What Is the Spectrum of Yoga Services?
At YogaX, we are often asked about the types of practices or services that can be considered “yoga”. We understand the question because yoga is so many things to so many people, and it can be difficult to define yoga clearly. Let me start with an acknowledgement that yoga can be a singular activity for many (e.g., people who just engage in the postural practice), a lifestyle for others (e.g., those who apply all eight limbs on and off the mat), and a profession for some (e.g., yoga teachers or yoga therapists). The heart of all of these applications – whether as a practice or a profession – is grounded in yoga psychology and yoga’s deep roots in ancient wisdom traditions, evolved across the millennia and deeply affected by the varied and ever-shifting biopsychosociocultural contexts in which yoga is practiced and applied. In this blog, I am sharing my ideas about the range of yoga services and how this relates to yoga as a profession – a profession that can have many manifestations and applications. Prior blogs have addressed yoga as a practice.
Services that can be provided by yoga professionals range widely, are often misunderstood, and may be confusing to the public and to healthcare providers whose patients may benefit from one type of yoga service but not another. It helps to look at this range of services from the perspective of scopes of practice and educational backgrounds of yoga professionals. The range can be roughly shown as a continuum from yoga teaching to yoga therapy, with therapeutic yoga teaching in the center – leaning toward the teaching end of the spectrum; and therapeutic yoga applications in healthcare – leaning toward the yoga therapy end of the spectrum.
Scope of Practice Definitions
As yoga teachers and yoga clinicians become more knowledgeable about health and mental health issues, it is crucial to continue to track and stay within an appropriate scope of practice. It helps to keep in mind differentiations within the yoga profession to adhere to the yoga services for which a teacher or clinician has been trained. It is equally important to clarify agreed-upon role(s) with any given client or student. For example, if the relationship was based on a pre-existing clinical contact, adding therapeutic yoga needs to be discussed and matched to the scope of practice of the healthcare provider. If the relationship was originally a yoga teacher-yoga student relationship, adding a clinical context needs to be discussed and within the provider’s greater clinical scope of practice. When a yoga teacher learns more about mental health issues, for example, this will not be sufficient to shift a teaching relationship into a therapeutic or clinical interaction. However, if the teacher is also a psychologist, such a shift may become appropriate, if explicitly negotiated with the student and with appropriate shifts in relationship and focus.
From my perspective, four broad categories of yoga services can be delineated. While I offer these simply as starting points for a conversation, I do believe they are fairly representative of the types of yoga services that are being actively offered in a variety of contexts. Yoga classes tend to be clustered in studio and other community settings (e.g., gyms) and are often fitness oriented. Yoga therapy is largely offered in private practice settings. The therapeutic yoga offerings between these two anchors might indeed cluster the way I suggest below; however, it is important to note that these clusters likely still miss or even obscure important nuances and variability that exist or are possible. It is the center of the spectrum that deserves careful attention in the future, as yoga evolves into a viable and clearly delineated therapeutic intervention in healthcare settings.
The center of the spectrum can perhaps be understood as driven from the bottom up, by community demand and patient need. Yoga therapeutics and therapeutic yoga can be tailored to specific collective and individual needs that emerge in a particular context and are provided by yoga professionals who are embedded in this same interpersonal matrix. In that sense, the center of the spectrum may be more culturally and emotionally responsive to communities than determined from the top down by professional organizations or business considerations. Their potential bottom-up, community-informed nature does not free the yoga services provided at the center from conscientiously and ethically adhering to professional needs and standards. It may simply invite a more flexible perspective on who is best situated and prepared to bring these services to the people who can most benefit from them. However, that idea is for another time and another blog.
Yoga Classes
Yoga classes take place in studios, gyms, and even online and range widely from being strictly exercise-based to including accessible practices from all yoga limbs. Classes vary greatly in size and exposure to other students, and may be so large that they do not support an individual relationship between yoga teacher and student. Classes are not specifically tailored to individual needs, though they may promote self-agency through encouraging the use of props, adaptations, and variations. Yoga classes are not offered for specific therapeutic reasons; however, they may offer yoga practices that can have benefits for physical and emotional wellness overall.
It is highly recommended that yoga teachers minimally complete a 200-hour yoga teacher certification. Additionally, yoga teachers are best registered with Yoga Alliance to reassure the public that they have been trained to a minimum standard of teaching practice. Specialty teaching (such as for children or pregnancy) may require additional training focused on the relevant topic or population. Commensurate supplemental Yoga Alliance registration is recommended.
