Post by Sarah Swindlehurst on Aug 23, 2010 7:25:38 GMT
Interview with Simon Hunt 4th July 2009
Interviewers – Peter Yates & Stefan Cartwright
Simon, can you tell us something about your work with Yoga within the Mental Health Service?
I am Community Psychiatric Nurse (CPN). I teach a Yoga class on Tuesday afternoons at the local psychiatric hospital in Dudley. I take referrals from our Substance Misuse Team and the wider Mental Health Service. I also teach Yoga to individual clients in the community.
Can you give us a bit about your approach?
In each class we do sitting meditation, asanas and savasana. It feels as though I am relinquishing my role as a CPN. Before we enter the room, I become a Yoga teacher or perhaps just myself and the clients are just themselves. However this works, the clients seem to pick up on it. The mood in the class is very light and irreverent. There is some mickey taking on all sides. There is quite a buzz about it and I get the sense that they are really looking forward to it. On whatever level, maybe subconsciously, they are aware they are going to drop the role they have adopted during the past week.
As we move into the class and start sitting down, we let go of our roles, conversation drops off and we start to work with awareness. I give very light instructions: just that whatever is happening is fine and it’s all just part of the material – the richness of the moment. Of course, some of the material they are using is, away from the class, very dramatic stuff that they might often struggle to handle. Suddenly a Gestalt Switch goes on and it all just becomes very powerful stuff. I can see a sense of relief in their faces. I just give very gentle suggestions to be aware of their breath and their bodies and after about fifteen minutes of that, they’re ready. Then, we do some very gentle asanas still maintaining the awareness in the postures.
I have noticed that they seem eager to move into savasana. It is not that they are impatient to finish the asanas exactly, but it is as though they have been doing enough movement throughout the week and they are already primed and ready to drop into savasana. It seems to happen more quickly with mental health or drug misuse clients than with others. This can be seen when a member of staff or a student occasionally comes into the class and he or she seems to be more wary, perhaps because there is more to lose. We play around with that though – have fun with it. For a client to see that, it can be quite liberating. They might normally see themselves in a certain way – in a mental health role, but in the context of the class, it’s gone. It endorses them.
A person’s sense of anxiety is habituated over years and can feel very dense, but it is not as fixed as they often imagine. It can go just like that. That does happen although they might pick it up again half an hour or so later.
Clients are often amazed that they can relax so much after just one session and they often ask what happened. Because I want to empower them, I tell them that they did it or that they stopped doing whatever it was that they had been doing.
Could you tell us a little bit about the mental health conditions and the types of drug and alcohol problems you encounter?
It’s everything. Because I happen to be an alcohol CPN and I develop a therapeutic relationship with the people that I see, I recommend to them that they come to the Yoga or I do Yoga with them in their own home. They will make up a large proportion of the group, although I do take referrals from other CPNs. A lot of people will have also used other substances and that seems to be increasingly the case particularly with the under-thirty-five age-group.
There is no clear distinction between someone who uses alcohol, someone who uses a particular drug and someone who doesn’t use either. A lot of our clients have dual diagnosis. For example, they may have Obsessive Compulsive Disorder and be using alcohol to cope. There is an argument as to which comes first, the addiction or the mental health problem. I feel that it scarcely matters which comes first. There is something very artificial about that anyway.
Do you treat people differently depending on their condition?
I remember a particular class, where there were clients from the Acute Wards who had Bipolar Disorder and were in an elevated state. I could have approached that situation by trying to dowse it but that would have been impossible, so we went higher and higher until we found their level. It was like hysteria but we worked with that and brought it down from there. It wasn’t that it was especially geared towards them, but because the other people in the class had been before and were comfortable with it and with me they weren’t fazed by it.
Whenever you have a new person in a class you have to focus on their needs but it needs to be done with subtlety. You have to treat everything as new but without making the new person feel as though they are being singled out.
I am also aware that a lot of people with mental health problems or addictions have experienced some form of abuse. I have always been aware of a physical boundary that I needed to respect. Over time though I have found that I don’t need to encroach in that way anyway and it just becomes part of how the class is.
Does the approach differ from that of a general class in the community at large?
That is a very important question. After a couple of years, I came to realise that you get the same people in both types of class. The problems in the mental health setting might be more apparent and more acute but the demarcation between a class in a mental health setting and a so-called general class is unreal.
In a sense a mental health class can feel more liberating because the fabrication of normality has been surrendered already. In a general class, the persona – the mask – is still there. With the mental health clients the mask is gone and you get a truer, purer Yoga.
