3-Steps to Building a Successful Ayurvedic Yoga Therapy Practice

By Jennifer Rioux, Ph.D., AD, AYT, CIAYT, RYT

The International Association of Yoga Therapists (IAYT) paved the way for recognition of yoga therapy in the U.S. Building on that recognition, NAMA has now debuted the new professional category of Ayurvedic Yoga Therapist (AYT-NAMA). Our conception of this emerging profession draws from the IAYT’s statement that “although all yoga is potentially therapeutic and healing, yoga therapy is the specific application of yogic tools—postures/exercises, breathwork, meditation techniques, and more—to address an individual’s physical, mental, and emotional needs.”

The National Ayurvedic Medical Association (NAMA) further defines Ayurvedic Yoga Therapy as the “application of Āyurvedic principles to the practice and principles of Yoga based on the Āyurvedic understanding of the nature of patient, the nature of imbalance, and the nature of the therapies, to promote healing and achieve a harmonious state of body and mind with respect to individual consciousness.”

Step 1: Reach the Appropriate Educational Standards

The education of a yoga therapist must go beyond the usual training of a yoga teacher to include instruction on client assessment and treatment. The individualized nature of yoga therapy separates it from yoga practice in a community studio. IAYT describes this distinction: “A general public yoga class can certainly ease everyday aches, pains, and mood complaints. But a yoga therapy session goes much further because it is tailored to the individual. Yoga therapists have in-depth training to help them assess and keep their clients safe. They work with you to address your specific goals while considering any limitations you might be experiencing.”

The unique nature of an Ayurvedic Yoga Therapist’s role dictates a Scope of Practice that includes services grounded in Ayurvedic theory and applied knowledgesof physiology and cause and effect according to the underlying gunasand the manifesting doshas. The AYT Scope of Practice states that “the Āyurvedic Yoga Therapist shall have the competency to design, implement, demonstrate, instruct, and teach an individual a yoga therapy program to help with their healing process based on the Āyurvedic Prakŗti/Vikŗti paradigm and Āyurvedic definition of health.” 

Currently, IAYT maintains high educational standards for yoga therapists that include the completion of more than 800 hours of training. IAYT now has over 175 schools worldwide that have been accredited to train yoga therapists. Comparatively speaking, our efforts to legitimize the field of Ayurvedic Yoga Therapy as conceived by NAMA are still in their infancy. Schools are in the process of seeking recognition to train individual practitioners. The accomplishment of these goals rests on the assurance that this professional designation requires extensive training t in both Ayurvedic medicine and yoga therapy that enables the practitioner to provide comprehensive whole-person care. To that end, the AYT Standards Committee has increased the required training hours d to between 1,100 and 1,500 hours, with 1.300 as the median.

Step 2: Take Policies into Consideration

An Ayurvedic Yoga Therapist has the ability to help with disease prevention, health promotion, and both acute and chronic health conditions. However, the legal status of such a practitioner will vary from state to state. The National Health Freedom Coalition lists 10 states with Health Freedom Laws. Ayurvedic Yoga Therapists in these states will have more leeway in describing and advertising their practice to the public and in interacting with clients. Consult your local and state statutes for the specific details.

NAMA is not qualified to dispense information or advice on legal issues related to AYT practice; however, we can provide information on what types of guidelines and administrative requirements may influence the nature of your practice. It will be critical that you ensure compliance with any licensing (business or provider related) that is relevant for hands-on healing in your area. It will be necessary to provide a disclaimer on your website and documents indicating that you are not engaged in the practice of medicine. State clearly that your professional objective is to treat Ayurvedic imbalances and request consent for treatment from your clients.

Likewise, it will be helpful to publish a code of conduct on your website that states how you will interact with clients, the parameters for physical contact, and the measures you have in place to protect their confidentiality. Ideally, your clients should feel fully informed before they walk in the door. Always ask if they have questions before beginning assessment or treatment. In addition, make sure that clients understand that you are not equipped to deal with healthcare emergencies. On your voicemail, remind clients to call 911 in the case of any health emergency. Familiarize yourself with NAMA’s Code of Ethics and make sure you can confidently address any client concerns related to ethical practice.