Therapeutic Yoga Classes
Therapeutic yoga classes tend to be offered for individuals with a particular characteristic, concern, or challenge. While some are offered in the same venues as yoga classes, they are well-situated in healthcare, allied healthcare, mental healthcare, and/or community health settings. Therapeutic yoga classes are provided and practiced in small groups, may have more than one teacher (and/or assistants), identify a health or mental health-related presenting concern (e.g., yoga for back pain; yoga for cancer survivors; yoga as stress reduction), and make explicit, deliberate, and demonstrated use of props, adaptations, and variations. An affiliative, direct relationship between student and teacher is encouraged. Teachers and assistants pay attention to individual students and offer specific directions and interventions that tailor the practice uniquely to each individual in the group. Therapeutic yoga classes, because of their shared and clearly-defined focus on a common physical or mental health concern, create more student-to-student relationships as well because of shared experiences, therapeutic interests, goals, or presenting concerns of participants.
It is recommended that yoga teachers who want to provide therapeutic yoga classes minimally complete a 200-hour yoga teacher certification with specific focus on yoga in healthcare (as opposed to fitness) settings. Training may focus on the populations the teacher wants to serve; it highlights how to bring yoga to individuals who can benefit from the practice, yet often do not have access to the practice for a variety of resource-, stereotype- or stigma-related reasons. To create more accountability to the populations they wish to serve, teachers who want to offer therapeutic yoga classes ideally seek certification at the 500-hour level of teacher training. This advanced credential holds them directly responsible for understanding the therapeutic yoga principles and practices that will most auspiciously support, honor, and address the needs of the potentially vulnerable individuals who access their therapeutic yoga class offerings. Additionally, yoga teachers can choose to register at the appropriate level (i.e., 200-hour or 500-hour) with Yoga Alliance to reassure their students that they have been trained to a minimum standard of teaching practice; and that they have the humility to recognize their responsibility to continue to learn more about the people they service and the services they provide. Additional specialty training may be indicated if therapeutic yoga classes are offered to specific clinical or age-related populations (e.g., therapeutic yoga for children or seniors; or yoga for specific healthcare topics, such as cancer, mental health, or pregnancy).
Yoga Therapeutics in Healthcare
Yoga therapeutics in healthcare are integrated and holistic interventions offered for individuals with particular characteristics, concerns, or diagnoses. They are offered in healthcare, allied healthcare, mental healthcare, and/or community health setting by a qualified healthcare provider with training in therapeutic yoga principles and practices. Yoga therapeutics are provided within the context of the healthcare professional’s existing scope of practice, either individually or in small groups. In small groups, yoga therapeutics are offered similarly and require the same humility and responsibility as therapeutic yoga classes, except that groups are clearly marked as yoga-therapeutically led by a healthcare provider with an existing commensurate scope of practice. Yoga therapeutics in healthcare, because of their clearly-defined focus on particular patients or specified physical or mental health concerns, typically are grounded in a clear care plan or intervention plan. The provider has in-depth, assessment-based knowledge about the clients that helps guide the yoga therapeutics offered in group or individual sessions.
Healthcare providers who aspire to provide yoga therapeutics can become credentialed by the International Association for Yoga Therapists via a new pathway for qualified health professionals who to want apply therapeutic yoga principles and practices to their extant healthcare practice. This new IAYT-Q credential designates that the QHP has specific preparation for using yoga therapeutics in the context of their defined healthcare setting. The expectation for the IAYT-Q credential is that yoga-therapeutically-trained QHPs honor their healthcare training and use therapeutic yoga principles and practices within an appropriate scope of clinical practice and therapeutic yoga specialization.
Yoga Therapy
Yoga therapy is offered one-on-one (perhaps one-on-two if a yoga professional has two clients with similar clinical presentations) and specifically tailored to the needs and presenting health or mental health diagnoses of the client. Client or patient and clinician create a clear understanding of the goals for the work together; explore needs and resources together; journey into a greater understanding of the client or patient over time; and have a clear set of ongoing assessment criteria that guide the healing journey. To honor identified needs and resources of each individual, tailored and individualized applications of props, variations, adaptations, and interventions are an assumed ingredient in the therapeutic work. Yoga therapy often occurs in collaboration with a referring healthcare provider (e.g., psychologist, physician, occupational therapist) and generally presumes a working relationship of the client with this medical or mental healthcare provider (depending on referral).
It is incumbent on yoga teachers who want to become yoga therapists to complete a formal yoga therapy training program. Ideally, such a program is accredited by the International Association for Yoga Therapists. Additional specialty training may be indicated if yoga therapy services are to be offered to defined clinical or age-related populations (e.g., yoga therapy for children or seniors; yoga therapy for specific health concerns or conditions, such as oncology, mental health, cardiology, neurology, and more).
Details about Credentialing
Yoga Teaching – Certification Preparation and Credentials
The yoga profession at the teaching level of scope of practice is not well regulated. The term ‘yoga teacher’ is not protected; anyone can choose to call themselves a yoga teacher, regardless of training or qualification. What they cannot do is call themselves a ‘certified’ or ‘registered’ yoga teacher, unless they have the commensurate training (see below).
