|
 
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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 11
| Issue : 1 | Page : 34-43 |
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Conceptual framework for yoga-based counseling: A systematic review of literature
Atmika Y M Ramsahaye1, K Rajesh Sasidharan2, Arun Thulasi1, Vikas Rawat1
1 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
2 Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| Date of Submission | 08-May-2022 |
| Date of Acceptance | 21-Dec-2022 |
| Date of Web Publication | 03-Feb-2023 |
Correspondence Address:
Ms. Atmika Y M Ramsahaye
Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jacs.jacs_4_22
Yoga has been acclaimed for its therapeutic benefits which are usually associated with the practice of asana, pranayama, and meditation. The counseling part of yoga therapy, cough not as explored as the practical aspect, dates back to ancient texts where the Guru acted as a counselor and the Shishya the counselee. This review explores yoga as a form of counselling and the means of incorporating it in conventional counseling. The aim of this study is to review the literature related to the application of yoga in psychological counseling, to assess the techniques and theories of Yoga-based Counselling (YBC) as well as to propose key aspects of YBC. Based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines PubMed/MEDLINE, Web of Science, Google Scholar, and SCOPUS were searched from the date of conception till August 2021. The MeSH terms and keywords “counselling,” “psychotherapy,” “yoga,” “yogic,” “bhagavad gita,” “patanjali,” and “ramayana” were used to search the databases as appropriate. The exclusion criteria for the search included yogic practices which do not explore counseling techniques or focus only on asana, pranayama, meditation, and relaxation. Out of the forty-nine articles, twenty-four articles were reviewed based on the study requirement. The articles were coded and qualitatively analyzed using the inductive thematic approach. The preliminary open coding of the articles was carried out by the first author. Themes and additional sub-themes were assigned and reviewed by the co-authors. The findings of the final list of studies have helped in evolving themes relevant to the application of YBC. The emerging themes are the theoretical foundation of YBC, integrating yogic counseling in psychotherapy, stages of counseling, ethical consideration, and precautions to be followed during sessions. These can act as guidelines for therapists willing to adopt YBC. This review delineates the ways in which YBC can be adapted in conventional counseling settings. The theoretical foundations and stages of applying YBC may give a consolidated understanding of yogic counseling. Likewise, the ethical considerations and precautions required during YBC for the smooth flow of sessions are highlighted.
Keywords: Counselling, Indian psychology, psychotherapy, yoga, yogic counseling
How to cite this article:
M Ramsahaye AY, Sasidharan K R, Thulasi A, Rawat V. Conceptual framework for yoga-based counseling: A systematic review of literature. J Appl Conscious Stud 2023;11:34-43 |
How to cite this URL:
M Ramsahaye AY, Sasidharan K R, Thulasi A, Rawat V. Conceptual framework for yoga-based counseling: A systematic review of literature. J Appl Conscious Stud [serial online] 2023 [cited 2023 Dec 9];11:34-43. Available from: http://www.jacsonline.in/text.asp?2023/11/1/34/369133 |
| Introduction | |  |
Psychology gained prevalence in the 19th century with the work of Wilhelm Wundt. This science of the mind and behavior dates back to the ancient civilizations of India, Greece, China, and Egypt. However, psychology has been present in ancient Indian scriptures as seen in the Vedas, Upanishads, Bhagavad Gita (Rao, 1962) as well as alternative medicines such as the Ayurveda (Bhargava et al., 2016). Psychological theories based on Indian scriptures have substantially influenced modern psychology such as psychoanalysis, humanistic psychology, and transpersonal psychology (Panchal, 2020). Research points out the synergic approach of eastern and western psychology with a forecast that by 2022, an increase in mindfulness and meditation-influenced psychotherapy can be expected (Norcross et al., 2013).
A search using the key terms related to psychology and mindfulness showed that the past five years accounted for nearly 49% of research in the field. This highlights the rise in empirical evidence linking the eastern and western philosophies of the mind and the scope of this science (Salagame, 2013).
