206 The Ethics of Scope of Practice & Scope of Competence With Yoga In Therapy: Episode By Chris McDonald

Chris McDonald: Have you been interested in bringing yoga into your therapy sessions, but are hesitant because you aren't sure it's in your scope of practice? Are you worried about bringing yoga into sessions and if it could put your license at risk? In today's episode, I'm digging into one of the most critical topics for therapists, incorporating yoga into their practice, the ethics of scope of practice and scope of competence.

How do you know if you're staying within your professional boundaries when offering yoga based interventions? What do these ethical areas mean and how do we know for an alignment with our scope of practice and how do we know if we're competent? Take a deep breath and tune in for this essential conversation on balancing ethics and learn how to protect yourself on today's episode of Yoga in the Therapy Room podcast.

Welcome to Yoga in the Therapy Room, the nontraditional therapist's guide to integrating yoga into your therapy practice. I'm Chris McDonald, licensed therapist and registered yoga teacher. This podcast is here to empower therapists like you with the knowledge and confidence to bring yoga into their practice safely and epically.

So whether you're here to expand your skills, enhance your self care or both, you're in the right place. Join me on this journey. to help you be one step closer to bringing yoga into your therapy room.

Hello, and welcome back to Yoga in the Therapy Room podcast, the non traditional therapist's guide to integrating yoga into your therapy practice. I'm your host, Chris McDonald. And I just wanted to let you know, I have a cold. So I've been having real difficulty talking today. So I gargled with some salt water.

I got my tea here. I'm gonna do my best to get through this challenging topic of ethics and integrating yoga with scope of practice, scope of competence. So this is the biggest question I do get from listeners. And this has been since the holistic counseling podcast I hosted. Um, so it's been many years that listeners have asked, so can we integrate yoga practices?

Is that within our scope of practice, our scope of competence, right? Can we do it safely as well, protecting our clients? and ourselves from potential legal ethical issues. So we're going to dive into this today because I know listeners that you also try to provide the best care for clients but of course with that comes that responsibility of staying ethical with our professional boundaries and unfortunately when it comes to using yoga practices and therapy it can be unclear.

where the boundaries lie. I've looked at many of the ethical codes. There is nothing clearly spelled out that says thou shall not use yoga practices in therapy, but it's true. There's nothing totally clear, but I did want to let you know that I have met with the American Counseling Association, their ethics committee chairperson.

I did talk to them. a couple years ago and consulted with them and I've done a lot of research over the past few years. So I hope today's episode is really going to help you get more clarity on scope of practice versus scope of competence and learn through examples in a case study, explore how to safely expand your skills, and provide the practical guidance for you.

to help you stay within the ethical and professional guidelines so that you can offer this impactful trauma informed yoga, all of these practices to your clients. I also want to touch on how to boost your competence with yoga and clinical sessions. So I know this can be a drier topic, but it is so important.

So I hope you can hang in there. in there with me through today's episode and that you can get something out of today. That's why I wanted to include some examples in a case study so that you can see the application of this in what it could look like for you. So a couple things before we start, this podcast is around the world.

So I always say, first thing is to check with your licensing board, wherever you are locally, any regulations, which. I'm going to guess you probably won't get anything totally clear, especially with new modalities. What does it say in your ethical codes? We're going to talk about some of that today, um, as far as scope of practice, scope of competence, and of course, consulting with your attorney to determine any potential legal or liability risks.

based on your licensure in particular and the practices you want to use. Getting that out of the way, let's, uh, talk about the basis as licensed professionals. We always strive to take care of the clients and not cause harm. Do no harm, right, is some of the basis of our ethical codes. We want to promote the well being of our clients, avoid any actions that could cause physical, emotional, or psychological harm.

Which brings us to where we are today with today's episode. So what is the difference? Let's start with scope of practice. As a definition, it's the legal boundaries of what a licensed mental health professional is permitted to do under their license. And it's typically defined by state licensure boards or professional organizations like the APA or ACA in America.

or wherever you are listening. So think of this, this is the legal issue, not an ethical one. Scope of competence, we're going to get to in a moment, that's more the ethical. This is the legal of what you can and cannot offer to clients. So get that clear. I'm a licensed clinical mental health counselor and some of you may also be a LPC, that's what we formerly were in North Carolina.

