06/27/2013 01:03 pm ET Updated Aug 25, 2013

Yoga, The How of Now: Working in an Acute Care, Inpatient Psychiatric Hospital

This is an interview with Joanne Spence, Executive Director of Yoga in Schools. Since the 80s, Joanne has worked in several fields of mental health including clinical and community social work, family therapy and inpatient psychiatric care, where she taught therapeutic groups and stress reduction classes. In 2000, Joanne discovered yoga after a car accident, after which she began infusing mind-body practices into her life and work. In 2004, she founded a non-profit organization, Yoga in Schools, to train teachers in self-care and self-awareness practices. In 2007, she joined the Creative & Expressive Arts Team at University of Pittsburgh Medical Center's (UPMC) Western Psychiatric Institute and Clinic (WPIC) as a yoga therapist, where she works with adults with mood disorders, eating disorders, and trauma.

Rob: What originally motivated you to do this work, and what continues to motivate you? How, if at all, has that motivation changed over time?

Fourteen years ago, I was in a debilitating car accident that left me in chronic pain. Two years later, I happened upon a weekend yoga course, which I found to be very challenging and nothing at all like what I had expected. Three days later, I was pain-free for the first time since the accident. I felt as if I had gotten my life back. I began studying yoga to try to figure out what had happened to me and how it could help others. Previously, I had been a social worker, and the more I learned about yoga, the more I could see how yoga could be a tool for healing-perhaps even more than traditional talk therapy. It was a complete surprise to me to notice the positive changes and stability yoga created in my mental health. Gradually, I realized that gentle movement combined with simple breathing practices were a balm for my overly-busy mind. It has stilled the minds of my patients, as well.

Shifts happen right in front of my eyes every week. This keeps the work fresh. Every day is new; every class is a fresh opportunity to connect with the people in front of me. Showing up for people--I sometimes call it a ministry of "presence"--is indeed motivating.

Is there a standout moment from your work in inpatient psychiatric settings with people with mood disorders?

I have many stories, but here is a fun recent one: I was on a unit for adults with mood disorders--anxiety, depression, and also some folks with trauma. A man, whom I will call David (not his real name), said to me skeptically, "If you can find four other people to do yoga, I will, too." I told him I wasn't sure if I could round up four people, but I would get back to him. Yoga is a voluntary activity (of course), so I checked in with some folks who had already politely declined my offer for a gentle chair yoga practice. Another young man, Gary (not his real name), looked sympathetic, disinterested, and dismissive. He told me how much his back hurt and that he could not do yoga; this was his claim despite never having tried yoga. I engaged him in conversation for a few minutes and convinced him that yoga might help. With four recruits and David, we were ready to roll. The best part was seeing the look of surprise and shock on Gary's face as he followed my directions to the letter and his back did indeed feel better in just 15 minutes.

Does this happen every time? No, but it happens often enough to keep me a true believer. I hear every day, "I feel soothed, I feel relaxed, I am less anxious. I didn't know that how I breathe could change my mood."

What did you know about the population you are working with before you began teaching? What were some of the assumptions you had about this population and how have those assumptions changed?

I had about 15 years of clinical social work experience with adults and children before I discovered yoga. During those 15 years, I had tried many different types of social work, from child protection work, juvenile justice (probation officer), family therapist, community educator, and teen parent coordinator, to group home worker. A short part of that time, I ran talk therapy groups in a different inpatient psychiatric hospital. I enjoyed the work but often asked myself if there was something else I could offer my patients. Over the years, I had gained significant experience working with adults and children with mental health challenges.

My biggest assumption that has changed is that I no longer look at people and think, "Who can I help fix?" but rather, "I will be with you as you learn to be with you." As much as is humanly possible, I try to let go of judgments; therefore, the distance between us is much closer. "I am with you" and "I see you" are essential messages to convey in the context of a group yoga class at WPIC.

What are two distinct ways that your teaching style differs from the way you might teach in a studio, and what are the reasons for these differences?

A big distinction is the lack of control of the environment while working in a hospital. We don't often have a dedicated space with mood lighting and quiet music. Sometimes, we practice in a corner of a common room or in a hallway. To me, teaching at the hospital is all about managing the environment and the continuous, mostly unavoidable, distractions. I have to consciously decide what I will pay attention to and carefully monitor myself. Where my attention goes, so goes the class. For example, it is commonplace for staff to walk through the tiny space where we are having class. Often, it is the only way to get where they need to go. Yoga is about acknowledging what is in front of you and proceeding from this real place, so this can also serve as an opportunity to learn how to focus in the midst of distractions and interruptions.

