Therapeutics in Iyengar Yoga: 'Your Job is to Put the Student on the Path to Yoga'

By Stephanie Quirk

It is tempting to list here all the marvelous things therapeutic yoga can do—what it can heal, calm, and alleviate —and I know there is a lot of interest in this. This shows people’s interest in the subject. Therapeutic yoga is often seen and understood on this layer of physical ailments only. But I thought I’d take this conversation in a way I hope might be more interesting and point out that therapeutics is actually benefiting all of us in Iyengar Yoga—the teacher as well as the student or patient.

A therapeutics class is often seen as one for people who cannot or should not attend a general class. These people come with various diseases, complications, and disabilities and are recommended to the medical class instead. It is viewed as not ‘real yoga,’ but something offered that is manageable for people. But in fact the people attending medical classes are being introduced to yoga in the way we are all meant to follow it.

Right from the beginning, their practice of yoga fulfills the aims of yoga (see Yoga Sutras I.2, 3, 4, 5 and II.1) For them, it is imperative that it does so, to reduce the afflictions and bring to a halt the distorting movements in the consciousness. (By consciousness I mean the whole manifestation of consciousness: the organs of action, senses of perception, elements and tanmatras, mind, intelligence, “I”-ness and inward-moving sensibilities.) Within a yoga therapeutics class, all this is undertaken through the implementation of restraint, rectification, extension, balance, “in-line-ment,” and integration. All these qualities are present in the sadhana (practice) the patient is introduced to. Like all practitioners, having undertaken the first steps on the yogic path, he or she still has a long long journey to undertake, but is fortunate to be positioned on the path.

The other person involved in the process is the yoga teacher. While training teachers, I have come to realize the enormously important role therapeutics plays in Iyengar Yoga. I am training them not to be an instructor of classes, though instructing skillfully and effectively is a great service, but training them to guide students and patients on the path, to awaken them to their inner content: breath, organs, energy, and mind. To awaken them through the ‘critically’ correct approach of yoga asanas and Pranayama. Everything has to work, or the outcome impacts straightaway on the already weakened and disturbed patient.

Through upaya-kausalam—skillful means in liberative technique—in the therapeutic situation, student and teacher together come closer and closer to the true subject of yoga, each learning and benefiting from the other. Because of the patient’s need to proceed skillfully to rectify the inner disturbing factors, and with the teacher’s skillful guiding, both come closer to the true practice.

This shared experience is a beautiful result of the therapeutic approach in Iyengar Yoga. In any therapeutics class people have to work together. It is hard work; often assistants are required. It is a communal activity. To learn, I encourage teachers to re-practice together what we cover in my workshops. Often teachers report back how much they appreciate this; they find that each of them recalls a different aspect of the work. Reviewing it together gives them a broader insight into what the “patient/student” is experiencing. This is coming together for learning and is outside the usual model of yoga teaching.

Most teachers learn from another teacher, then begin to teach themselves. Too often in the west, the new teacher leaves his teacher to embark on a teaching career, stepping away from the richness of learning. Here, in studying therapeutics, teachers return once again to learn. They learn with one another and share information, notes, and experiences. This sharing occurs because therapeutics as a study isn’t conducted with the teacher isolated on a platform. Everyone has to work together. There is no such thing as “in isolation” in teaching or learning therapeutics, even at very high levels. Instead, it is a process of giving to others, tirelessly, as we see with our own Guru.

Student and teacher together come closer and closer to the true subject of yoga, each learning and benefiting from the other.

Richard Jonas: Would you talk more about your comment that "Therapeutic yoga is really Iyengar Yoga."

Stephanie Quirk: Often therapeutic yoga comes in the guise of an alternative health therapy, along the lines of the medical model. It is acclaimed for the illnesses and diseases it can cure. The teacher can fall into the error of hiding behind the role of clinician. This way of seeing tends to make teachers search out only lists of props and sequences. This is like wanting a prescription to cure the ailment. But for the teacher this doesn’t work. Teachers aren’t physicians; they are yoga practitioners. I often have to remind them to look to their own years of study as yoga practitioners.

Therapeutics isn’t a separate specialty. There is not yoga here, and “therapeutics” over there. Therapeutics isn’t another clinical method—these ideas are actually near-enemies for the teacher. Many try to make therapeutics fit those models, but truly it is the approach of yoga that most suits yoga. I try to get teachers to look at their own practice of yoga, and take direction from inside yoga.