I think there's LPCCs, there's so many different licensures out there. So I'm going to guess that this is similar for a lot of you. So within my scope of practice, I can assist individuals, groups, families with counseling, treatment plans, other psychotherapeutic techniques to develop an understanding of personal problems, diagnosis, defined goals, and basically help them through whatever it is they're dealing with, personal, social, emotional, educational progress, occupations, and careers, right?

Sound familiar? This is all within our scope. So LCSWs are similar. So they have, they have to limit scope of practice to those clients for whom they have the knowledge, skill, and resources to serve. They shall be accountable for all aspects of their professional judgment, behavior, and decisions. From what I've seen from all, looking at all the different ethical codes, it's all similar.

We're all pretty much in the same pathway. One thing I thought was interesting looking at my board, they define not in our scope. The practice of counseling does not include the facilitation of communication, understanding reconciliation and settlement of conflicts by mediators by community mediation centers.

That is not covered to be a mediator under our licensure. That would be a separate scope of practice, which I didn't really discover that till today as I was looking at this. So they do clearly define it. So look up your own guidelines wherever you are too, just to make sure. Now, looking at scope of practice, some examples.

Discussion of medication with clients. Unless you are a psychiatrist or a psychiatric nurse practitioner, you should not be discussing medication and what drugs clients should go on. That is out of our scope. We cannot prescribe medication. And it's really important not to talk about, you know, Adjusting levels of medication and that we need to just tell clients to talk to their provider about that if they go to primary care psychiatrist, whoever it is to bring those questions.

That is something to tell your psychiatrist. That is something you need to ask your psychiatrist. However, you want to word it, but. it can get us in some hot water. If we give any information about medication, this can be very tricky territory, especially as you get more experience and you learn a little bit about some medications that you've seen that have helped former clients, but that is not in our area.

So just be real careful about that. I had a nurse practitioner told me once that, psychiatric nurse, that we're not really supposed to say anything about it. Anything other than any medication questions come up, talk to your provider. And that's it. So, just to protect yourself. And I think, of course, if any conversations come up, you can also put this in document in your clinical notes.

That's also important to be thinking about. Because what if you do tell a client, hey, maybe you should just taper down your medicine. You're not a prescriber and they decide to go off the medicine or taper down too fast and they have negative effects, it's going to come back on you. So that is one area that is not in our scope.

Now let's say a client comes in and they're having a lot of pain in their shoulders. And maybe you like the massage techniques when you went for a massage and you offer to massage a client. I can see a lot of you cringing right now. Massage is not in our scope of practice in North Carolina. We are not allowed to put hands on clients for any reason.

We can't do that with unless we are a massage therapist. So, unless you have that specific training, that is not in your scope of practice. Check with your licensure for that as well because it may be different in your state. Or if you're interested in, let's say, I know a lot of you are holistic therapists and you like to talk about how the impact of eating and the food, type of foods you eat, how often you eat can impact mental health.

Again, we have to be careful with that. Stepping across the line of scope of practice could be giving meal plans to clients. Or the other part, as far as holistic practices, exercise plans to clients. That is out of our scope. Now we can say to them, you know, you may want to consider exercise as part of treatment for depression.

That's an option. But we're not going to, if we write out exercise plans, that is out of our scope. So, it is a tricky area. So, we have to be real careful in the messaging that we give to clients that could be out of that scope. I hope all this is making sense. So, yoga integration consideration. So, bringing yoga into therapy sessions does fall within a therapist's scope of practice.

If it aligns with improving mental health outcomes, if it aligns with helping them with their goals, which we'll be talking more about on this podcast, that yoga can help with lots of mental health conditions with anxiety, depression, emotional stability. But of course, we can integrate, but without adequate training, we're going to exceed our scope of competence.

So that's the next thing we're going to be talking about here. Scope of competence. So this is not legal. Scope of competence is more of ethical concern, and the definition refers to the specific areas or interventions which a therapist has appropriate education, training, supervision, and experience.