While teaching yoga as therapy, I like to use props like mats, blankets, chairs, and blocks. In the hospital, I have to improvise a lot and be creative as to how I can support a patient with the tools I have and am allowed to take onto the unit. For instance, at my studio I often use a yoga strap, but at the hospital a strap is considered contraband, so I have to think of another way to achieve my teaching goals.

What has been the greatest challenge in your teaching experience and what tools have you developed for addressing that challenge?

At our hospital just over a year ago, we experienced a tragedy that affected all of us, when one of our colleagues was killed by gun violence. The whole staff was deeply affected. For me, it heightened my sense of purpose and urgency. We all need real skills (and practices) that allow us to self-regulate. Yoga helps us do this, helps us to improve our ability for self-care, self-regulation. These are critical characteristics of whole, functional, and compassionate people. We now have heightened security measures at the entrance of our building. I have an opportunity to practice deep nasal breathing every time I enter and leave the building. It helps, as does the sense of being called to this work.

My greatest tool is practicing yoga for myself, not just to be other-focused, but to incorporate the practice as a lifestyle choice. Getting a good night's sleep is also one of the best coping strategies I have found. I think we highly underrate sleep in our culture. I also pray, a lot.

What advice would you give to anyone who is going to teach in the population you work with?

It is absolutely essential to work on yourself. Perhaps that means being in therapy. It certainly means practicing your own self-care. If yoga is not your own practice, don't teach. This is not new information, but certainly worth re-stating. People who are in the acute phase of mental illness may be in a weakened state, but still highly perceptive: they can sense inauthenticity in a heartbeat.

My classes are always less than an hour. People want to feel better, and they want specific direction. If they already knew how to relax, calm down, and focus, they would be doing it. They want to know how: "Tell me what to do." As teachers, we need to know how to give simple and concrete instruction that allows people with no connection to their bodies to experience their bodies in a tolerable and even pleasant way. Every time this happens, it is memorable!

Additionally, gathering academic credentials is helpful in a health care setting. Until the yoga industry is regulated, the only recognition in a health care environment that counts towards your remuneration is the degrees you have, not your yoga credentials, no matter how impressive. A degree in social work or psychology is very helpful, and, more often, a graduate degree is necessary. I have sought out teachers like Amy Weintraub (Yoga for Depression) and Bo Forbes (Yoga for Emotional Balance) because their work directly relates to mental health.

What are some of your ideas about or hopes for the future of "service yoga" in America in the next decade?

I dream that more yoga teachers will reflect on how they can give back and make meaning from this practice that has served them so well. I encourage yoga teachers to get quiet and think about who they resonate with. Who are you drawn to? It is an inquiry worth exploring.

How has this work changed your definition of service? Your definition of yoga? Your practice?

I think it has clarified some things. I am my patients. They are me, my brother, my mother. I am continually challenged to answer the question: if it were me in inpatient psychiatric care, who would I want to be teaching me yoga? What if it were my mother--who would I want to be with her? My own yoga practice is essential to my well-being and to my ability to show up as my best and healthiest self. My definition of yoga is the art of giving exquisite attention to what is in front of me. That is truly a gift to be cultivated and is my act of service to others. I now see service as being not doing. Yoga has taught me this. My practice these days is breath-focused and restorative in nature, revolving around gentle poses, like the six movements of the spine.

What other organizations do you admire?

My work has led me to cross paths with some outstanding people, particularly in the arena where yoga, children, schools, and mental health intersect. Last year at the inaugural Yoga Service Conference, I was heartened and inspired by meeting many more individuals who are drawn to serve specific groups of people. It is thrilling to come across so many individuals with big hearts doing great work.

There are so many organizations I greatly admire. I think the Niroga Institute is at the top of that list. Every time I hear B.K. Bose speak, I think, "I must put aside everything and teach in schools and health care to the underserved," and then I remember, "Oh, I am doing that!" He inspires me to keep going, and I am grateful for that.

I love what Ali, Andy, and Atman are doing in Baltimore with the Holistic Life Foundation. Their commitment to mindful practices and their neighborhood is what fuels their passion to see kids graduate.

Then, there are individuals who quietly chip away one school at a time, like Susan Solvang and her committed team in Milwaukee Schools called Growing Minds.

I am deeply appreciative for the work of the International Yoga Therapy Association for forging a path for yoga as therapy and for creating standards for us.

Unwind your mind, as well as your body with Joanne's DVD, classes or workshops at

Editor: Alice Trembour

Are you a yoga instructor giving back to underserved or un-served populations? Email if you're interested in being interviewed for this series. Thank you for all you do in the name of service!

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