasbecause the structure did not exist at Chil-dren’s Colorado that would allow me toget all the clinical “talk therapy” experi-ence I needed to graduate (280 hours ofdirect client contact, to be exact). Butunder my guidance as a licensed psy-chotherapist who integrates yoga and talktherapy skills, my intern is learning to dothe same while also fulfilling Naropa’srequirements.In addition, Dr. Wamboldt and I areworking closely with Hansa Knox, directorof PranaYoga and Ayurveda Mandala inDenver, where they have created a com-prehensive children’s yoga teacher train-ing. By 2014, Children’s Colorado will be apracticum site for PranaYoga studentsenrolled in this program.
Job Requirements
In order to do what I do at Children’s Col-orado, I have worked hard to meet certainrequirements. I am a Registered Chil-dren’s Yoga Teacher (RCYT) who hasfacilitated therapeutic yoga for childrenand families for seven years, and I havetaught yoga in general for sixteen years. Ihold a master’s degree in ContemplativePsychotherapy from Naropa University(Boulder, CO) and I am a Licensed Pro-fessional Counselor (LPC) through theState of Colorado. I am trained in Dialecti-cal Behavioral Therapy (DBT), an evi-dence-based mindfulness therapy, andhave much training and experience intrauma therapy. At Children’s Colorado,we require the following of yoga therapistsor yoga therapy interns:
s!,ICENSEDINPSYCHOTHERAPYPSYCHOLO
gy, or social work, or B) currently seek-ing an internship to satisfy graduateschool requirements in clinical practicefrom one of the fields listed;
s#URRENTLYAN2949OGA!LLIANCE
plus two years of teaching experience;and
s4WOYEARSEXPERIENCEWORKINGWITHCHIL
-dren (such as childcare or teaching). 
Anatomy of a Yoga Therapy Inter-vention for Mental Health
Though I don’t think of yoga therapy andpsychotherapy as separate any more, Iunderstand that this is still a fairly new con-cept for most. So I will highlight each set ofskills as I practice them in a single session.Let’s go back to that APU group I men-tioned at the beginning to understandwhich part is psychotherapy and which partis yoga therapy. The check-in and check-out practice with each adolescent beforeand after each group is a psychotherapytechnique that helps create attunement(my responsiveness to each teen). Byattuning with the kids from the start, I amable to decide what yogic interventions touse. In this particular group, the check-inwent like this: “What’s your name? Howare you feeling? And if you could start anynew school club what would it be?” A men-tal health counselor developed this lastquestion, and its informal tone is purpose-ful: it creates a casual atmosphere that isrelaxed and attuned to adolescents whomay be new to yoga. Through the check-in/check-out technique, I am practicingbrief therapy (a common and well-researched therapy model). The goal ofbrief therapy is to build therapeutic rapportwith the patient as quickly as possible.Rapport literally means “relationship” inFrench, so therapeutic rapport refers to theprocess of building relationship betweentwo individuals in a therapeutic relation-ship. Attunement is one of the ways tobuild therapeutic rapport. All of these psy-chotherapeutic tools (attunement, brieftherapy and rapport building) help me tocreate a therapeutic yoga environment, inwhich adolescents feel they can trust me.While I’m establishing rapport, I’m alsoassessing each teen’s behavioral profile.For instance, am I working with a groupwho has eating disorders or Autistic Spec-trum Disorder, or do their issues vary? TheAPU have been admitted to Children’s Col-orado because they are in danger of hurt-ing themselves or someone else. Yet theirmental health issues can vary widely: in agroup of 10 teens, three teens may beseverely depressed and struggling withsuicidal ideation, three teens experiencinghallucinations, and the other four rapidlycycling from anxiety to depression (i.e.,bipolar mood swings). My job is to designa yoga intervention that helps the entiregroup regulate their moods, or learn to bepresent with uncomfortable thoughts, feel-ings, and sensations.To determine the most beneficial yogatechniques for the group (or individual), Ithink about what direction I want to guide
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YogaTherapyToday| Spring 2013 www.iayt.org
Feature Article
continued
-ICHELLEASSISTINGASTUDENTIN0SYCHIATRIC$AY
Treatment
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Being clear aboutthe scope of one’spractice is vitallyimportant in anenvironment likeChildren’s Colorado.

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