Integration of Yoga and Individual Psychotherapy — Two Case Histories

Sannyasi Shantachittam, Italy

The application of the science of yoga in clinical and therapeutic settings of psychology and psychotherapy has gained an increasingly large diffusion over the past years, thanks to many studies and related articles with scientific validity which appeared in the most important contemporary reviews of the field.

In the west, courses of mindfulness have slowly become a wanted asset in training psychotherapists, despite the difficulties and resistances of some theorists and transmitters of mindfulness in accepting that, the most part of the practices and techniques of this 'young' discipline, definitely come from the millenary science of yoga. In recent times, it has become more frequent to get in touch with psychotherapists and teachers of mindfulness than with psychotherapists and teachers of yoga.

The situation is gradually changing within the clinical panorama which sees an increasing number of psychologists and psychotherapists undertake training in yoga, with the aim to integrate and enrich their therapeutic profession.

After a consistent and continuous training in the Satyananda Yoga method, I have had in recent years the possibility to verify personally the potential of applying Satyananda Yoga to individual psychotherapies and to verify in patients the benefits over short, medium and long periods, both from the point of view of the psychic-mental well being and in relation to the increase of self-awareness and perception of the patients inner world. I found that they could improve the ability to relate to the external world and to cope with the experiences, even adverse, of life in general.

In order to give evidence, I will illustrate two clinical case histories whose therapeutic paths began several years ago, and have had a consistent evolution with the recent insertion of yoga techniques.

Tommaso

Tommaso was adopted a few weeks after his birth in Ecuador by an Italian couple from north Italy. He grew up in a well-to-do context, showing, since childhood difficulties in interpersonal relationships, recurrent emotional states of shame and inadequacy, feelings of exclusion and lack of belonging.

The parents, mother seen by Tommaso as anxious and judgemental and father not very present, seem to have limited the thrusts of autonomy and exploration of the world of the son. He managed to get a degree in computer science after a long period at university and lastly found work in a digital programming firm.

The symptomatology of Tommaso goes back to the first adult age and was characterized by the prevalence of anxiety episodes which sometimes lead to panic attacks, significantly improved after some months of individual psychotherapy. In recent years, phobic and depressive symptoms arose after the father's death, due to the difficulty to mourn. The weekly psychotherapy was progressively and gradually integrated with practices of Satyananda Yoga, in particular:

  1. Pawanmuktasana 1 series and 'grounding' asana (e.g. tadasana)
  2. Techniques of breathing; from the simple observation and awareness of breath to nadi shodhana pranayama, ujjayi pranayama, bhramari pranayama.
  3. Techniques of relaxation, such as yoga nidra.
  4. Practices of antar mouna 1, 2, 3.
  5. Exercises of yama and niyama and application of the method SWAN by Swami Niranjanananda Saraswati.

During the talks, some theoretical-psychological concepts linked to the discipline of yoga have been introduced. They have helped Tommaso in considering the possibility to enlarge his mental horizon towards new and less schematic points of view regarding the surrounding world.

Since a couple of years, the regular practice of yoga nidra supported by audio cd done by himself in his private home, has become a strength on the path of treatment. With higher frequency in therapy, Tommaso reports how, thanks to the integrated path, he can see the difficulties and problems as something to be faced and surmountable. They are no longer overwhelming obstacles. The increased feeling of trust in his capacities and the greater acceptance of the unpredictability of existence, allow him, without being too scared, to tolerate that things happen the way they must happen. Besides he reports to need less external stimuli to feel alive and vital.

During the last months, thoughts connected to death, to the fear of dying, and the feeling of vacuum, often present during therapy, have been faced in the practice of antar mouna.

During one practice of antar mouna 1 and 2, the patient refers to the appearance of a series of visualizations that go from those related to the image of the father in hospital on his death- bed, to the visualizations of a child alone, abandoned, surrounded by hands whose contact seems unpleasant because without heat. All this gives him the possibility to express the pain linked to the vacuum of the early separation from his natural mother and to give, at last, frame and meaning to the recent and deep discomfort coming from thoughts about death; despite images and contents potentially 'dangerous', during the practice Tommaso can actually maintain the attitude of the witness, drashta.