To begin, teachers need to stop and think of what Sutra II.16, heyam duhkham anagatham implies—its message and what it is spelling out to them! That Sutra implies a radical turnaround of all one’s actions and behavior, both in and out of practice time. If suffering can or is to be avoided, what has to change from the way things are now? To be honest, truly taking on just this single and apparently simple Yoga Sutra requires courage, faith, determination and an open, positive approach ready to adapt, learn, and absorb. Everything has to change, and this is so very true for the patient who is suffering.

Then we have Abhyasa and Vairagya. No alternative health method has this. Your job as a yoga teacher isn’t to be someone’s doctor, nurse, or psychiatrist. Your job is to put the patient/student on the path of yoga. They must become followers and practitioners if they are to finally eradicate all trace of what disturbs them (dosha). Abhyasa (practice) and Vairagya (detachment) are at the core of everything one has to undertake. They are the irreducible plinths upon which yoga is based, and what truly separates the yogic path from other alternative health therapies.

Therapeutics isn’t a separate specialty. There is not yoga here, and ‘therapeutics’ over there.

Another aspect that defines therapeutics as Iyengar Yoga is “technique and precision, or technique applied with precision.” Along with the technique appropriate for the patient’s conditions, we must find the precision in asana that is specific to that condition. Finding that precision also means finding what is missing in the asana. We must trace what is obvious, seeable, and do-able, as well as what is hidden and dormant. We must observe where there is liveliness, where dullness. We have to know the asana and, by observing the patient’s presentation of it, find out: Is the asana integrative or disintegrative? How does it affect all the layers (kosas) generally, and how does it target the disturbance specifically? These are abstract, but can be addressed by the techniques we have all learned, but with increasingly refined precision and subtlety.

When we achieve this, we are doing what Guruji has tried to present to us as “Iyengar Yoga,” simultaneously multidimensional and comprehensive. This is “whole-istic,” not just muscular-skeletally and physiologically, but yogically. Through that experience, the student finds their own experience and their connection to a sense of well-being.

RJ: How does Iyengar Yoga’s rigorous training prepare teachers for therapeutics?
SQ: We have a seemingly long process of study in Iyengar Yoga. Many other systems award certificates after a weekend course, but we have years and years of study and absorption and integration ahead of us before our observation and teaching become mature. No accumulation of information, no adeptness at entwining a limb here or there in advanced poses, can bring this maturity. One has to be forever a student. Guruji himself often says he is only a learner (though not a beginner). Recently he made a statement very pertinent to this topic: "I trace the defects; so for me what I am doing is not important, it is what I am not doing that is important."

His one simple statement sums up the entire approach needed to progress in one’s own art as well as the art of helping others. This approach in Iyengar Yoga of tracing defects, of bringing asana and Pranayama to a state of refined excellence, is a very long process. By careful attention and correction, we cultivate our ability to make further refinement.

In tracing defects in practice, the teacher delves deeper and deeper into the techniques of the asanas and Pranayamas. One employs these techniques in one’s own practice for the knowledge they bring. Gradually those means are used with increasing precision as they bring insight into that which covers or veils the truth or the view of the self. It starts right at the beginning, though in a rudimentary way. In this way, beginner students and teachers may have been training for therapeutics for quite a number of years.

A common catchphrase is often applied to Iyengar Yoga from outside: “alignment.” However, this word can become superficial; it can begin to mean only outer measurement and placement. Perhaps a better guideline is “in-line-ment”; the teacher should look to see if all the sheaths or layers of the self are in line. Is the mind equally placed throughout the pose? Is there an even feel of the skin touching everywhere, or are there some parts untouched and unfathomable? This is where alignment progresses to in-line-ment. With further precision the teacher can evaluate: Is it exactly in line, equal? Is it dual or non-dual? Is there any trace or place unknown? Here the teacher’s inquiry needs to move from what is disproportionate to proportionate, from disparity to parity, in order to nullify the dueling vacillations in the body-breath-mind complex.

The techniques we train in are those of measurement or placement, contact or touch, of tracing, expansion, elongation, and extension. They are the techniques of stabilization, grounding (or “descendance”), and ascendance. They are making lighter, making heavier. Balance and arrangement. Aerating, fanning, and moistening. Moving and restraining – the list goes on. Too often the teacher knows the correct outer frame of an asana, but unless they study the contents of that frame, what is happening is virtually unknown territory. That’s why so many questions still come to the Iyengars about what to do in therapeutic situations.