Going beyond the practices such as asanas and pranayama for physical fitness, yoga philosophy has aroused interest in mental health professionals (Duros and Crowley, 2014; Kamradt, 2017). Recent studies on Yoga-based Counselling (YBC) have outlined the psychotherapeutic perspectives of yoga philosophies and its possible integration with various conventional psychotherapy techniques (Bhide et al., 2021; Forfylow, 2011; Kamradt, 2017).
YBC can be understood as the integration of western counseling techniques with yoga philosophies as expounded in yogic texts. Further, YBC includes dietary changes, lifestyle modification, as well as the component of problem identification (Adams 2008 & Kumar, 2008). The aim of YBC is to help individuals overcome difficulties of physical, psychological, or spiritual nature. The lack of a set definition of YBC calls attention to the need for a formal theoretical restructuring. The purpose of this literature review is to unearth philosophical concepts for YBC as a theoretical foundation and its implication strategies based on research evidence.
| Methods | | |
The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were used for this review study. Published articles were identified through Web of Science, Scopus, and MEDLINE/PubMed databases using the Boolean operators (“counseling”[Title/Abstract] OR “psychotherapy”[Title/Abstract] OR (“counsel”[All Fields] OR “counseled”[All Fields] OR “counselings”[All Fields] OR “counselled”[All Fields] OR “counselling”[All Fields] OR “counseling”[MeSH Terms] OR “counseling”[All Fields] OR “counsellings”[All Fields] OR “counsels”[All Fields])) AND (“yoga”[Title/Abstract] OR “yogic”[Title/Abstract] OR “bhagavad gita”[Title/Abstract] OR “Patanjali”[Title/Abstract] OR “ramayana”[Title/Abstract]). For each databases, the appropriate search strategies were adapted. References of articles were also verified to obtain additional related articles. Articles published in English from inception till August 2021 were considered for the review of literature. Articles that elaborate on the theoretical basis for YBC and its application were included in the study. Studies which focused only on the asana, pranayama and meditative aspects of yoga instead of YBC were excluded. There were no limitations pertaining to the study type. Literature which did not provide sufficient information about yogic counseling were also excluded.
Data extraction
The articles which fell within the inclusion criteria were coded and qualitatively analyzed using the inductive thematic approach. The preliminary open coding of the articles was carried out by the first author (A.R.). Themes and additional sub-themes were assigned. The co-authors reviewed the final list of themes and any modifications suggested was carried out.
| Results | | |
From the systematic review of literature, 49 articles were selected initially, out of which, seven books and eight-teen articles were excluded as they did not meet the study criteria [Figure 1]. The findings from the final list of 24 studies were extracted and themes relevant to the application of YBC emerged. | Figure 1: PRISMA flow chart illustrating the search and screening strategy for the literature review. PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analysis
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Each article was found to have a predominant concept [Table 1] related to YBC and after listing the concepts from each paper, commonalities were and formulated a set of general themes pertaining to the application of YBC. The themes are illustrated in [Figure 2]. Ten articles explored the theoretical foundation of YBC, seventeen discussed the integration yogic counselling in psychotherapy and eight mentioned about the ethical considerations and precautions to be adopted by the counsellor. | Table 1: List of nineteen articles and the relevant predominant concepts based on the study result
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| Discussion | | |
The influence of various Indian scriptures such as the Bhagavad Gita, Patanjali Yoga Sutra, Yoga Vashistha, Ramayana, and the Upanishads was a common observation. Based on these, we have consolidated the major theoretical foundations of YBC which underline the Upanishadic concept of the mind, Pancha Kosha concept of personality, Patanjali Yoga Sutra's concept of the mind, and anecdotes from Indian literature. An understanding of the theoretical basis given below can equip the yoga counselors with a framework which can further be explored during the counseling process.