During the following psychotherapy session, it has been supposed how the emerged contents were associated to the first neonatal experiences in the clinic, when the very early detachment from the maternal contact, which provoked deadly feelings, was replaced by a varied nurturing probably perceived as cold and alien by medical and nurse staff.

In the following days, he refers to a decrease in thoughts related to death and vacuum and a general improvement of his psycho-emotional state.

The psychotherapeutic path is going on, alternating classic sessions sustained by the SWAN method and sessions in which the interview with the patient immediately follows the yogic practice, in particular antar mouna 1, 2 and 3 with the intention to approach the next level of antar mouna 4.

Romina

The second case is that one of Romina, a woman of about 38, who began the therapy three years ago, with certain discontinuity and an interruption of about one year, until the beginning of the yoga-psychotherapy integration. Some techniques of Bihar Yoga have been gradually inserted. Her quick learning was favoured by her previous experience of yoga practice, though with a different method. It has been possible to achieve quickly some improvement in the continuity and the constancy of attendance of weekly/fortnightly sessions.

Romina showed a dependent personality, following the sudden and traumatic death of her husband, when their little daughter was only a few months old. She had developed a post-traumatic stress disorder, accompanied by defected mood, apathy, lack of desire to live, retreat from the world, feelings of profound distrust of herself and of the possibility to find a way out, and an ineluctable sensation to be victim of an adverse fate. The duty to take care of the baby has always been considered by Romina with an excessive sense of responsibility and a consequent feeling of inadequacy related to the perception of being an unfit mother.

Episodes of depersonalization the perception of the body as stranger episodes of binge and self-injury characterized Romina's symptomatology at the beginning and in the first phase of the psychotherapeutic pathway.

Considering the patient's previous knowledge of yoga, the insertion of the techniques of Bihar Yoga in therapy consisted of a gradual sequence of asana from the pawanmuktasana series a, some pranayama (particularly kapalbhati, considering the frequent migraines suffered by the patient), relaxing techniques, yoga nidra, and the practices of antar mouna until the third level.

Also in this case, the application of SWAN practice and gradual exercises on yama and niyama are still a basic aspect of Romina's therapy.

The practice of yoga nidra helped in contacting the emotional core linked to the drama of the sudden death of her husband and in bringing to the surface the sensations and the experiences blocked and 'frozen' for years, such as the deep pain due to his absence, furthermore she could express the rage. This is a part of the interview: . . . During the practice I was cold and then I was cold all week long, as if I were frozen. Now I feel angry. First I was fattened, now I am very reactive.

The other yoga techniques have also helped to unlock the emotional world which had been kept so long coerced and unexpressed. A strong sadness accompanied by sudden weeping episodes, and the anger reactions, sufficiently contained, are taking the place of acts of self-injury, the affective numbness and the psychosomatic symptomatology (fever, migraines, body cooling) which had been invalidating her for some years.

In the last period, subsequent to the practices of antar mouna, Romina could understand how the feeling of considering herself a victim of an adverse fate is due to a magic construct, linked to the conviction to have to pay for the sins of previous lives, 'It seems like a continuous punishment. It's as if life is punishing me for something . . . as if I had to pay for something I've done in previous lives . . .'

From here the patient developed a deeper awareness and the possibility to question such feelings and beliefs, trying to put into place some concrete choices that make her feel more active and more of a decision-maker in her own life.

Summing up

The exposure of these two clinical cases represents a really infinitesimal part of the work that must, and can still be carried out in this direction.

There are many common points between yoga and modern psychotherapy, but there is a fundamental aspect which psychology has not taken into account so far and that is the spiritual aspect.

In the first half of 20th century, enormous merit goes to the great Swiss psychiatrist and psychoanalyst, Carl Gustav Jung, for having introduced in psychoanalysis questions of vital importance linked to the soul, the spiritual evolution of the person and the community. I think that for any psychoanalyst, the deep knowledge of Jung's complete works, constitutes a fundamental trait union or link between yoga and psychology.