I have noticed that the success of a therapeutic approach seems to depend on the patient’s own vision. No matter the state they are in, at some stage they must pick up and grasp hold of the yogic process and make it their own (carpe diem). This is a vital step. The student must have a view of the larger path he is following. The teacher needs to help the student develop the aspiration to follow this path beyond his immediate painful situation.

So too must the teacher cultivate their own inspiration, their connection with the aims of yoga. Otherwise they will fail to take the next necessary step. Once we determine our true “self,” beyond the ego based on possessions and needs, will we have the clarity and lucidity of head and heart to truly act as though heyam duhkham anagatham is in fact possible?

In its multidimensional yet comprehensive approach, the truly outstanding qualities of Iyengar Yoga make themselves apparent.

A better guideline is ‘in-line-ment.’ The teacher should look to see if all the sheaths or layers of the self are in line.

RJ: Can you share some of your experiences in the Medical Classes at R.I.M.Y.I.?
SQ: I cannot actually replicate for teachers what I have learnt through all those years of climbing the stairs. I can’t give them the experience of daily helping in the Medical Classes. One thing teachers don’t understand is that everything they need for teaching in Medical Classes is actually what they have been studying all along. They have been practicing the asanas for years. Often they seem to be waiting to be shown something they don’t know. It is quite amusing for me to be teaching them asanas which they have repeatedly practiced, but haven’t really delved into, to find their inner qualities and properties.

I find it hard to describe the vibrant emotional force and moral strength the Iyengars bring into the Medical Classes. Sometimes people find it disturbing. The Iyengars are legendary for their fierceness and passion. I have come to appreciate more and more their strength and the emotional presence they bring to the class. Certainly their years of experience and knowledge can’t be equaled, but it is their personal connection that gives them something deeper than any clinical expertise. Their involvement reaches across the divide between themselves and the student they are trying to help.

RJ: What advice would you give teachers about therapeutics?
SQ: You have a great resource at your fingertips: You need to study and learn from each other. Teachers must meet in community to study and practice what is presented in workshops so they understand it first in their own bodies.

Geetaji said in Portland that we must all spend at least a year digesting what she taught there. Don’t be afraid, don’t worry about how other methods don’t take the time we do for study. Unfortunately this is a sign of how the world sees yoga—as a hobby, a sideline. They don’t give it credibility. It is the same for many disciplines that have their root in eastern spiritual traditions. The materialistic world of today won’t give credibility to something that is as creative as the yogic approach to health.

RJ: What about cautions and guidelines?
SQ: Yes, I do give cautions—not so much about what to do and not do for a particular disease, not contraindications like in a pharmacological manual—but more about protecting the teacher from error. A harmful error is a tragedy for the teacher. It is shattering.

When working directly on a patient’s asana, the teacher needs to think of how the patient is able or not able to absorb or tolerate being in the pose. There is no point in taking them to a pose that is too strong, too far for them to reach. The reverse is also true. It is a common misunderstanding that therapy is all about “resting” or restorative poses. There may be fatigue or circulatory problems or mental imbalances that have to be released at the beginning of an asana session, but to allow the patient’s circulatory, nervine, and mental systems to sink into dullness can create more problems.

To help teachers avoid injuring students, I give teachers some very simple guidelines. The first is asking—often repeating—“How do you feel now?” Teachers should observe the patient’s color and their breath; they should watch especially the neck and abdomen for signs of imbalance and stress. They should touch and see if there is any inner shaking. Too often the teacher may be skilled at adjusting and placement of props, but may fail to see what transformation is gained from them. When adjusting, “listen” through your hands to read the resistance or acceptance of the movement.

Today so much information is available; compare that to years back where information was scarce. Now you have to approach learning in a different way. Be prepared to create your own learning, to make mistakes, and to learn again. Learning has to include failure because failure is instructional. You have to “do it,” to play, to inquire. To enter into the real space and find your hand, your vision. That’s why I have so many sessions where teachers work together and on each other, to give them a chance to find their eye, to find their hand in the subject. They don’t just watch me doing the work on someone and take notes. They do it themselves. There are many good books available (all that information again!), but teachers still ask what to do. They have to “get their hand.” They have to develop skillfulness, compassion, and wisdom (kausalam, karuna, and prajna). The techniques and information will be there, but more important, there has to be immersion in the subject with a full heart. Only then will these qualities come.

Stephanie Quirk has been observing and working with the Iyengars at R.I.M.Y.I. since 1994, assisting in all the classes including the medical and women’s classes. For the last several years, she has been conducting comprehensive six-part training workshops on therapeutics, sharing her knowledge and expertise with Iyengar Yoga teachers around the world.