Reflections on the Future of Yoga Therapy

Today’s post represents a departure from the usual focus on emerging research in the science, psychology, and social context of well-being.

The following entails a response to the decision on the part of IAYT to put forth a new designation, the Q-IAYT, for healthcare professionals. The Q-IAYT designation will allows licensed healthcare providers to apply yoga in clinical settings after going through a 300-hour training.

IAYT’s decision was a surprise to most of its members. Many of us had not heard of such a program being in the works at all. Additionally, two pilot programs were chosen, again unbenownst to most of us, to begin in January.

The new Q-IAYT designation for healthcare professionals is at odds with the extensive 800-hour C-IAYT training program and standards.

This post contains my reflections on the change, on the communication patterns therein, on the social context around the change, and on the future of yoga therapy.

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Hi Colleagues!

The Town Hall meeting is coming up tomorrow; my hope is that these reflections may be of use.

In the week since its inception, this group has reached a membership of 900 and counting. It has been a joy to become acquainted with so many of you, and to bear witness to the vastly creative ways in which you have integrated yoga into your professions.

For context, I’m a clinical psychologist, yoga teacher, and yoga therapist. I write, teach, do clinical group supervision for LHCPs, and consult to organizations. In my spare time (what’s that?), I love open water swimming, cold immersion, and hanging (and working) upside down.

Like many of you, my passion as a neurodivergent (AuDHD) human is to integrate seemingly disparate fields of study (which, like neurons, touch without touching) into a cohesive, fluid whole. For me these include neuroscience, psychology, embodiment, fascia research and therapy, epigenetic trauma, gender-based violence, embodied approaches to neurodivergence, and social justice and equity.

I offer online courses on the above topics that are part of IAYT’s APD offerings. I write a column, “Bodies of Knowledge,” on the same. I’m also a research collaborator, most recently on a RCT of yoga (including interoception and fascia work) for mental health, published in the Journal of Mental Health and Physical Activity (Farb, Forbes, et al., 2022).

While the Q-IAYT designation doesn’t affect me, it shapes the future of yoga therapy and of yoga therapists as a collective. The "what will this do to future healers?" is the generative question that drives these reflections.

I’ve been a member of IAYT’s Advisory Council, participated actively in the early meetings of schools and standards discussions, keynoted SYTAR three times, and have written for IJYT.

This post is based on my experience as an LHCP. Perhaps most importantly, I write it with trust in and affection for IAYT's Director, Board, and other volunteers, and in the spirit with which they have listened to, held space for, and witnessed our conversation. My intention is to help deepen the conversation and offer potential ideas that can serve as a springboard for my colleagues' creativity.

OUTLINE:

I. Process

II. Relationality

III. Power, Social Inclusivity, and Equity

IV. The Q-IAYT designation

V. Licensure

VI. Actionable Steps

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I. Process + Overview:

(a) Many of you have shared here that like me, you have felt on the margins of several professions. This feels like one of our strengths as a collective. As my mindfulness teacher Sebene Selassie says, being on the margins helps us observe the center with greater clarity. My hope is that we mine our positionality to see clearly what’s happening: within our respective professions, with IAYT, in healthcare, and in society—and that we innovate from that unique perspective. This feels generative, particularly in light of our disappointment about the way IAYT has not met us fully and transparently in the issue at hand. It feels like a way forward.

(b) As yoga therapists, healers, and world citizens, we are collectively in a liminal space. We are witnessing, at least in the U.S., the degradation of a healthcare system designed for profit. We are riddled with chronic illness. We rank first among wealthy nations in the poorest healthcare and in medical bankruptcy. We face an election with implications for the current healthcare system (including its potential abolishment, which would leave many of us worse off than we are now). We face potential cutbacks in care and benefits for children and seniors. Despite a plethora of research and opportunity, we are unprepared for future pandemics, and unwilling to act on behalf of the collective in the way we address them.

(c) Yoga therapy itself may be entering a liminal space, where what once worked no longer does, where doors we labored to open have moved or changed form, where the market (online education, tech, and AI) are shaping us, and where old ways of doing things work less well, but the new forms have not yet replaced them. If true, IAYT is in such a space as well. I can’t help but think how beneficial it would be for them, for us, and for those we serve to co-create with a direct and thoughtful dialogue about how IAYT and we can mutually support one another and be of service in a rapidly changing world.

