I'm on the couch in therapist Bree Greenberg-Benjamin's office, but it's not what you think. Instead of digging into my past while I lie supine, she is demonstrating bakasana, or the crow pose, with her hands resting on the floor and her knees balancing on the backs of her elbows.
"When you're trying to balance on your hands," says Greenberg-Benjamin, her voice slightly strained from the effort as she returns to standing position, "you can't really focus on what you're going to eat."
For many of her clients, focusing on what they're going to eat - or, to be precise, what they're not going to eat - is what brings them to this small white house in South Burlington. Here Greenberg-Benjamin shares office space with a number of other psychotherapists, many of whom have their doors shut with an "in session" bar slotted below their names, as clients enter and exit the building discreetly.
Greenberg-Benjamin treats one of the deadliest forms of mental illness: eating disorders. And the yoga poses she's now demonstrating aren't a distraction from the treatment; they're part of it.
As one of the country's first clinicians to combine the ancient Eastern practice with contemporary Western psychotherapy, Greenberg-Benjamin hopes to break through to anorexic and bulimic patients - while breaking a sweat on the yoga mat. "Yoga has profound healing effects," she says. "This is huge."
According to the Seattle-based National Eating Disorders Association (NEDA), nearly 10 million girls and women - along with 1 million boys and men - suffer from anorexia, bulimia or other potentially fatal eating disorders. NEDA also reports that when women between 15 and 24 suffer from anorexia nervosa, the eating disorder is 12 times more likely to kill them than all other causes of death combined. Every decade since 1930 has seen a rise in the incidence of anorexia.
These statistics, along with the particular challenges of helping anorexics and bulimics, led Greenberg-Benjamin into her current line of work. A licensed therapist, she also has a Master's in Education. "I've always been attracted to treating populations that have poor cure rates," says Greenberg-Benjamin, who worked with at-risk kids in Miami before relocating to Baltimore, Washington, D.C., and eventually Burlington. (She practiced more traditional therapy in those other cities.)
Greenberg-Benjamin says she's drawn to the personality issues that eating disorders raise. "Girls who have eating disorders tend to be acutely aware, very bright, multilayered and very difficult to get to," she says. "The central issue, which is the core of what most females struggle with, is having a very unformed, scattered sense of self."
In 1996, when Greenberg-Benjamin was 24, she dealt with her own health crisis when she suffered adrenal failure and went through early menopause. She sought alternative-medicine solutions, discovered yoga, and was hooked, she says. "The moment I got to yoga, it was like I had been there for 100 lives," says Benjamin.
A study published in 2005 in the Psychology of Women Quarterly tested whether yoga might help women with eating disorders. Working with nearly 150 women, the Berkeley-based researchers discovered that "yoga practice is associated with greater body awareness and responsiveness, which, in turn, are associated with lower levels of trait self objectification, greater body satisfaction, and lesser disordered eating attitudes." Yoga training, the authors concluded, could be used to help prevent and treat such disorders.
Nonetheless, Greenberg-Benjamin says she's still one of the only therapists who fully integrate yoga into their practice. "At lots of inpatient centers, yoga's an activity that people can attend," she says. "The difference here is that yoga is specifically therapeutic, and it ties into the work we do in a group."
Last fall, Greenberg-Benjamin launched a three-pronged, 14-week program for a handful of Burlington-area teenaged girls with eating disorders, consisting of 50-minute individual therapy sessions, hour-long yoga classes and hour-long group meetings based on the Internal Family Systems model. "The goal is to bring the body and the mind into balance," she says. "There's less focus on the symptoms, such as weight loss or purging, and more focus on the feelings and emotions that promote the symptoms." She calls the practice "Pratyaagati," or "journey home."
For the high schoolers undergoing last year's program, the yoga was particularly emotional. "With eating disorders, emotions are so tightly locked up that these girls are completely numb - they have no connection with their bodies at all," Greenberg-Benjamin explains. "In yoga, I'm instructing them to bring their mind to that sensation, so they're making a connection, and all those feelings they've put away begin to erupt; there would be crying during poses."
For treatment of eating disorders, Greenberg-Benjamin says some of the best movements are grounding and balancing poses such as downward-facing dog, tree, standing half-lotus and the warrior series. She combines these asanas with breath work and Buddhist meditation to teach her clients nonviolence.
"An eating disorder is about violence to oneself," Greenberg-Benjamin explains. "It's all about starving yourself and beating yourself up."
Of course, many women, with and without eating issues, turn to yoga as a way to tone their bodies. Given that, could Pratyaagati be one of the many factors that "trigger" such disorders? On the contrary, she says: "That's the way I get people to do the yoga - they think [they're going to get in better shape]. But that isn't the type of yoga we teach."
Instead, the practice slows down over the course of several weeks, allowing her patients to become more "still" and more conscious of their imbalances. The results of last year's pilot program, says Greenberg-Benjamin, were "fantastic - every one of those girls is doing really well right now."
On October 6, she will initiate a second session of Pratyaagati, this
one for women 18 and older. For Chrystie, a 19-year-old participant in last year's session, the approach was more of a journey inward. "I hated yoga - I thought it was ridiculous, and I'd have a thousand thoughts running through my head at first," Chrystie says. "But then, after three weeks of trying to do a headstand, I learned that I couldn't trust myself, and I couldn't trust others."
The breakthrough, she says, allowed her to discover healthy eating habits that she had long resisted, even during four years of supposed recovery. When she went into Greenberg-Benjamin's program, she was eating two meals of very small portions per day. Since completing Pratyaagati, she's been eating three square meals. "I feel good about myself; I'm not counting calories," says Chrystie. "And the biggest thing? I could eat chocolate cake on my birthday."
For more information on Pratyaagati, call Bree Greenberg-Benjamin at 658-4208, ext. 113, or visit http://www.pratyaagati.com.