Theoretical foundation of yoga-based counseling
Upanishadic concept of the mind
Although Yoga is predominantly known for the practice of asana and meditation, the literature explored suggests the theoretical application of yoga philosophies in counseling (Prem, 1994). A common factor between the yogic science and psychology is the exploration of the mind's potential. Western psychology tends to segregate the mind and the body (Satish, 2014). Yogic philosophy does not project the body and mind as dichotomous (Prabhu and Bhat, 2013). Rather, a third layer known as the consciousness is superimposed (Narula and Midha, 2021). According to the Vedanta philosophy, the mind is made of four components- manas (the central processor), ahamkara (ego) and buddhi (intellect), and chitta (consciousness) (Rao, 2014). The Kathopanishad uses the allegory of a chariot, the reins, horses, and the charioteer. The sense organs represent the horses which are held by the reins or the mind. The mind is driven by the intellect leading the chariot or the body. In the chariot lies the charioteer or the Atman (soul) (Sastri, 2011). The Katopanishad points out that the role of the mind is to facilitate the pursuit for moksha (liberation) (Rao, 2012).
Pancha Kosha concept of personality
In addition to the mind, this review explores the human entity's different layers with reference to the Pancha kosha model or the five layers of personality as depicted in the Taittiriya Upanishad (Manickam, 2013). They are the annamaya kosha (physical sheath), pranamaya kosha (vital sheath), manomaya kosha (mental sheath), vijnanamaya kosha (intellectual sheath), and the anandamaya kosha (blissful sheath).
Modern psychology identifies biological factors, environment, trauma, substance abuse among others as the causes of mental illness (Deekshitulu, 2015). According to yogic philosophies, mental disorders arise due to imbalances in the Manomaya kosha (Nagendra, 2013).
1.3 Patanjali Yoga Sutra's concept of the mind
According to the teachings of Maharishi Patanjali, the five modifications of the mind are pramāņa the (right knowledge), viparyaya (wrong knowledge), vikalpa (distracted), nidrā (sleep), and smṛti (memory) (Nagendra, 2020). The mind is the conglomeration of thoughts manifested and unmanifested as exemplified in the Patanjali Yoga Sutra (Nagendra, 2020) Patanjali states that the causes behind suffering are the kleśa or afflictions at the subconscious stratum which reflects on the emotions. The klesha are divided into avidya (ignorance), asmita (I-feeling), raga (liking), dvesha (repulsion), and abhinivesha (fear of death) (Satish, 2019). To manage the emotional unrest related to these klesha, it is recommended to put into practice the four paths of yoga: raja yoga, jnana yoga, karma yoga, and bhakti yoga, and a way of leading one's life (Kamakhya, 2019). The same is put forward by two reviewed articles (Balodhi and Keshavan, 2011; Reddy, 2012) with special allusion to the concepts of karma. Another article highlighted the need to achieve the state of citta prasadanam or the blissful state of mind through the application of the eight limbs of yoga and adopting the attitude of friendship (maitri), compassion (karuṇa), joy (mudita), and indifference (upeksha) (Satish, 2014).
Anecdotes from Indian literatures
One common theme across all the articles referring to Indian literature is the aspect of Gurushiṣya (teacher–student relationship). In the context of YBC, a parallel is brought with the relationship between the Guru (Lord Krishna, Sage Vashistha and Jambavan) and disciple (Arjuna, Rama, Hanuman) with the relationship of the therapist and patient (Bhargava et al., 2016; Bhole, 2016; Jacob and Gopala Krishna, 2003; Manickam, 2013; Panda, 2017; Reddy, 2012; Shukla, 2018). Some authors underlined the ways in which Indian texts such as BG, Ramayana, and Yoga Vashistha can be used in the context of counseling (Bhatia et al., 2013; Jacob and Gopala Krishna, 2003). Concepts such as raja yoga, jnana yoga, karma yoga, and bhakti yoga are illustrated in the BG as well as the mention of the importance of good nutrition and yogic lifestyle (Balodhi and Keshavan, 2011). These themes and anecdotes can help the patient to find similarities and insight to their current state of mind as well as alternate coping modalities (Bhatia et al., 2013; Jacob and Gopala Krishna, 2003) suggest that psychological states like grief, role transition, lack of self-confidence and motivation, as well as interpersonal conflicts can be supported by the themes of the BG. Likewise, Bhide et al. showed the parallelism between Ramayana anecdotes, negative emotion management, and corresponding psychological techniques. An account of this is when Rama is angered by the abduction of Sita by Ravana, Lakshman uses the Gestalt therapy technique of perspective-taking and focuses on the “here and now” by counseling Rama to focus on finding his wife rather than contemplate the guilt. These research studies exemplify the need for further parallelism between Indian literature and modern psychology as the values of Indian texts are universal and do not require patients' prior knowledge of the story for its therapeutic success (Bhide et al., 2021).