II. Relationality

(a) Many have posted on the theme of relationality, or lack thereof. How is it that most of us had no idea that the Q-IAYT designation was a notion, much less that it was already in progress? This indicates a rupture in communication and relationship that can and should be repaired, no matter the official guidelines for decision-making. I feel optimistic that collectively (and by that I include IAYT) can start anew.

(b) The heart of IAYT is its members and member schools; without us, IAYT would not exist. (And vice versa.) Dr. Ganesh Mohan's thoughtful reflections (A-4 on his post) pointed to ways that IAYT could leverage technology, including AI, to improve relationality and to democratize changes of all kinds. They could invite yoga therapists to ask questions, weigh in on changes, and offer input and solutions. We can encourage, even press for this. At the same time, this lack of democratization is to my mind a microcosm of a larger issue that relates to power, equity and inclusivity.

III. Power, Social Inclusivity, and Equity:

(a) IAYT’s website has a land acknowledgment and a statement on anti-Black racism, which is a good start. (Though I could not find anything on cultural appropriation.) But IAYT—and by extension we as a social body—haven’t prioritized inclusivity and equity. Does IAYT’s Board represent the fullness of all who practice yoga, from whose rich traditions yoga, somatics, and healing stem? Do we, in who we choose to teach and to serve? My sense is no, not at the moment. This pattern is also reflected in the faculty of IAYT’s member schools, in the leadership and faculty of those chosen to pilot the Q-IAYT programs, and in the makeup of this group. These groups are comprised primarily of white people with multiple nodes of privilege. Is this in keeping with the spirit and the potential of yoga?

(b) DEI position statements aside, what are we doing to create true and lasting change in inclusivity and equity within the field of yoga therapy? (This has long been an issue in psychotherapy, but there the conversation has begun to get off the ground.)

(c) Despite urging from some of us over the years, the Standards for yoga therapists do not require, or even explicitly mention, training in the history of colonialism and caste (in the expansive, Isabel Wilkerson sense of the term), anti-Black racism, gender-based violence, and other forms of oppression. They do not require training in how these forms of oppression have shaped the development of yoga and yoga therapy in the West as fields of study and as professions, how these factors shape society itself, and how they shape us as individuals within a social context. How can we address the socio-cultural sources of harm without understanding the causes and conditions that created it? How do we address epigenetic trauma without understanding its cultural antecedents? How can we hope to improve the health of our minds, bodies, spirits (and those of our clients) if we do not know what harm entails, and if we don’t have full awareness of our social locations and our positionality within dominant cultural power structures? How can we provide trauma-informed yoga therapy, for example, if we do not intimately understand the history of racial caste and oppression and the forms it takes, and the way traumatic racial stress operates both as the “unseen” backdrop to daily life and as a real and present source of danger? If we do not understand these social determinants of health, how will we know when to refer a client to someone who does, or even, when we are causing harm, however inadvertently? These questions, to me, get at the heart of ahimsa, satya, and the cultivation of vidya.

(d) At best, such an understanding might fit in the Standards only as an elective, e.g. Category 2.4. Additional Knowledge. Here, the Suggested Guidelines say, “10 hours minimum for this category.” Specifically, this might fall under Subcategory 2.4.2, Familiarity with the influence of familial, social, cultural, and religious conditioning on mental and medical perspectives of health and healing. What is systemic oppression and racism, if not social and cultural conditioning? But this is only a suggestion, and I haven’t heard of anyone who has received ten hours of this in their 800-hour yoga therapy training—even though it is in now in many 200-hour and 300-hour yoga teacher trainings.

(e) Yoga therapy programs are costly. This reinforces the racial wealth and opportunity gaps in the U.S. and in most countries that hold yoga therapy trainings. What are IAYT, its member schools, the heads of training programs, and we ourselves doing to ensure that all marginalized folks have representation? What can we do to ensure that they hold positions of power in our organizations and in the job market, and are included in the decision-making process?

(f) IAYT’s social power and decision-making is concentrated in the hands of a select few. According to the bylaws, organizational power lies with the Executive Director and Executive Committee. Communication happens among selected people, who then have buy-in to pilot Q-IAYT programs for their own professional and economic benefit. Perhaps this is something we can discuss, and consider changing.