It seems to me that you go to the situation of the ‘Yoga class’, both in mental health settings and in the community at large and you approach it with an openness and responsiveness to what you find in the moment and allow something to flow out of the meeting between you and the people who turn up. Would you say that I have got that right?
That is the certainly the case. I think if I had just done the Yoga class without being a CPN then I might not have noticed that happening. When I first started this I was more comfortable with being a Yoga teacher than a Psychiatric Nurse. Where that became most clear was when I going into someone’s house. In that situation, I would adopt a sense of ease, but it would be artificial whereas in the Yoga role, I have realised that it’s OK to be authentic. This fits in with the ethos of the Mental Health Service, which encourages authenticity.
I am always working with people’s preconceived ideas. There is a very macho working-class culture in the Black Country. But I am also working with ideas of my own. The most unlikely people: those with a history of violence or a prison history are practicing yoga and meditation, and why wouldn’t they? Just through doing Yoga with people, my preconceived ideas along with my inhibitions have fallen away.
So you gain confidence over time with the inherent alrightness of the situation. You can work directly with the reality of the moment and your confidence builds over time?
In my CPN role, for good reasons, I am discouraged from inappropriate disclosure. In yoga, I am aware that disclosures about your life are irrelevant. If I am genuine, the client will pick up that the Yoga is occurring and that I am OK. They may well feel that I am not as interested as they think I ought to be in their dramas but, in a non-aggressive way, I am deflating that.
So when you are in this situation, what happens to your identity as CPN or Yoga Teacher?
The identity has gone. I am not a CPN. I am a human being interacting with another human being and sharing that moment. All the paraphernalia and ostentation that provides me with the licence to be sitting with that person is dissolved and in that moment it is just two people. The rapport comes from the fact that no judgement is being made. The client’s role as the person with the addiction and my role as CPN are just not part of what’s happening in that moment.
What is the attitude of the mental health establishment towards what you are doing?
The attitude is excellent. My line manager, the Psychiatrist and the whole Substance Misuse Team are all positive about the Yoga. There have never been any difficulties there. Of course Yoga has been around for many years and it’s not seen as my toy or as anything unusual within psychiatry. It doesn’t contradict the NHS targets or the Prochaska and DiClemente Stages of Change Model that we use. Of course, it does have a depth that can’t be measured. When I come to write down what’s happened in the Yoga, it can seem prosaic and formularized. This is partly due to the pressures of time and targets. But it certainly doesn’t take anything away from what’s happening in the Yoga.
Do you find that your practice is at odds with your colleagues?
No, not at all. People who go in to psychiatry are pretty liberal and broad-minded anyway. For example, there are people in my team who practice Buddhism and Taoism.
What change would you like to see in the establishment regarding the patients with mental health and addiction problems?
It would be easy and obvious to say that I would like Yoga to be more a part of what we do. But that feels as though I am not saying anything at all. Of course, it does depend on what we take yoga to be.
The trend might be for it to become more accountable and measurable. I feel that what is measurable may have limited value in yoga at the same time it would be great for yoga to be given greater acknowledgement and recognised as an integral therapy within the NHS.
What would you do if you had the resources, in addition to your weekly class?
I would offer a Yoga class every weekday morning for all clients in the acute wards, which would continue after a client has been discharged. I would like for Yoga to be recognised in the same kind of way as Cognitive Therapy is. I want people to understand the enormity of Yoga not just to see it as a hobby or a coping strategy. I believe there is a window for this to unfold.
I am aware though that there is a danger that Yoga might be trivialised. People could turn it into their own thing and it would become crystallized. A particular body might be given the power to say what Yoga is or is not. It would be awful if someone were to come in to a class and say that your down-dog was incorrect, for example. There needs to be some kind of freedom.
If Yoga enters an institution and its importance is recognised – how can its freedom be maintained?
To justify my approach, I feel it should be empirically verifiable but, at the same time, I want to indicate the dangers of that. The power of Yoga in this context is that it debunks assumptions about a person’s role as mental health patient. That could seem dangerous to the system itself.
Apparently my approach is very down to earth. Because there is no flowery language, it is more palatable to people but also more powerful. If someone were to teach by chanting mantras (I don’t want to disparage that at all) it might not go down so well in Dudley. Also if someone were to encourage Kundalini to rise that might be bad for someone with schizophrenia. It needs to be non-threatening but, at the same time, to divest a person of their conceptual straight jacket.
Thanks for that Simon. It was illuminating and brilliant and hopefully stimulating to our readers, and I’m looking forward to seeing more work of this type in the context of mental suffering.