Certification of yoga teachers (so that they may call themselves ‘certified yoga teacher’) can be accomplished via any yoga teacher training that offers a certificate program in yoga. Such programs are not regulated and competencies taught may range widely from program to program. Registration of a yoga teacher (so that they may call themselves ‘registered yoga teacher’) depends on the completion of a yoga teacher training program that is registered with Yoga Alliance.
Yoga Teaching – Registration Preparation and Credentials
Yoga Alliance (YA) is the organization that has taken charge worldwide of defining basic competencies and setting foundational standard for yoga teacher training to ensure the basic skills necessary for teachers to provide yoga classes to the public. Yoga Alliance embraces “a thoughtful, creative, and broadly community-centered approach” to yoga teaching that assures that everyone feels included, welcomed, and represented in a practice of yoga that reflects and honors a multitude of perspectives and voices (https://www.yogaalliance.org/Strategic_Plan; retrieved on 8.3.2024). Teacher training programs that meet the YA requirements for their basic competencies and standards (including ethics and scope of practice commitments) can apply to become a Registered Yoga School. Once a yoga school is registered by Yoga Alliance, it can advertise itself as such (using a Yoga Alliance-provided logo), signaling to applicants and trainees that – upon graduation – they will be eligible to apply to Yoga Alliance to become a registered yoga teacher. Only graduates from registered yoga schools are eligible to apply to Yoga Alliance to become ‘registered yoga teachers’. Registration as a Registered Yoga School by YA simply means that the school’s program has met the minimum standards set for a particular level of yoga teacher training. Registration alone does not guarantee high-quality instruction or content as there are currently no checks and balances to investigate ongoing compliance by an RYS, once it is registered.
Registration for schools and teachers happens at two levels of education (200-hour and 500-hour). At the teacher level, there is also an experience-based designation defined by yoga teachers exceeding a certain minimum number of direct teaching hours. Specialty registrations are also defined. At different levels of registration, different requirements exist for ongoing continuing education. Ideally, CE is obtained from a Yoga Alliance Continuing Education Provider (YACEP), a teacher who meets minimum hours of experience with yoga teaching.
The following details summarize the current state of affairs related to registered yoga teaching credentialing:
RYS200 – This designation identifies a Yoga Alliance-registered yoga school that provides 200-hour yoga teacher training that meets the basic standards set by Yoga Alliance.
RYS300 – This designation identifies a Yoga Alliance-registered yoga school that provides 300-hour yoga teacher training (beyond the 200-hour teaching level) that meets the basic standards for a 300-hour training program by Yoga Alliance.
RYT – This designation identifies a registered yoga teacher who successfully graduated from a teacher training program that is registered with Yoga Alliance. Such teachers must complete 30 hours of Continuing Education plus 45 hours of direct teaching every 3 years to maintain registration.
There are two levels of education:
RYT200 = These registered yoga teachers have completed a minimum of a 200-hour yoga teacher training program registered with YA.
RYT500 = These registered yoga teachers have completed a minimum of a 500-hour yoga teacher training program via programs registered with YA.
There are two levels of experience:
E-RYT200 = Experienced registered yoga teacher at the level of 200-hour yoga teacher training have completed a minimum of 1,000 hours of direct yoga teaching experience.
E-RYT500 = Experienced registered yoga teacher at the level of 500-hour yoga teacher training have completed a minimum of 2,000 hours of direct yoga teaching experience.
There are two specialty registrations:
RCYT = Successful graduates of a 200-hour teacher training plus at least 85 hours of additional child-specific training, both from an RYS, may call themselves registered children’s yoga teachers.
RPCT = Successful graduates of a 200-hour teacher training plus at least 95 hours of additional pregnancy-specific training, both from an RYS, may call themselves registered prenatal/postnatal yoga teachers.
Therapeutic Yoga Preparation and Credentials
While yoga teaching is clearly under the purview of Yoga Alliance and yoga therapy is clearly under the purview of the International Association of Yoga Therapists, therapeutic yoga is largely undefined territory. There are 300-hour yoga teacher training programs that are therapeutic in nature (such as the YogaX YTT300; https://www.yogaxteam.com/300hr-ytt) and are clear about preparing yoga teachers for working in healthcare settings. However, Yoga Alliance neither has a clear educational pathway, nor educational standards for programs that train teachers to work in the breadth and complexity of healthcare settings. This leaves yoga teachers who have this professional interest to their own devices in locating and vetting possible YTT300s that can prepare them auspiciously for such work.