(g) This moment of upheaval also offers tremendous opportunity. IAYT has a chance to take a leadership position on social inclusivity and equity, as do we. If we want to be heard and to have equity, I believe we need to use our voices to push for inclusivity and equity for everyone. We can do this in membership, leadership, and education—not in a numbers-game kind of way, but within the context of decolonial praxis and in a way that opens the field wider, no matter how constricted and protective of our territory we may feel in this moment. In waiting, or trying to remedy a lack of power in one situation without doing so systemically, I feel we do a disservice to ourselves, our colleagues, and the profession.

IV. The Q-IAYT designation

(a) As of 9-20-24, IAYT stated that its goal for the Q-IAYT Program was to “introduce a process for accreditation of the Foundations of Therapeutic Yoga Principles for Healthcare Professionals program for those who want to understand and apply yoga in patient care—within their own scope of practice." Importantly, that’s the premise on which they created two pilot programs scheduled to begin in January and others in the pipeline but now paused. I should add that this rationale is echoed in the YogaX pilot Q-IAYT program, which it has been advertising on its website. The following, referenced under Sources, below, is YogaX’s description of their Q-IAYT program, which has been taking applications and is scheduled to begin in January:

“IAYT has created a new 300-hour pathway for qualified healthcare professionals to gain a solid foundation in yoga principles and practical applications within a holistic approach to patient care.  This IAYT-accredited pathway allows healthcare professionals to earn an IAYT-Q credential that certifies that they have gained the therapeutic yoga skills necessary to bring yoga strategies into their extant healthcare practice. 

This advanced therapeutic yoga program is accredited by the International Association of Yoga Therapists. It is specifically designed for qualified healthcare providers who want to bring yoga into their existing healthcare practice. Trainees can expect to develop holistic and integrated conceptual understandings and therapeutic yoga skills (in line with IAYT’s standards) that are transformative, encourage inquiry, and promote health, resilience, and growth.”

(b) The letter they sent this week reads that the programs “are not intended to enable healthcare professionals to practice yoga therapy, and they do not result in a certified credential like the C-IAYT. Instead, these programs are intended to facilitate referral relationships between other healthcare professionals and fully qualified C-IAYTs. These programs also support the integration of C-IAYTs into interprofessional care teams."

(c) The latest amendment contradicts the first. It may be designed to ease the concerns of C-IAYTs, but makes little sense to me. Before even completing internship/residency, LCHPs are fully trained in how to create healthy referral relationships, conduct and participate in multidisciplinary staff meetings, and integrate other professionals (e.g. social workers, art therapists, music therapists, outpatient therapists) into a multidisciplinary team. This is part of our earliest training. Most of us couldn’t imagine taking a 300-hour course on how to make such referrals.

(d) Dr. Mohan’s post (see B-1) shared that IAYT told him that the purpose of the Q-IAYT designation is to get more advocates for yoga therapy in the U.S. healthcare system and to get billing codes for yoga therapy. This is a third, altogether different, reason than the two conflicting ones they’ve already given.

(e) This is a perplexing rationale. Billing codes (or CPT codes, as they’re also known), are used by LHCPs to bill managed care companies. As far as I’m aware, unlicensed professionals can’t use them unless under the supervision of an LHCP. And for those of us who are LHCPs, there already exist several CPT codes under which we can bill. The Board should know this, because several LHCPs worked on this initiative before it was launched, including, and this would have been explored early on. It concerns me that the underlying reasoning for a major policy change is at best inconsistent and inconsistently communicated.

(f) As Dr. Shailla Vaidya mentioned in her powerful reflections: If IAYT’s goal is to have a Q-IAYT licensed healthcare professional take a 300-hour course in order to make referrals to C-IAYTs in healthcare settings, who will supervise those C-IAYTs and bill for them? The liability is too great for many facilities or individual LHCPs to take on.

(g) If the goal is to refer patients to C-IAYTs outside a healthcare setting, this puts yoga therapists right back in the dilemma of how those patients self-pay out of pocket for the services of a C-IAYT. YTs can do their own networking to get referrals without such a program.

(h) Finally, the Q-IAYT designation will create confusion across for many entities—hospitals, universities, health centers, the public—as to the difference in training between C's and Q's. It’s already hard to discern the difference between a yoga teacher and a yoga therapist. Wouldn’t the added Q-IAYT further blur the distinction? It would seem so.