Competence can vary within the broader scope of practice. For LCSWs, They're responsible for confining their practice to those areas in which they are qualified to practice. And I think this can be different for psychologists. I did talk to some that felt they couldn't do it, but from what I found, and this was from another country though, for the U.

S., psychologists include services based on APA to teach and conduct research. with populations in areas only within the boundaries of their confidence based on education training. So as you can see, a lot of this overlaps, right? With education, training, supervised experience, consultation, professional experience.

I think this aligns so much similar, similar guidelines across the board, no matter what your licensure is, that we really have to be careful with. making sure that we have the training. The other piece as far as psychologists, which I think this also transfers to other licensures, is cultural competence.

Yoga does originate from Eastern traditions, but we have to really approach it with cultural sensitivity, recognizing and respecting its spiritual and philosophical aspects. With, of course, we don't want to misappropriate the practice. So knowing that we have to align with that cultural competence and taking just one cultural competence course in grad school.

is not enough. So we all need to make sure that we are learning as much as we can how to help clients from different backgrounds and especially with yoga too. Here's the case study for scope of competence with yoga. So this of course is fiction, but just to give you a little bit more clarity and what this could look like.

Dr. Emily is a licensed mental health therapist with a master's degree in counseling psychology and 10 years of experience with trauma focused therapy. She's well versed in CBT, EMDR, and. She learned a lot about yoga by going to different classes in her community and seeing firsthand the potential calming and grounding effects.

So after six months of going to yoga personally, she feels confident in its benefits, she decided to try to introduce it into her therapy sessions. However, Emily has not received any formal training in yoga or trauma informed yoga practices. She bases her integration based on her own experience. and what she's read online.

She did not receive any formal supervision or consultation regarding the ethical or safety aspects of this. So she starts using yoga techniques with her clients, particularly breathing and grounding. She asks her clients to engage in yoga postures during sessions, believing it'll help them regulate emotions and stay present.

One of her clients though, Sarah, has complex trauma. including physical abuse. Emily introduces a body scan combined with deep breathing and a few seated yoga postures early in their therapy work. During one session, Emily guides Sarah into a child's pose, which is that calming yoga pose associated with surrender and grounding.

However, Sarah begins to feel increasingly anxious. The pose reminds her of times when she felt physically overpowered. and trapped during childhood trauma. Sarah tries to communicate her discomfort but her anxiety heightens and she experienced a flashback. Emily panicked not knowing how to handle this.

She tried to reassure her by giving her some deep breathing and grounding. Unfortunately, this further escalates Sarah's anxiety. The breathwork that she taught her caused more symptoms than it did relief, leading Sarah to leave the session abruptly. The ethical issue. So Emily failed to practice within her scope of competence, a violation of the ethical standards.

Although she was knowledgeable and competent in trauma therapy, she lacked the formal training in yoga and trauma informed practices. As a result, she inadvertently triggered Sarah's trauma response without fully being prepared of how to save it in a safe, trauma informed manner. She did not also look at the risk of harm.

So we cannot underestimate the negative, potential negative impact of some of these practices. Not to say they're all bad. But with people with trauma, especially complex trauma, they can be triggering. That's why we have to have the training so we can do these mindfully with clients and being able to help them, especially if they go out of their window of tolerance, which means they're into that hyper arousal of high anxiety, even anger, irritability, or hypo arousal where they may shut down.

How are you going to handle it if you don't have the training? Now, of course, a lot of us are used to helping clients through difficult emotions, but with these practices, if you aren't used to this and you use some non trauma informed cuing and you're just telling clients what to do, you're not doing it with them, it may feel unsafe.

It can bring up lots of trauma. I had a client recently that this happened with. She did breath work with someone who is not a licensed therapist and it was one of those programs where they guarantee that you can work through trauma, but unfortunately it triggered her so bad that she backslid and it caused all kinds of trauma responses.

So just know that this can happen if it's not done right. Safely and ethically with the right training. So if you're going out of competence, you're setting yourself and your clients up for risk. And again, going back to we're all here to do no harm to avoid actions that could cause that physical, emotional, psychological harm.