Step 3: Understand Best Practices

Best Practices include behaviors, actions, and approaches that will help you to ensure a high standard of care for your clientele. This may include organizational systems, strategies for keeping yourself accountable to your scope and ethics during sessions, protocols for client documentation, and standards that ensure each client receives equal and appropriate care. You may also want to have an online appointment system or a designated return-call policy of 48 hours. You should have a set of documents you use for recording assessment and treatment information for clients to standardize recordkeeping across your practice. You may want to develop “charting” strategies for tracking patient progress as wellaspprotocols for common conditions that you can use as a foundation for personalized care.

Everyone will set up their practice differently; however, following some of the previously mentioned advice will help the field of Ayurvedic Yoga Therapy gain legitimacy and will helpt AYTs communicate with each other and with other health professionals more effectively. As we recognize more individual members of the AYT professional category and begin to approve training programs, it will benefit all of us to be mindful of the impact of training requirements, the defined Scope of Practice for AYTs, and local and state policy considerations on your approach to providing AYT services. The manner in which we implement best practices will ensure that the public has quality information and will ultimately increase both accessibility and effectiveness of Ayurvedic Yoga Therapy, thereby increasing the clientele for this emerging healing discipline. 

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ABOUT THE AUTHOR

Jennifer Rioux, Ph.D., AD, AYT, CIAYT, RYT specializes in the professionalization of Ayurveda/Yoga and their relationship to Integrative Medicine. Dr. Rioux has been faculty and researcher at the University of New Mexico, Arizona medical schools and the University of North Carolina.

How to Build a Successful Ayurvedic Practice with Education, Legalities and Business Practices

By Felicia Tomasko, RN, C-IAYT, AP

If you’ve embarked on a course of study of Ayurveda, you’ve likely done so out of passion. You may have found some purpose in the teachings or even some measure of healing in your own life. Then, perhaps you decide to put the teachings into practice in a practical way and build a profession from your passion. When it comes to building a successful Ayurvedic business, there are a number of factors to address, from understanding the scope of practice in relation to your education, to knowing the laws you are practicing within, to fully understanding yourself. In addition, even if you didn’t set out with this goal in mind, it’s time to embrace the art of being an entrepreneur. Here are some suggestions for transitioning from Ayurveda as passion to Ayurveda as practice.
 

Know Yourself

While this may seem like a bit of a cliche, taking some time for an inventory of self-awareness is a key component to building any successful career. This is distinct from understanding the scope of your education. Knowing yourself includes understanding something about the ways in which you want to engage with your practice and your business. Where and how do you want to work? For example, do you thrive as part of a team and want to join an integrative medical clinic or group? Do you prefer to set up a solo practice? If so, is there a space at home where you can create a professional office space? Are you looking to make or sell products? Are there specialties within Ayurveda that you feel you want to focus on? Do you visualize a full-time practice or part-time work to accommodate family or other commitments? Try journaling or finding a friend, mentor, or colleague who is willing to brainstorm or heartstorm (as one of my friends says) with you. Know that some of your ideas might change, but it’s helpful to start the process of self-inquiry at the beginning, as it may inform some of your direction and subsequent decisions. As with any business, you’ll be starting where you are in the moment yet making plans to grow a practice and hold an expanded vision.

Embrace Your Education and Scope of Practice

Ayurveda is a vast science and practice. In order to promote clarity in the different educational paths, the National Ayurvedic Medical Association (NAMA) offers separate categories of practitioner types, each with their own course of study, requirements and scope of practice. Of course, Ayurveda is a life-long pursuit, and no matter where you begin there are options available to earn new certifications. In the meantime, understand where you are now and organize your business so that you are operating within the scope of practice appropriate to your educational competencies and certification. Continuing your education is important from the perspective of adhering to ethical guidelines as well as setting yourself up for success.

Commit to Continuing Your Education

Wherever you land in terms of a certification and title, completing continuing education on an annual basis is an important part of staying fresh and current. Even if you are seeing clients daily, nothing substitutes for an ongoing infusion of knowledge and insight from master teachers, clinicians with different experience than your own, and the ongoing wisdom that comes from being a perpetual student. This will continue to expand your skill as a practitioner, clinician, and businessperson, promoting your personal success. Through conferences, classes, and even conference calls and webinars, NAMA offers and refers numerous opportunities for continuing education. Personally, every event or class I attend provides at least one (if not many) a-ha moments that fine-tune or expand my ability to practice successfully.