(i) A Q-IAYT designation for LHCPs has the potential to change the position of yoga within the healthcare market, by increasing the potential for yoga to be used primarily as isolated portions of a different healthcare session, e.g. physical therapy, psychotherapy, etc.. Most LHCPs don’t have time to add much more to existing sessions, and as managed care now stands, yoga would not be able to comprise the bulk of such sessions. The Q-IAYT program may curtail the potential for yoga therapy to be used as a valid, standalone practice in healthcare settings.

What is the true rationale for the Q-IAYT designation? I’d love to see a transparent conversation about this.

I have questions for IAYT’s Board and Committees related to this process. For example:

• What was not working in the current landscape of yoga therapy and the design of the 800-hour C-IAYT training and designation, that drove them to make this change?

• Did IAYT feel that yoga therapists don't have a valid path forward in the current professional climate?

• Does IAYT believe that the best way forward for yoga therapy is to educate LHCPs who can bill insurance for their work?

• What effects does the Committee believe this designation will have on existing C-IAYT yoga therapists who are not healthcare providers, and by extension, on the field of yoga therapy itself?

V. Licensure

(a) From a quick read of this page and in other conversations, many C-IAYTs feel that licensure will legitimize the profession of yoga therapy, enable yoga therapists to work in healthcare settings, and facilitate better pay.

(b) I urge caution before moving in this direction. (I wrote about an opinion piece about yoga therapy and managed care for the International Journal of Yoga Therapy way back in 2010, in case anyone is interested.) If helpful, LHCPs could compile a post on what it’s like to work within the managed care system and how that will address C-IAYT’s goals.

(c) The goals above are unlikely to be met by licensure, which then necessitates managed care, insurance contracts, allowable fees and percentages of those fees, and the need for auxiliary billing people, resulting in (when you do get paid) receiving only a fraction of the amount of money you should be getting.

(d) Yoga has been seen as alternative/complementary care for decades. Do we want to change that perception? Medicalizing yoga therapy—bringing it under the auspices and control of state-regulated managed care systems—may not bring us the freedom, opportunity, or financial benefits we desire. We may want to have frank discussions about what this would mean.

VI. Actionable Steps:

(a) Many of the wonderful humans in positions at IAYT are volunteers, and give their time on behalf of all of us. We can assist IAYT in several capacities as we move through this transition as we express our heartfelt opinions.

(b) One suggestion is that several members of this Group could test-drive a technology-centered democratic process in action (that IAYT might wish to use or adapt) by preparing a petition comprised of our statements, posting it on this page so that everyone who wishes to can suggest edits, putting the “final” version on a webpage to gather signatures, and then submitting it to IAYT. This would help us in articulating our collective position as well as the variations of that position we have seen emerge in this group.

(c ) As Dr. Ganesh Mohan suggested, several of us (especially those who are tech and AI savvy) could create a process to assist IAYT in obtaining feedback in a streamlined and time-effective manner, that could be used and adapted in the future.

(d) Perhaps several subgroups, such as LHCPs and C-IAYTs who are not licensed healthcare providers and their opinions on the Q-IAYT designation (as well as those in favor of licensure and those against it—since it appears to be a theme), can also compile and send letters to IAYT, if that would be helpful.

(e ) It might be helpful for several groups of us to write position pieces for Yoga Therapy Today so that all members can benefit from a diverse dialogue.

(f) We might consider whether to request that IAYT pause all Q-IAYT programs, including those two scheduled to begin in January, so that IAYT can dialogue more thoughtfully and extensively with us: not through one carefully curated Town Hall, but several focus groups and multiple forms of dialogue. But I’m open to other ideas.

I remain optimistic that this moment of upheaval can inaugurate structural, programmatic, and social change. It is with this optimism that I’m approaching the Town Hall tomorrow and the discussions that I hope we can have in its wake.

If you’d like to join the Future of Yoga Therapy Facebook Group and keep an eye on how IAYT and we as a body of yoga therapists shape the conversation and are shaped by it over time, we’d love to have you.

Blessings to all. 💚

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Sources:

Q-IAYT Pilot Programs: Yoga X Program: https://www.yogaxteam.com/yogax-iayt-q and https://www.yogaxteam.com/yogax-iayt-q-300-hour-program