So we need to build on that. That competence so that we can best help our clients in a safe, ethical way, which is the point of this podcast as well. So that you can get all the proper information to help protect yourself and your clients. Now, the other piece that I didn't mention as part of the ethical code, not going to get too far into it today, but I think it needs to be recognized is informed consent.

So what does informed consent mean? With yoga, we need to have it in the written version with your informed consent for therapy practices. We need to offer informed consent each and every time that we provide a yoga practice with clients. We cannot assume that clients want to do a yoga practice every time they meet with us, even if it went well last time.

Because I've had that too, where clients have declined in That's totally fine. We roll with it and do something else or just offer them space to continue talking about their concerns. Part of the informed consent, we also have to say what are the benefits and what are the risks. And in that case scenario I just shared with you, she did not do that.

She did not inform Sarah about the potential risks. Because just like regular therapy, talk therapy, there are risks, right? That can bring up some difficult emotions and lots of You know, sometimes we can get triggered and sometimes it can get worse before it gets better. That's just the way things are with therapy.

We're allowing that space, that safe space, but still difficult emotions, sensations can come up. And with yoga, it can really trigger some people if we're not careful. Now, even if we are careful, sometimes things can come up, but we got to have the training, especially with trauma. That this can happen because Emily was thrown off guard.

She did not realize it because she thought, Oh, it feels great for me, but she's coming from a more regulated nervous system. I think keeping that in mind, too, and some of them I have post traumatic stress disorder, their window of tolerance is going to be much smaller. It's going to take less for them to go into that hyper arousal.

Or hypoarousal or both. We just don't know how that's how it's going to be impacted. So that's a little bit about informed consent. Like I said, I'm not going to get too deep on that. There is more to it, but I wanted to let you know that that was another ethical crossing boundary crossing that happened with her.

Last year, I went to a state conference and met someone just randomly, another therapist, and she did say to me something that stuck out to me that, Oh, I have gone to yoga myself many times. I don't need training to integrate it. Can't I just do what I've learned in yoga class? Similar situation with Dr.

Emily. Just because it feels helpful to you doesn't mean you can just take that from a personal practice and integrate it safely with clients. So just keep that in mind. The other piece to competence is it has to be, there has to be ongoing efforts to develop and maintain competence. This goes for licensed psychologists and licensed clinical counselors, whatever your licensure is.

That's why we often have to have a certain amount of credits per renewal. And I know a lot of you get upset with that and don't like it, but there's a reason, right? This is part of our competence that we have to keep up with. Because let's say that you went all the way and got a full 200 hour yoga certification, but maybe you got that 30 years ago.

Things have changed. Things are always changing. Science changes on what can be helpful in therapy. So it's important to remember whatever you're trained in, whatever modality that we can forget. I know with brain spotting, when I first got my level one, I was using it for a while, and then I got training in two, and then I had a big gap.

By the time I worked on my certification and had supervision, I realized that I was doing one of the protocols wrong. Now, technically we can't always do brain spotting wrong, but there was one cue that I was missing, right? So I think it's important to remember, we forget that we're humans, right? So it's important to keep up the competence and that's why it's important, I think, too, to really specialize because if you have way too many things that you're trained in.

It can be difficult to keep up that competence if you have like, let's say six different areas of specialty. It's going to be much more challenging to keep up with it. So the more you can specialize with your modalities and keep it more grounded in just a few, I think that's going to be more doable. The other thing is, Let's say that you go to a one day workshop about integrating yoga into clinical sessions.

Does that mean you're competent? It may not be. So sometimes we got to think about getting the most training we can get and what that could look like for you to feel it's not just competent, but confident. Being able to use this, these modalities in session. Are you struggling with burnout and feeling exhausted?

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org forward slash workbook today. So how do we know we are competent to integrate yoga into therapy sessions? Number one, have I received training in this? So we need at least some minimum training and practice. The more we can practice with colleagues, with friends, with family to practice these skills, the more.

Competent and confident we can become. I'm going to say it again. The more we practice these skills, the more competent and confident we can become. So that brings me to the next question. How confident am I feeling in using this with clients? If you're noticing imposter syndrome, self doubt, I'm not good enough, you may need to embody these practices more.