Taken from Namaskaram - Independent Yoga Network - of which I am a member of.
www.namaskaram.co.uk/page10.html
Interviewers – Peter Yates & Stefan Cartwright
Simon, can you tell us something about your work with Yoga within the Mental Health Service?
I am Community Psychiatric Nurse (CPN). I teach a Yoga class on Tuesday afternoons at the local psychiatric hospital in Dudley. I take referrals from our Substance Misuse Team and the wider Mental Health Service. I also teach Yoga to individual clients in the community.
Can you give us a bit about your approach?
In each class we do sitting meditation, asanas and savasana. It feels as though I am relinquishing my role as a CPN. Before we enter the room, I become a Yoga teacher or perhaps just myself and the clients are just themselves. However this works, the clients seem to pick up on it. The mood in the class is very light and irreverent. There is some mickey taking on all sides. There is quite a buzz about it and I get the sense that they are really looking forward to it. On whatever level, maybe subconsciously, they are aware they are going to drop the role they have adopted during the past week.
As we move into the class and start sitting down, we let go of our roles, conversation drops off and we start to work with awareness. I give very light instructions: just that whatever is happening is fine and it’s all just part of the material – the richness of the moment. Of course, some of the material they are using is, away from the class, very dramatic stuff that they might often struggle to handle. Suddenly a Gestalt Switch goes on and it all just becomes very powerful stuff. I can see a sense of relief in their faces. I just give very gentle suggestions to be aware of their breath and their bodies and after about fifteen minutes of that, they’re ready. Then, we do some very gentle asanas still maintaining the awareness in the postures.
I have noticed that they seem eager to move into savasana. It is not that they are impatient to finish the asanas exactly, but it is as though they have been doing enough movement throughout the week and they are already primed and ready to drop into savasana. It seems to happen more quickly with mental health or drug misuse clients than with others. This can be seen when a member of staff or a student occasionally comes into the class and he or she seems to be more wary, perhaps because there is more to lose. We play around with that though – have fun with it. For a client to see that, it can be quite liberating. They might normally see themselves in a certain way – in a mental health role, but in the context of the class, it’s gone. It endorses them.
A person’s sense of anxiety is habituated over years and can feel very dense, but it is not as fixed as they often imagine. It can go just like that. That does happen although they might pick it up again half an hour or so later.
Clients are often amazed that they can relax so much after just one session and they often ask what happened. Because I want to empower them, I tell them that they did it or that they stopped doing whatever it was that they had been doing.
Could you tell us a little bit about the mental health conditions and the types of drug and alcohol problems you encounter?
It’s everything. Because I happen to be an alcohol CPN and I develop a therapeutic relationship with the people that I see, I recommend to them that they come to the Yoga or I do Yoga with them in their own home. They will make up a large proportion of the group, although I do take referrals from other CPNs. A lot of people will have also used other substances and that seems to be increasingly the case particularly with the under-thirty-five age-group.
There is no clear distinction between someone who uses alcohol, someone who uses a particular drug and someone who doesn’t use either. A lot of our clients have dual diagnosis. For example, they may have Obsessive Compulsive Disorder and be using alcohol to cope. There is an argument as to which comes first, the addiction or the mental health problem. I feel that it scarcely matters which comes first. There is something very artificial about that anyway.
Do you treat people differently depending on their condition?
I remember a particular class, where there were clients from the Acute Wards who had Bipolar Disorder and were in an elevated state. I could have approached that situation by trying to dowse it but that would have been impossible, so we went higher and higher until we found their level. It was like hysteria but we worked with that and brought it down from there. It wasn’t that it was especially geared towards them, but because the other people in the class had been before and were comfortable with it and with me they weren’t fazed by it.
Whenever you have a new person in a class you have to focus on their needs but it needs to be done with subtlety. You have to treat everything as new but without making the new person feel as though they are being singled out.
I am also aware that a lot of people with mental health problems or addictions have experienced some form of abuse. I have always been aware of a physical boundary that I needed to respect. Over time though I have found that I don’t need to encroach in that way anyway and it just becomes part of how the class is.
Does the approach differ from that of a general class in the community at large?
That is a very important question. After a couple of years, I came to realise that you get the same people in both types of class. The problems in the mental health setting might be more apparent and more acute but the demarcation between a class in a mental health setting and a so-called general class is unreal.
In a sense a mental health class can feel more liberating because the fabrication of normality has been surrendered already. In a general class, the persona – the mask – is still there. With the mental health clients the mask is gone and you get a truer, purer Yoga.
