Lesson 7: Putting It Together – The Whole Picture
In this final section of the online background portion of POLY III, we will look at two different but related areas: how to make sense of the information you gather from your student or client in a holistic way; and how to speak and listen so that you are helping that person identify their goals and work towards them effectively.
Gaining understanding through the lens of yoga
We know that we are more than our parts. We are more than just a collection of our aches and pains. In the Western approach to health, addressing the body, mind, and spirit in an integrated manner is called holistic health care or medicine. WebMD describes holistic medicine in the following way:
Holistic medicine is a form of healing that considers the whole person — body, mind, spirit, and emotions — in the quest for optimal health and wellness. According to the holistic medicine philosophy, one can achieve optimal health — the primary goal of holistic medicine practice — by gaining proper balance in life.
Holistic medicine practitioners believe that the whole person is made up of interdependent parts and if one part is not working properly, all the other parts will be affected. In this way, if people have imbalances (physical, emotional, or spiritual) in their lives, it can negatively affect their overall health.
In yoga philosophy, the five layers of the self, or pancamaya, is the framework through which to understand the complexities and interrelatedness of the various aspects of the self. This understanding is rooted in the Vedas. The articles at the end of this section explain this in detail. The pancamaya system not only explains the different layers of our being, but also how they interrelate to one another as a system.
The five layers are:
- Annamaya – the physical structure
- Pranamaya – the energetic structure
- Manomaya – the mind, and the knowledge that one has gained
- Vijnanamaya – the personality, which drives one’s actions
- Anandamaya – the innermost structure that contains our deepest essence and feelings, and capacity to experience affection and bliss.
The tools of yoga address these various structures or layers. None of them impact only one layer. Each tool has an effect on the others as well. For instance, the practice of asana is physical, but it addresses one’s energy, mind, and capacity to experience bliss. Asana, when done with focus, integrates body, breath, and mind. Pranayama, as well, is a breath and energy practice, but it too impacts the other aspects of our being, and when practiced as directed by a teacher with appropriate skills, can affect the health of the physical body as well as the mind. Consider for instance, how different breathing practices can slow us down, and perhaps lower blood pressure, or help warm us up when it’s cold.
According to Chase Bossart, in his article Yoga Bodies, Yoga Minds (in the link below):
The interconnectedness described by the pañcamaya model is the positive basis of yoga as a holistic system of healing and health. It is also the theoretical underpinning of almost all yoga practices. For example, by changing the length of a person’s breath (through âsana and/or prânâyâma), we can greatly influence that person’s mental and emotional state. The same is true of working on the mental level. By asking the practitioner to focus on a particular object, we can see that the breathing also changes, and over time so do the body and personality. This process takes time, but it is a key mechanism underlying the effectiveness of yoga for healing.
Those who have taken Prime of Life Yoga I, or have read any of the Yoga for Dummies books, know that when designing a yoga routine or practice for someone, including ourselves, we need to take all the layers or mayas into account. Here are just a few examples:
- What is the person experiencing physically? Do they have physical pain and limitations, and if so, what are they?
- What is the person’s energetic state? Are they hyperactive? Low energy? Depressed?
- What does the person already know? Start from where they are to help them find some immediate benefit and be able to progress over time with practice.
- What is the person’s personality like? Is this a type A person who approaches all things in overdrive? Is this person relaxed? Methodical? How likely are they to commit to a practice, and to what sort of practice? 20 minutes per day? Only 10 minutes at a time? 90 minutes without fail?
- How can we tap into a person’s intrinsic motivation and guide them to utilize the practices we teach so that they experience the breadth of what yoga has to offer? Will they use it as a stretching series accompanied by music or the TV, or will they focus and turn inward to experience the movement of breath and energy, and the stilling of their minds, and not just a routine to exercise their torso and limbs?
How can we help it along?
The Stages of Change and Motivational Interviewing
Note: This information was included in POLY II, but it bears repeating. Practice using these skills will be included in the Zoom portion of this course.
It can be frustrating when we give good advice and guidance to students only to find they don’t follow through, especially when they might have come to you asking for that guidance. Practitioners in all fields talk about compliance, and the lack of it. Will the person follow through?
Whether you teach one-on-one, speak with students after class, or hold workshops, it’s helpful to have some principles of teaching and guiding adults in mind and be familiar with a few techniques that could improve your effectiveness in helping people identify their own needs and goals, and helping them make the positive changes they want to make.
Change doesn’t generally happen all at once, from one moment to another, from one day to another. Rather, it is a process that has certain recognized phases, including a lack of awareness of the need for a change, and setbacks. This is the nature of people. Think about your own life. Regardless of what you may have worked on, or were encouraged to work on by someone else, you may have been completely unaware of the need to make a change at first. As you gained more information and awareness, you may have considered that making a change may be helpful, but remained on the fence about whether it was worth it for you; i.e. you may have felt ambivalent– it’s a lot of work, do I really want to do that much?, I’m kind of fine with the way things are, except for….” Once your ambivalence was resolved enough to move forward, you may have begun to gather resources. Then, with your resources at hand, you began doing whatever it was you chose to do. At some point you may have dropped the ball and experienced a setback. And then, becoming aware of the setback, you may have decided to gather up your resources once again and dedicate yourself anew to the change. Consider:
“I used to do yoga every day. It felt so good. But then I got busy and eventually stopped. Now I feel stiff and sluggish. I’d like to start again, but I don’t know if I really have the time? What can I do to make it work for me this time?”