That's why in my yoga basics training, I really encourage, if you want to integrate yoga into sessions, that you embody these practices, that you develop a daily yoga practice, personal practice, so that you can really feel these practices inside and out. I think it's very difficult to teach these practices to clients in sessions if you aren't doing them.

And that leads me to, we're role models. We have a responsibility to be showing clients that we do these practices. And I'm not going to give homework to a client if it's not something that I'm not willing to do. And with yoga, I don't want to give homework and say, you do yoga, I'm not going to. What message does that give?

How are they going to know, right? I know they may not know, but still I'm going to know and I'm a genuine person. That's one of my values. And I think that's really important that I'm in alignment and I really embody these practices and feel them within. So I remember my 200 hour, my, it was funny because I remember Christine Weber, who teaches subtle yoga that I did the training with, that she, She could tell, I don't know how she knew if she had psychic abilities, but she knew which one of us actually did personal yoga practices.

And I don't know if it's the way that she could tell with how they taught the different yoga or what, but she just knew and she encouraged them, you need to do more yoga practices personally. So just keep that in mind if you're not feeling confident that maybe you haven't used it enough or taught enough with other people that aren't clients to move forward.

Another question, sign that you're competent. It's a question to ask. Have I received any consultation or supervision on using any of these modalities? Something to think about. And I think it's hard for us that those of us who are in the field a long time and no longer are required to have weekly supervision, I still seek out supervision and consultation because we need it.

And of course, no, I don't do it weekly anymore. It's not necessary every week, but I still try to get some input from colleagues. I still pay for supervision at times, I have to. It's so important because we can't possibly know everything about integrating yoga into clinical sessions. Things are going to come up with certain clients, there may be difficulties.

There may be struggles with different kinds of diagnosis. How do I integrate with this kind of diagnosis? I've never done this before with someone who's bipolar or has psychotic tendencies. What could that look like? So just keeping that in mind to keep that going as far as consultation and supervision.

Another question to ask about competence, how are your clients responding to these interventions? So this is time to get real clear, real honest with yourself. Is it helping them with their therapeutic goals? Yeah. Or are they feeling, seeming to be triggered and having a difficult time in session with these?

Are they not wanting to do the interventions anymore and declining each time you offer them? So something to think about. Are you able to adapt yoga practices for individual and cultural needs? Are you able to be flexible? How do you handle it when someone is triggered? What are some of the dangers, right?

So that you are aware. And again, this goes back to the competence with the training. So knowing the training and how to integrate safely, ethically, and how to do it slowly, titration, because with trauma, especially, we don't want to go gung ho and, you know, Just jump right in. We want to take our time mindfully engaging these practices with clients and helping them to find safety.

That's the first part of trauma healing is helping them find safety. So what are the red flags for incompetence? I think the number one red flag, if you've only gone to yoga classes passively and have had no training, that's a red flag. Lack of training, period, of course. And I find that for me, even though I have had my 200 hours, I've had a 60 hour mindful movement training.

I've had several other weekend yoga trainings that I'm always learning more. I'm doing my own personal study all the time. I'm continuing to go like I went to Dr. Ariel Schwartz workshop in September of this year to learn more polyvagal integration and vagal toning. There's always more to learn. And I feel like yoga is a lifelong learning process.

So keeping that in mind, the breadth and depth of yoga can go on for several lifetimes if we had it. And I feel like I'm constantly upgrading my yoga basics course because I'm learning something new that could be helpful for therapists to integrate. And I think this helps up level who we are as professionals because we're, Increasing our competence, the more we read, the more we listen to podcasts, the more trainings we go to.

And for me, I learned from other yoga teachers, the different types of teachers, there's so many ways to increase our competence. And one last red flag is, is lack of client progress or discomfort with clients. with a yoga practice. So if they seem very confused all the time with your cues or your directions and they just seem uncomfortable or they decline every time, like I mentioned, maybe they're not meeting their treatment goals.