Know the Laws and Choose a Business Structure

Once you understand the scope of your Ayurvedic specialty, relate that to the laws where you are. This includes understanding the state or regional regulations that apply to the practice of complementary and alternative medicine or therapies. If you have an active medical license, make sure that you are operating within the scope of practice of your Ayurvedic certification as well as your medical license.

Follow the legalities of operating a business in your local area including maintaining a business license and sales tax reporting (if applicable). Look into liability and other insurance policies that relate to both your place of business as well as your practice. Also, create a business structure and accounting system to provide the greatest ease and set yourself up for a long-term successful practice. You may decide to operate as a sole proprietor or to create an LLC or other business corporate structure for liability reasons, for greater clarity, or to facilitate long-term growth if you plan to hire employees or sell products.

Even though you may start small, keep in mind your extended vision. Set up the structures that support your growth. This projected growth may be from one client to five clients or one client to five thousand. The size of the expansion doesn’t matter but having systems in place that create a container for your practice allows you to be the best practitioner you can be. Along the way, utilize the support available for small business owners and budding entrepreneurs. In the US, resources like the Small Business Administration offer free- and low-cost classes as well as opportunities to access mentors.

Ethics Including Confidentiality

Taking an online ethics course is part of maintaining your ongoing professional status with NAMA. Implementing appropriate ethics is essential to maintaining a long-term successful practice. Make sure to implement the appropriate levels of confidentiality surrounding record-keeping and working with clients. Apply this to the systems you set up as well as how you conduct yourself in public. Your clients will notice the care with which you handle sensitive information; it helps to build trust and empowers them to confide in you more freely. This allows you to make appropriate recommendations that set your client up for greater success.
 

Build Your Networks

When it comes to building your networks, think about this from a variety of perspectives. On one level, it relates to building out-bound as well as in-bound referral networks in your community. Who will you call upon when faced with something that is outside your scope of practice? Who will you turn to for advice? Continue to maintain referral relationships with the teachers and mentors from your Ayurvedic programs when you need to discuss (confidentially, of course) a specific case. In addition, develop relationships with people in your community, including providers from other disciplines, for when you are looking for advice or when one of your clients needs services from another system. Get to know acupuncturists, chiropractors, OB/GYNs, massage therapists, energy workers, primary care providers, and more. Find people that you feel sympatico with and would feel comfortable making referrals to. At the same time, develop relationships with people who would be willing to refer clients to you. There may be other providers in your community who are looking for an Ayurvedic specialist whom they can trust. Considering providing some of them a free introductory session so they can get to know you, or offer to give a talk at their office. You may want to host an Ayurvedic tea and chat and invite them for a meet and greet. Developing these relationships in your community is an important aspect of solidifying the success of your own practice.

The other part of building your network is related to growing your group of clients. Start out by connecting to your spheres of influence and being open and communicative about your practice and what you do. You could volunteer at health fairs, donate gift certificates when the opportunity presents itself, encourage (and reward?) referrals from your regular clients. Come back to knowing yourself and your areas of specialty and/or competency. Connect to relevant communities through your areas of expertise. This may include working with kids, women, men, special populations or conditions, areas of interest, and more. As you know yourself, share yourself. As you grow, expand and nurture your networks. Take every opportunity daily to connect your passion to your practice.

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ABOUT THE AUTHOR

Felicia Tomasko, RN, E-RYT-500, combines decades of Ayurvedic study with her background as a registered nurse. Her experience includes working in hospice care, in drug and alcohol recovery, and in biochemical and cognitive neuropsychology research and is the editor in chief of LA YOGA Ayurveda and Health Magazine.

BAMS In the U.S.A

Over the past 40 years, many graduates with a Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree, as well as BAMS MD, have come to the U.S. We owe a great deal to these individuals and are very fortunate for the risks they have taken and challenges they have overcome in bringing Ayurveda to the west.

We can consider these generous souls to be our Ayurvedic godmothers and godfathers as many were our first teachers, offering short courses and introductions to Ayurveda. As their students increased in number and dedication, many began to teach more formally. Historically, this is how many of our current Ayurveda schools were founded. It is because of the dedication of these early leaders and teachers that Americans leapt into the sacred waters of Ayurveda and began to study in earnest.