Integrating yogic counseling in psychotherapy
All the articles presented in this review support the integration of yoga into psychotherapy. This reflects the need to have a systematic structure to facilitate the application of this emerging form of counselling. Nine articles delineate the methods and key aspects necessary for the smooth combination of these two schools of psychology. As of date, yoga practices such as breathing exercises, and meditation have been incorporated into conventional psychological counseling. Yoga techniques acts as a support to other modes of treatment as seen with the integrated approach to yoga therapy (IAYT). As part of the IAYT model, YBC has been included in the form of lectures or satsang whereby the key concepts of yogic personality (Triguna theory, Pancha Kosha, relevant anecdotes) (Villacres et al., 2014). However, the lack of structured application of yoga in counseling surfaces as a necessity for its replication. Few aspects that need to be addressed are the adequate training of the counselor, their qualification and assessing when and how YBC needs to be integrated (Adams, 2008). This leads us to the methods in which YBC can be applied.
Stages of yoga-based counseling
Like other psychotherapeutic techniques, YBC is made up of steps that can be adopted by the practitioner. These steps need not be linear and can be adapted as per the client's requirements. Likewise, we have devised stages of YBC which act as a guide to professionals willing to integrate YBC in their practice.
Client assessment
YBC needs to be structured around the patient by keeping in mind that each individual case is different from the other (Forfylow, 2011; Kamradt, 2017). No formal diagnostic tools for YBC like the International Classification of Diseases exist at present. The aim of the therapist is to identify the status of the manas (mind) by the means of prashnam or questions (Satish, 2019). One method of diagnosis is the guna assessment and awareness of the kosha affected (Rybak and Deuskar, 2010; Satish, 2014). The guna or vedic personality of the patient may help in tailoring the therapy as per the person's needs and predominant guna (Rybak and Deuskar, 2010).Gunas are the psycho-spiritual components of an individual personality and are characterized in three or triguna (Puta and Sedlmeier, 2014). Rajasic guna is attributed by the desire for a sense gratification, tamasik guna has qualities of mental instability while sattvic guna displays equilibrium (Wolf, 1999).
Psychoeducation on yoga therapy and counseling relationship
At the initial phase, we merged two points suggested in three articles related to psychoeducation and rapport building (Caplan et al., 2013; Prem, 1994). The therapeutic relationship is built between counselors and patients from the first interaction (Sarah Asri et al., 2020). It is an opportunity for the therapist to build a safe space for the patient's free expression. It is also important that the patient has a clear understanding of what YBC is and how it can be helpful to them (Caplan et al., 2013). The therapist can highlight the concept of the mental disorder in light of the philosophy of yoga.
Yogic practices
Most of the articles propose the practice of asanas, pranayamas, mind-body relaxation (Caplan et al., 2013; Satish, 2014; Shapiro, 2013). Others suggest the use of storytelling and chakra meditation (Panda, 2017; Rybak and Deuskar, 2010). Inspiration is drawn from the BG, the Yoga Vashista, and Ramayana which exemplify the use of YBC. These yogic techniques are practiced with the aim of removing psychological blockages of the counsellee (Reddy, 2012) and balancing the koshas (Manickam, 2013).
Goal setting and therapy
According to Caplan, Prem and Shapiro, understanding the desire and goal of the patient is an important part of the therapy (Caplan et al., 2013; Prem, 1994; Shapiro, 2015). This can help in directing the therapist toward the appropriate therapeutic strategy best suited for the patient's objective and act as a guide for the client to estimate their progress. The goals need to be realistic and achievable to the client and principally targets physical, psychological, emotional and spiritual well-being. Having a defined goal accentuates the types of resources required and the level of motivation needed to reach the objective.