The International Association of Yoga Therapists has stepped into this undefined territory by creating a novel pathway for healthcare providers who want to integrate therapeutic yoga principles and practices into their extant clinical work (https://www.iayt.org/page/ACC-qhps-in-yoga-therapy). This pathway for Qualified Health Professionals (QHP) became available in January 2024; the first program accredited under this novel initiative was the YogaX IAYT-Q program at Stanford Medicine/Psychiatry (https://www.yogaxteam.com/yogax-iayt-q-300-hour-program). Programs in the QHP pathway train healthcare professions in foundational therapeutic yoga principles and practices.
To become a healthcare provider with a QHP credential from IAYT (designated as IAYT-Q) requires graduation from an IAYT-accredited Foundation of Therapeutic Yoga Principles for QHPs Program. The program must require a prerequisite of evidence of a healthcare profession or enrollment in the clinical phase of a healthcare preparation. QHP programs require 300 hours of training in foundations of therapeutic yoga principles and practices, including at least 30 hours of practicum. Maintenance of certification as an IAYT-Q requires a minimum of 10 CEs every three years. There is a one-time registration fee for the credential; annual membership (required for credentialing) is $85.
Yoga Therapy Preparation and Credentials
The International Association of Yoga Therapists (IAYT) is the regulating body for yoga therapy programs in the US and worldwide. IAYT certifies programs and teachers who want to move from yoga teaching to providing yoga therapy services. Yoga therapy is defined by IAYT as the “professional application of the principles and practices of yoga to promote health and well-being within a therapeutic relationship that includes personalized assessment, goal setting, lifestyle management, and yoga practices for individuals or small groups” (retrieved 7.31.2023 https://cdn.ymaws.com/www.iayt.org/resource/resmgr/strategic_plan_2021/Strategic_Plan_2021-2024_Mem.pdf).
To become a yoga therapist, certified by IAYT (designated as a C-IAYT), requires successful graduation from an IAYT-accredited yoga therapy program. IAYT-approved yoga therapy programs must require a minimum of 800 hours of yoga therapy training (including at least 150 hours of practicum plus 30 hours of mentorship), in addition to a prerequisite of having already successfully completed a YTT200 (i.e., adding to a minimum total of 1,000 hours of yoga training). Maintenance of certification as a C-IAYT requires a minimum of 24 CEs every three years as well as successful completion of an ethics exam. A worldwide competency exam for C-IAYT applicants needs to be passed before certification is granted, even if the applicant graduated from an IAYT-accredited yoga therapy program. There is a one-time registration fee for the credential; annual membership (required for credentialing) is $85.
IAYT has expressed a preference that CEs be obtained from IAYT-approved continuing education providers (APDs [which stands for Advanced Professional Development provider]) to assure that trainers (even of ongoing education) meet minimum therapy training requirements. IAYT provides many resources to its membership, including a quarterly newsletter, The Yoga Therapist, and a PubMed-indexed professional journal that is published annually, the International Journal of Yoga Therapy. IAYT sponsors two annual conferences, one geared to the entirety of its membership and one focused on research in yoga therapy.
Concluding Thoughts
The time has come to honor yoga’s long tradition as a healing art and lifestyle practice. Therapeutically, yoga can be applied as a primary, secondary, and tertiary prevention strategy. It can be used to support human beings in a journey toward thriving, moving beyond healing and coping. As a prior blog already discussed, yoga is a lifestyle as well as a means of practicing lifestyle medicine. It has much to offer to healthcare settings – for patients and providers alike. Integration of yoga into healthcare settings presents an innovative and multifaceted opportunity to revolutionize at least some of the challenges within current healthcare systems. Yoga’s core principles are uniquely aligned with a commitment to comprehensive, coordinated, and integrated person-centered preventive and supportive care while enhancing provider wellbeing. The integration of yoga’s ancient wisdom into modern healthcare can create a more resilient healthcare ecosystem that places emphasis on integrated and holistic wellbeing and lifestyles for patients and care providers alike.
For yoga to take its proper place in life and healthcare, we must create clarity about what yoga is and how a scope of practice can vary from yoga service provider to yoga service provider. In this blog, I have simply offered my current ideas and recent thinking. A larger, nationwide effort is needed to establish clear guidelines for yoga service professionals to ensure ethical practice, guided by the ethical (yama) and lifestyle (niyama) practices and principles of the ancient yoga tradition, and aligned with professional practice codes in modern healthcare.
I am looking forward to the evolution of the germs of yoga-scope-of-practice definitions offered here. With gratitude to all who embrace the practice and contribute to its definition and refinement,
Chris
About the Author:
Christiane Brems, PhD, ABPP, E-RYT500, C-IAYT, is the Director of YogaX, a clinical psychologist, registered yoga teacher, certified yoga therapist, and certified Buteyko (breathing) Teacher. She has practiced yoga for nearly 50 years. You can read more about her on the YogaX Team page.