It is not an easy task to introduce a new system of medicine into a completely different culture. It has taken these pioneers of Ayurveda several years in order to be comfortable enough to talk about and share their wisdom. They have had to acclimate themselves by examining our western culture, the environments in which we live, the foods we eat, and our ways of being in order to appropriately apply the principles of Ayurveda to our western world. Through their own personal studies of the American culture, they have succeeded in translating Ayurveda into not only the English language, but also the western culture as a whole.

Unfortunately, it is not possible to presume that all immigrants with a B.A.M.S. have had this kind of exposure to and education about the U.S. To practice or teach Ayurveda here, it is essential to understand the laws pertinent to practicing as a health care professional – licensed or otherwise. Currently, it is not legal to practice the full scope of Ayurveda here in the United States as it is in India. Considering that 40 out of 50 states do not have health freedom legislation, anyone residing in those states and practicing Ayurveda must understand their legal limitations and take the appropriate steps to protect themselves and their practice.

Much of what Ayurvedic doctors and B.A.M.S. professionals practice in India is not legal here. There are many herbs, treatments and procedures that simply cannot be offered. In many states, Ayurvedic professionals can only work as Ayurvedic educators within the realm of diet and lifestyle. This, of course, limits the scope of practice that many B.A.M.S. graduates have been taught.

Equally important for those relocating to the United States is taking the time to learn the language, the types of foods people eat, and the American lifestyle. It is difficult for Americans to understand recommendations that do not apply to their environment and lifestyle. Often these interactions end up being ineffective and clients walk away discouraged and confused.

In conventional medicine, doctors emigrating from other countries are required to meet U.S. medical school standards, which often requires returning to school and passing a series of tests before they are allowed to practice as an M.D. Although this is not expected for B.A.M.S. immigrants, it is encouraged that a period of education and acclimation be considered before entering into an American practice.

Recommendations for Recent BAMS Immigrants 

1. Join NAMA as a professional member. This will provide many levels of support and education that you may need as well as connect you with a community of Ayurvedic professionals including members with B.A.M.S. degrees that have experience practicing in the United States.

2. Take time to polish your English conversational skills.

3. Find a local NAMA member to mentor you. Shadow them for a while to get comfortable with American customs and attitudes.

4. Take Professional Ayurvedic Continuing Education (PACE) courses for topics in which you may need additional training or study.

NAMA Responds to Issue of Heavy Metal Toxicity

National Ayurvedic Medical Association (USA)
Ayurvedic Practitioners Association (UK)
Verband Europäischer Ayurveda-Mediziner und -Therapeuten (Germany)

Joint Response to the August 2008 JAMA Article

A study conducted “to determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic” has concluded that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” The article can be found in the August 27 issue of JAMA, the Journal of the American Medical Association (Vol 300, No.8 p915) titled “Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet.”

The National Ayurvedic Medical Association (NAMA), Ayurvedic Practitioners Association (APA) and Verband Europäischer Ayurveda-Mediziner und -Therapeuten (VEAT) welcome all efforts to enhance quality and safety of Ayurvedic products but recommend that this study be interpreted with caution. We recognize and support the need for effective quality control in the use of all Ayurvedic products and promote the use of suppliers who use Good Manufacturing Practices. We agree that there is clearly a challenge with heavy metals throughout the food chain as a whole.

“Metals,” “heavy metals” and “toxic metals” are all terms used for a group of elements which include lead, mercury, arsenic and others that are known or suspected to cause toxicity in certain forms and at certain doses. The detectable presence of these elements in dietary products and food or water is not the same as toxicity. These elements are present in many of our everyday foods and as shown in this study, Ayurvedic dietary supplements. In the case of foods and herbal products their presence can occur because: 1) they are naturally occurring in the soil, water and air, 2) from pollution as a result of human activity where in both cases theses elements are taken up by the plants, 3) from contamination in the manufacturing process, and 4) these elements are intentionally added. Toxicity is the result of too much of the specific form of metal being ingested over time.