Cognitive restructuring
This stage focuses on restructuring the mind pattern of the patient. This may involve motivating the counsellee and applying the concepts of yoga related to the specific cognitive distortion (Balodhi and Keshavan, 2011). For example, analogies can be derived from the BG, with a focus on the path of yoga best suited for the respective cognitive restructuring. Jacob elaborates how the therapist should have a mastery over the epics so as to match the relevant themes discussed with the patient's turmoil (Jacob and Gopala Krishna, 2003). Likewise, depending on the kosha to be managed, the ashtanga yoga (eight limbs of yoga) of sage Patanjali can be adopted (Satish, 2019). For example, imbalance at the annamaya kosha can be rectified by applying the third limb of yoga which is asana (Kavuri et al., 2015).
These stages as shown in [Figure 3], need not be followed chronologically but are frameworks that yogic counselors may adopt. Finally, at the stage of termination, the patient can provide feedback for the therapist (Shapiro, 2013) and during follow-up, the patient can discuss the application of the yoga-based lifestyle suggested by the therapist.
Ethical considerations and precautions
One interesting theme that emerged during this review is the ethical practices that need to be adopted in YBC. Similar to conventional therapy, consent needs to be taken from the patient (Caplan et al., 2013; Kamradt, 2017) and confidentiality (Forfylow, 2011) asserted. The therapist should ensure that the patient is willing to partake in the therapy sessions (Forfylow, 2011). Asserting that the patient is comfortable with the philosophy of yoga is important to avoid any clash of beliefs (Jacob and Gopala Krishna, 2003). Appropriate disclosure of information pertaining to the safety, nature, and benefits of yoga and YBC is necessary (Forfylow, 2011; Kamradt, 2017). Patients need to feel safe during the therapy sessions (Caplan et al., 2013; Forfylow, 2011). The therapist needs to clarify the boundaries of physical contact and take consent in case of the need for physical touch (Caplan et al., 2013). This is pertinent, especially for sensitive cases like post-traumatic stress disorder.
The therapists need to be aware of their limitations as a counselor. They may seek professional collaboration or seek the help of religious teachers (Balodhi and Keshavan, 2011; Kamradt, 2017). Multiple articles mentioned the need for the therapist's to have adequate training as a mental health professional and equipped with the knowledge of practical and philosophical teachings of yoga (Bhargava et al., 2016; Forfylow, 2011; Kamradt, 2017; Patwardhan, 2016; Shapiro, 2013). The learning process is continuous with the therapist being aware of the scientific development of yoga (Kamradt, 2017). Therapists need to ensure that the patient is comfortable and aware of the dual relationship between them (Forfylow, 2011). Therapist need to minimise, if not avoid any harm to the client (Forfylow, 2011; Kamradt, 2017). This needs to be assured by having the medical details of the patient in order to prescribe appropriate practices and avoid treatment which could negatively harm pre-existing medical conditions (Cohen, 2007). Ensuring that the yoga practices or technique adapted for the patient is suitable to his/her condition is essential (Boudette, 2006; Adams, 2008) by adapting the intensity of practices and consulting with a yoga expert. Appropriate supervision needs to be done routinely with regard to the welfare of the therapists too (Bhargava et al., 2016; Forfylow, 2011) which helps in sustaining appropriate practice.
The findings of this review point out the lack of a validated program or module on YBC. Researchers may look into this growing field of Indian psychology and promote its application in a scientific manner, favoring empirical studies.
| Conclusion | | |
This literary review sheds light on the theoretical basis, modes of application, precautions, and ethical considerations necessary to conduct YBC. The stages of counseling can be of help to counselors willing to include aspects of yoga philosophy in their practice while taking into account the ethical considerations. In order to make YBC more practical, structured YBC modules are required to make this form of indigenous therapy more accessible.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 48. | |
[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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