Monday, November 25, 2019

Interview with Lara McLenan-Ben on Yoga for Outpatient Geriatric Mental Health Patients

Lara McLenan-Ben responded to our call for interviewees and what follows is our discussion about her thoughts and tips on teaching yoga to outpatient geriatric mental health patients.

Priya: Tell us a bit about your yoga training and experience teaching yoga.

Lara: I have been a social worker for the past twenty years with a focus in mental health and geriatrics. I shifted gears and started focusing more on self-care when I was diagnosed with Crohn’s Disease roughly fifteen years ago. I began practicing meditation and also started an asana practice, a recommendation from my gastrointestinal medical team to better manage my chronic illness. I had little to no experience with meditation and asana practice at the time but felt drawn to them and wanted to gain more grounding.

I attended the Mindfulness-Based Stress Reduction program in Mind-Body Medicine, a seven-day professional training with Jon Kabat-Zinn and Saki Santorelli at the Omega Centre in Rhinebeck, New York, in 2013. Subsequently, I took yoga teacher trainings––the 200-hour certification program in 2014 and the 300-hour program in 2018 at Yogaspace, Toronto.

I wanted to devote all my time to teaching yoga but found it difficult juggling the stress of working part-time as a hospital social worker, raising a family, and managing my Crohn’s Disease. I was able to squeeze time into my busy week with paid work teaching yoga at a community centre and also in a small yoga studio in the west end of Toronto a couple evenings a week.

At the community centre, the space was not ideal but I continued teaching for several years in a small classroom setting with no props––because of the enthusiastic students. The owner of the small yoga studio was mismanaging her business and unable to pay her staff at times and ended up having to close the studio shortly after I started working for her. I realized that getting paid was not a motivating factor for me to continue to teach yoga––I liked instructing yoga so much that I would do it for free. So in 2017, I began to focus on teaching yoga on a volunteer basis to mental health patients at the Centre for Addiction and Mental Health who had little to no access to the practice.

Due to my previous work in mental health early on in my career, I had identified a need for accessible yoga for patients in the mental health system. Initially I taught yoga to an underserved, female, outpatient population in a mood and anxiety program, and then switched to the geriatric outpatient clinic, a growing population that receives little attention when it comes to the practice of yoga.

Priya:​ I'm curious about your involvement with geriatric mental health outpatient students. Can you share with us some of the specific poses, language, or techniques that you use when teaching these individuals, and please explain why they are appropriate for them?

Lara: I began my working career in the geriatric mental health program at the Centre for Addiction and Mental Health (CAMH) in Toronto as a social worker on an allied health team, including occupational therapists, social workers, psychologists and nurses. I returned to CAMH in 2017 at the request of a colleague in the Geriatric Outpatient Mental Health Clinic who had identified a need linking well-being and yoga practice with their clients. She asked me if I would run a yoga group in their clinic which provides psychiatric consultation for patients 65 and older who have a clinical diagnosis of depression, anxiety, schizophrenia, schizoaffective disorder, and/or dementia.

I initially met with a group of both female and male students, about six to eight individuals, once a week for 45 minutes. I quickly noticed that the group numbers fluctuated on a weekly basis and that sometimes I would not see certain students again for a couple of weeks to a month later. I had no knowledge of a student's diagnosis and would rely on their clinician to come speak to me before class to let me know if their client had been re-hospitalized as their health had declined. I learned to adjust to having one to two students some weeks, or none at all.

The majority of the students were mainly low-income seniors on Old Age Security pensions living in subsidized senior’s housing, with little to no access to yoga. Most had never experienced the practice of meditation or yoga poses prior to coming to this class, due to their life circumstances.

I began teaching the class by incorporating mindfulness meditation practices (e.g. body scan) with gentle hatha yoga poses (e.g. Surya Namaskar, Sun Salutation) seated or standing. We would begin by sitting on a chair for a five-minute body scan and simple breath work (e.g. belly breath), focusing on present moment awareness. I would constantly encourage them to start wherever they found themselves depending on how they were feeling that particular day, and to not be hard on themselves. 

I would observe classes where a student who was struggling emotionally or having difficulty focusing would get up and leave, or I would need to suggest that they excuse them self from the class. Similarly, a student would consistently come to class late as they had difficulty with starting their day. I would always welcome them into the class knowing that they were struggling and yet still making the effort to come to class. I would remind students, especially those with mobility issues (using walkers and canes) to not judge themself, because yoga should not focus on what your body can or cannot do in any given pose.

My constant reminder for students was “to recognize one’s own body’s limits within the pose” which became a bit of a mantra in each class. Students would explore the boundaries of their range of motion within their bodies. They would build confidence as they became more familiar with their bodies and mastered settling the vrittis, turnings, of the mind.

The students enjoyed poses like Tadasana, Mountain pose, Downward-facing Dog (by holding the back of a chair), seated forward bends and seated twists––all tend to improve posture which can further lead to better respiration, circulation, and heart health. I kept the instructions simple and the pace of the class slow to give students time to move down and up from their chair. I would help them "get into their bodies" by inquiring how they feel in the pose and ask them to observe how it feels in a particular part of their body. I kept the poses to a minimum as the students who came regularly were beginning to build confidence in knowing what poses to expect with little to no confusion in accessing the poses.

Priya: Before we end the interview, are there any closing thoughts or anecdotes you'd like to share with us about teaching yoga to geriatric mental health outpatient students?

Lara: The students told me that they looked forward to coming to class because it made them feel good and they felt like they were part of a community. Friendships amongst strangers developed between group members by being present with each other for 45 minutes every week. When time allowed, I started including a
debrief session after class for students to check in on how they were feeling. They reported that yoga practice was offering them an opportunity to build better coping mechanisms when dealing with their mental illness. I witnessed the group evolve with new members slowly becoming more aware of their bodies through yoga. Sadly though, we had to say goodbye to two of our ongoing members who passed away suddenly from multiple health issues.

Lara A McLenan-Ben BA (Psychology), BSW, MSW, RSW, YT500, received a Master of Social Work from York University, Toronto, Ontario in 1999. She practices as a registered social worker in Toronto, Ontario and received certificates in Foundations of Applied Mindfulness Meditation in 2012 at the University of Toronto, and Mindfulness-based Stress Reduction Mind-Body Medicine in 2013 with Jon Kabat-Zinn and Saki Santorelli at the Omega Centre in Rhinebeck, New York. In 2014, Lara received her 200 hour yoga teacher training, and 300 hour advanced yoga teacher training in 2018 from Yogaspace, Toronto. She took a mental health sensitivity 10 hour training with Aaron Moore and trauma sensitive yoga 20 hour training with David Emerson in her 300 hour advanced yoga teacher training - as well as a 30 hour training in creating accessible yoga classes for all ages, body sizes, and abilities with Darcie Clark.

This post was edited by Patrice Priya Wagner, Managing Editor of Accessible Yoga blog and member of the Board of Directors.

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