The Stages of Change
The stages of change model began in the field of addiction counseling, working with people to help them make deep and sustained changes in their lives. It has now become the foundation for coaching and counseling in a variety of health related fields. A basic tenet of this model is that it acknowledges that knowledge isn’t enough to promote and sustain change.
Pre-contemplation stage – Before embarking on making a change, a person must first be aware that there is a need for something to be different. Even though others may see the need for change in another person, if the person herself doesn’t see or feel it, she is in the pre-contemplation stage – not even thinking about it.
Contemplation stage – Once the person has acknowledged that a change may be beneficial, there is often ambivalence, weighing the pros and cons of making the change. Even unhealthy behaviors, such as smoking or spending too much time dwelling on the couch, have benefits for the person engaged in those behaviors, that they may not be completely willing to give up.
Preparation stage – Once a person has decided the pros outweigh the cons and is ready to make the change, he is ready to prepare to make the change. This stage is appropriately called, preparation. This is the easiest time to help a person make change, because they are highly motivated and ready to go, and for those who have information and skills to share, it is very rewarding to do so.
Action stage – The final stage is called the action stage and it is when the person is on a roll and has embraced the change.
The graphic on the next stage lays out the stages of change model.
What might this look like in the context of Yoga practice? Think about students you may have worked with who have asked for your advice but didn’t follow through on your suggestions. Might this model explain any of the frustration you might have felt? Could it be that the person was ambivalent, still weighing the pros and cons of changing their status quo?
What is motivational interviewing (MI)?
Motivational interviewing is a method of tapping into a person’s own intrinsic motivation to change. It acknowledges that people are at different states of readiness for change, and are often ambivalent about making whatever change would be beneficial for them. For instance, let’s say you are working privately with a student who complains about an achy back every day when she gets out of bed. You know the answer is a regular Yoga practice focusing on some specific postures. She probably is aware that something needs to change although she may not know exactly what. You share your information with her and give her private teaching, yet she doesn’t do it. Why not? That’s where motivational interviewing and understanding the stages of change come in. The techniques of motivational interviewing and its implicit attitude of respect and autonomy help people explore their own ambivalence and work through it.
Motivational interviewing was developed by two clinical psychologists, William Miller and Stephen Rollnick, in their work with problem drinkers, and was first described in 1983. Since then, health educators, physicians, and therapists working with people about all sorts of change have adopted this method.
The spirit of motivational interviewing can be characterized in a few key points:
- Motivation to change is elicited from the client, and is not imposed from outside forces
- It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence
- Direct persuasion is not an effective method for resolving ambivalence
- The counseling style is generally quiet and elicits information from the client
Core principles for working with and teaching adults
Empathy and compassion
It’s not necessary to agree with a person’s beliefs or behavior to try to understand the person’s life or viewpoint.
Respect and acceptance
It’s important to refrain from judging the person and their behaviors, even when you don’t agree.
If people don’t feel emotionally as well as physically safe, it will be hard for them to open up and be receptive.
It is the client or student who will decide what to do. She is an autonomous adult.
Start from the person’s strengths and successes. Build upon what’s going well.
Recognize that people may have mixed feelings about making change and this may appear as resistance.
Basic MI techniques
Let’s use the example of a student who comes to you because her body is stiff and asks for you to work with her so she can feel better.
Seek to understand. Ask open-ended questions.
What is an open-ended question? (This is an example of an open-ended question).
An open-ended question is one that cannot be answered by yes or no. It invites conversation and allows you to know your student better. We can also use a prompt for information, which, although not a question, does the same thing.
- How does your body feel on most days?
- Tell me more about how you generally feel.
Check for understanding and let the person know you understand. Reflect back what you heard.
A reflective statement can be as simple as using the person’s own words or paraphrasing back what you think you heard. This gives the person a chance to correct you if you misunderstood, and also lets her know you’ve listened carefully.
- It sounds like you are tired of feeling so stiff.
Help the person recognize her own ambivalence
Even when we want things to be different, we may hold mixed feelings about what it would take to make things different.
- It sounds like you want to start a daily morning practice before you leave for work, but you also enjoy lingering over your morning coffee.
Help the person work through her ambivalence
Further reflection and follow-up questions can help a person find her own solution – one that works for her life and that she can sustain.
- One the one hand, you want to feel better, and on the other, your current morning routine is very enjoyable to you. What is one thing that you think you can change to fit a daily Yoga practice into your life?
Summarize your conversation so far
Hearing back what she has resolved to do is very helpful.
- So far, we’ve talked about your desire to feel more agile and less achy, and that a daily Yoga practice would be very helpful. You expressed your concern about a change in your morning routine, and decided that what could work for you is……
Did I get it right?
Assess her confidence in carrying out the change (the ruler)
- On scale of 1 – 5, with one being not confident at all, and 5 being very confident, what number reflects how confident you feel about making this change so you can have a daily practice?
Help her brainstorm about how to achieve and sustain the change she wants to make, focusing on her strengths
Let’s say she said 3.
- You said 3, which means you feel more confident that a 2 or a 1. Tell me about the confidence you feel.
- What would you need to do to be able to answer 4? Tell me about that.
In summary, the spirit and techniques of motivational interviewing respect each individual’s autonomy and responsibility for their own lives, and lay a path for the coach, counselor, or helper to be instrumental in helping the person contemplating change to untangle the knots that prevent change from happening, and move forward.
Stages of Change Model