In the U.S, there is no current national law precisely regulating the amount of lead, mercury and arsenic in dietary supplements. There are various opinions on what the maximum safe daily limits for lead, mercury and arsenic in dietary supplements should be. For example, four authorities are, mentioned in the JAMA article and their limits vary considerably. They are: the California Safe Drinking Water and Toxic Enforcement Act (California Proposition 65) that gives a maximum level of 0.5 μg /day for lead as a reproductive toxin; The American National Standards Institute (ANSI)/National Sanitation Foundation (NSF) International Dietary Supplement Standard 173 that gives a maximum level for lead at 20 μg /day, mercury at 20 μg /day and arsenic at 10 μg /day; the US Environmental Protection Agency (USEPA) that gives a maximum level of 21 μg /day for inorganic mercury and 21 μg /day for inorganic arsenic for a 70 kg adult; and The Food and Agricultural Organization / World Health Organization Joint Expert Committee on Food Additives (FAO/WHO) that give total dietary intake maximum levels of 250 μg /day for lead, 50 μg /day for mercury and 150 μg /day for arsenic for a 70 kg adult. In the absence of specific standards it is difficult for the dietary supplement industry and Ayurvedic community to know what limits to meet. NAMA, APA and VEAT welcome government guidelines for the industry. [μg = mcg = micrograms or one millionth of a gram = 0.000001 sometimes referred to as ppm or parts per million -- mg = milligrams or one thousandth of a gram = 0.001]

The JAMA article states that “one-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.” However, as discussed above, the simple presence of any of these elements does not in and of itself translate to toxicity. This “one-fifth” (or 20%) was based simply on whether lead, mercury or arsenic was able to be detected in the product, not the specific forms of these metals that are of concern and without consideration of the resulting daily dose. More importantly, all these products were said to “cause ingestions exceeding at least 1 regulatory standard.” The “regulatory standard” with the lowest levels is California’s Proposition 65, with a maximum level of 0.5 μg /day; the lowest by far of all of the limits cited in the article and one that does not take into consideration naturally occurring lead. It is important to note that California Proposition 65 is not a regulation prohibiting sales of these products, but rather requires a specific warning to the consumer if a product contains these elements above its limits. If a different analysis were done using the daily dose limits of ANSI/NSF, USEPA and FAO/WHO, we would find that the percentage of products containing heavy metals and resulting in daily doses above their recommended amounts is approximately 8% of total products, not the 20% stated in the article.

There is one more important issue to consider. Among the products tested, there were some traditional Ayurvedic products that intentionally contain specially prepared forms of lead, mercury and or arsenic. Although these products have been in use in India for hundreds of years with claims of efficacy and safety, they have not been proven by modern medical science to be either safe or effective. NAMA, APA and VEAT recommend that practitioners and consumers should avoid the use of products in which lead, mercury and or arsenic have been intentionally added until these products are better understood by modern science and medicine, and there are clear guidelines both from within the Ayurvedic community and national laws. Finally, if we were to count only those products that do not have lead, mercury or arsenic intentionally added but would still result in daily doses above the authorities other than California Proposition 65, we find about 5%, not “one fifth” 20%.

In order to adequately and effectively meet the existing challenge of heavy metal contamination in Ayurvedic products, NAMA, APA and VEAT make the following recommendations:

1.  That government and industry establish sound, scientific daily dose limits for lead, mercury and arsenic in all dietary supplements and establish Good Manufacturing Practices that all manufacturers demonstrate compliance through independent third-party testing using validated preparation and testing methodologies, not just for Ayurvedic products and dietary supplements but also for conventional foods.

2. That manufacturers, marketers, practitioners and consumers of herbal products stop importing, manufacturing, distributing, selling, recommending and using any product for which lead, mercury or arsenic have been intentionally added until such time as modern western science and medicine have proven the safety of such products.

3. We support those companies who adhere to the points in these recommendations, Good Manufacturing Practices, quality control and who are members of one or more recognized industry associations that are committed to safety and quality.

4. Until such time as government and industry can agree upon and establish scientifically sound daily dose limits for lead, mercury and arsenic, we recommend that manufacturers and practitioners adhere to any government regulations currently in existence and at a minimum follow the lower of the guidelines established by ANSI/NSF and FAO/WHO which are currently 20 μg /day for lead, 14 μg /day for mercury and 10 μg /day for arsenic. Consumers must make their own decisions on what is safe for them based on sound scientific, medical and expert advice according to their own personal situation.

NAMA-APA-VEAT Joint Response to JAMA Article on Heavy Metals in Ayurvedic Medicines - September 2008