It seems to me that you go to the situation of the ‘Yoga class’, both in mental health settings and in the community at large and you approach it with an openness and responsiveness to what you find in the moment and allow something to flow out of the meeting between you and the people who turn up. Would you say that I have got that right?
That is the certainly the case. I think if I had just done the Yoga class without being a CPN then I might not have noticed that happening. When I first started this I was more comfortable with being a Yoga teacher than a Psychiatric Nurse. Where that became most clear was when I going into someone’s house. In that situation, I would adopt a sense of ease, but it would be artificial whereas in the Yoga role, I have realised that it’s OK to be authentic. This fits in with the ethos of the Mental Health Service, which encourages authenticity.
I am always working with people’s preconceived ideas. There is a very macho working-class culture in the Black Country. But I am also working with ideas of my own. The most unlikely people: those with a history of violence or a prison history are practicing yoga and meditation, and why wouldn’t they? Just through doing Yoga with people, my preconceived ideas along with my inhibitions have fallen away.
So you gain confidence over time with the inherent alrightness of the situation. You can work directly with the reality of the moment and your confidence builds over time?
In my CPN role, for good reasons, I am discouraged from inappropriate disclosure. In yoga, I am aware that disclosures about your life are irrelevant. If I am genuine, the client will pick up that the Yoga is occurring and that I am OK. They may well feel that I am not as interested as they think I ought to be in their dramas but, in a non-aggressive way, I am deflating that.
So when you are in this situation, what happens to your identity as CPN or Yoga Teacher?
The identity has gone. I am not a CPN. I am a human being interacting with another human being and sharing that moment. All the paraphernalia and ostentation that provides me with the licence to be sitting with that person is dissolved and in that moment it is just two people. The rapport comes from the fact that no judgement is being made. The client’s role as the person with the addiction and my role as CPN are just not part of what’s happening in that moment.
What is the attitude of the mental health establishment towards what you are doing?
The attitude is excellent. My line manager, the Psychiatrist and the whole Substance Misuse Team are all positive about the Yoga. There have never been any difficulties there. Of course Yoga has been around for many years and it’s not seen as my toy or as anything unusual within psychiatry. It doesn’t contradict the NHS targets or the Prochaska and DiClemente Stages of Change Model that we use. Of course, it does have a depth that can’t be measured. When I come to write down what’s happened in the Yoga, it can seem prosaic and formularized. This is partly due to the pressures of time and targets. But it certainly doesn’t take anything away from what’s happening in the Yoga.
Do you find that your practice is at odds with your colleagues?
No, not at all. People who go in to psychiatry are pretty liberal and broad-minded anyway. For example, there are people in my team who practice Buddhism and Taoism.
What change would you like to see in the establishment regarding the patients with mental health and addiction problems?
It would be easy and obvious to say that I would like Yoga to be more a part of what we do. But that feels as though I am not saying anything at all. Of course, it does depend on what we take yoga to be.
The trend might be for it to become more accountable and measurable. I feel that what is measurable may have limited value in yoga at the same time it would be great for yoga to be given greater acknowledgement and recognised as an integral therapy within the NHS.
What would you do if you had the resources, in addition to your weekly class?
I would offer a Yoga class every weekday morning for all clients in the acute wards, which would continue after a client has been discharged. I would like for Yoga to be recognised in the same kind of way as Cognitive Therapy is. I want people to understand the enormity of Yoga not just to see it as a hobby or a coping strategy. I believe there is a window for this to unfold.
I am aware though that there is a danger that Yoga might be trivialised. People could turn it into their own thing and it would become crystallized. A particular body might be given the power to say what Yoga is or is not. It would be awful if someone were to come in to a class and say that your down-dog was incorrect, for example. There needs to be some kind of freedom.
If Yoga enters an institution and its importance is recognised – how can its freedom be maintained?
To justify my approach, I feel it should be empirically verifiable but, at the same time, I want to indicate the dangers of that. The power of Yoga in this context is that it debunks assumptions about a person’s role as mental health patient. That could seem dangerous to the system itself.
Apparently my approach is very down to earth. Because there is no flowery language, it is more palatable to people but also more powerful. If someone were to teach by chanting mantras (I don’t want to disparage that at all) it might not go down so well in Dudley. Also if someone were to encourage Kundalini to rise that might be bad for someone with schizophrenia. It needs to be non-threatening but, at the same time, to divest a person of their conceptual straight jacket.
Thanks for that Simon. It was illuminating and brilliant and hopefully stimulating to our readers, and I’m looking forward to seeing more work of this type in the context of mental suffering.
Taken from Namaskaram - Independent Yoga Network - of which I am a member of.www.namaskaram.co.uk/page10.html