Maybe it's time to reevaluate. Are they needing something more, something different? So just remember competence isn't just about confidence though. It is interlinked, but it's also having the formal knowledge, training experiences to back it up. But this can be created, right? We can create our own experiences.

I know when I was doing my yoga training, I created my own course for four weeks. Once a week, I taught yoga to a group of friends who would come over on a Sunday afternoon. It was really fun and a little nerve wracking, of course, as you're learning in the beginning, but that's how we learn and grow. The more we offer these practices, the better we get.

It really, there's no way around it other than just getting in there and teaching it. And it could look different for you because maybe you just want to teach your kids. That's okay too. So finding different people, I would teach my husband. My poor husband has been victim of so many different things I'm trying to teach.

And because it's really cool if you can find someone who has had no yoga experience and that's my husband, he is not flexible. He struggles. So that helps me to be a better teacher because if we just teach people who know the same practices and are, you know, have a thousand hours of yoga training, it's going to be a different experience than if it's someone who has none or a very beginner.

Continuing the discussion with boosting competence with integrating yoga into sessions. So highly encourage you to consider training with a licensed therapist who integrates yoga because what I find is a lot of listeners get formal yoga training at a studio, which is great. It's good to get that baseline of training.

So you have a good understanding of all the parts of yoga and many practices. But the problem that's lacking is how to integrate into therapy sessions ethically and safely. That's where, what is missing if it's not geared towards mental health therapists. So just keep that in mind. Um, I do offer a yoga basics course for therapists because I do think it's important to learn also, how do we integrate with clinical theory?

What does that look like? So just knowing. That we are different in that way from traditional yoga teachers because we are mental health therapists. So we offer a lot more different practices based on clinical theory, too, and as far as our interventions go. So we want to keep it all aligned and consistent.

Working in the best interest of our clients, and if you're able to get a certification, even better, but it's not required. We don't have to have a 200 hour to integrate yoga into sessions, but we need some training. The more you can get supervision and consultation. Of course, the better peer consultation groups.

Workshops with other professionals. So helpful. Integrate gradually. I always say start smaller. So maybe you've learned a practice on this podcast or in another training. Start with breath work. That's usually the most accessible or with a mindfulness practice. And you can just do that seated in a chair.

You don't have to get a mat out. You don't have to be changing to yoga clothes. It can be super helpful just to start. small and figure out what's comfortable for you and try it on your own for a little bit. And if you want to practice with someone else too, that again, that helps with the competence. You can also deepen understanding beyond movement, breath and meditation with yoga and learn about yoga philosophy, some of the guiding principles.

This can help you to integrate yoga in another way that helps respect the cultural origins and aligning with your clinical work. Aligning with you and where you are in your learning journey and who you are as a professional and personally. So key takeaway, boosting confidence takes time and commitment to continuous learning.

The depth and breadth of yoga is so rich, which is amazing because we can learn so much from different teachers in the field. I hope this was a helpful discussion. I know this was jam packed with all the ethics that can be not the most exciting part of our field, but so important. And you might need to circle back to this episode, I realize, or look at the show notes if you need to, to refresh yourself or the transcript, because it does take a little bit of reflection and time to really think about the whole scope of practice, scope of competence, and really knowing when you are competent takes some time.

Get clear on how to build a trauma informed yoga practice. Gain understanding on cues and basic sequencing for therapists. Discover clear guidelines and examples on the how and when to introduce yoga to clients in session and how to build confidence in teaching yoga to clients with my four step method.

Plus this year as an added bonus, you get two 30 minute consultation sessions with me to further build your competence. Come join the interest list and be the first to know when When the doors open for this course, go to hcpodcast. org forward slash yoga course interest. That's hcpodcast. org forward slash yoga course interest.

And once again, this is Chris McDonald sending each one of you much light and love till next time. Take care. Thanks for listening to today's episode. The information in this podcast is for general informational and educational purposes only. It is given with the understanding that neither the host, the publisher, or the guests are giving legal medical.

Medical, psychological, or any other kind of professional advice. We are not responsible for any losses, damages, or liabilities that may arise from the use of this podcast. Yoga is not recommended for everyone and is not safe under certain medical conditions. Always check with your doctor to see if it's safe for you.

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