Kriya yoga

1. Introduction

Version followed: Kriya Yoga as published by Self-Realization Fellowship (SRF) and its Indian counterpart Yogoda Satsanga Society of India (YSS), the organisations founded by Paramahansa Yogananda, using their own public web pages. Ananda Sangha, founded by Yogananda's disciple Swami Kriyananda (J. Donald Walters), teaches a closely related sequence and is cited where it differs. Other Kriya lineages that trace back to Lahiri Mahasaya through other disciples exist [uncertain: not verified] and are not described here.

Kriya Yoga is a modern teaching organisation's path, not a psychotherapy. SRF presents it as a home-study course (the SRF Lessons) that leads, after preparation, to initiation into the Kriya technique, described by SRF as "a highly advanced Raja Yoga technique of pranayama". The core technique is given only to initiated students under a pledge of confidentiality. This guide therefore gives the public outline only and focuses on the psychotherapist's work with clients who practise it. [source: SRF Kriya Yoga Lessons page; SRF techniques page]

How change is understood, as the tradition holds it: SRF says that practice of Kriya reinforces life energy (prana) in the spine and brain, and that it speeds the practitioner's spiritual evolution towards Self-realisation and "God contact" (Yogananda's phrase as quoted by SRF). Initiation is described as formally establishing a guru-disciple relationship with Yogananda and his lineage. These are religious claims of the tradition, reported here as the tradition states them, neither affirmed nor dismissed. [source: SRF techniques page; SRF Kriya Yoga Lessons page]

Lineage as the organisations publish it [source: SRF Lineage and Leadership page; YSS 150th anniversary page]:

• Mahavatar Babaji: SRF says there are no historical records of his birth or life and describes him as a deathless avatar who revived Kriya Yoga in this age.
• Lahiri Mahasaya (born 1828, Ghurni, Bengal; died 1895, Banaras): met Babaji near Ranikhet in the Himalayas and was initiated into Kriya. YSS dates this revival to 1861. He lived as a householder in Banaras.
• Swami Sri Yukteswar (1855 to 1936, Serampore): disciple of Lahiri Mahasaya and Yogananda's guru.
• Paramahansa Yogananda: went to America and founded SRF in 1920; died 1952. His Autobiography of a Yogi is the movement's best-known book. It was first published in 1946 [uncertain: not verified]. YSS says he personally initiated about 100,000 disciples.
• Current leadership: Brother Chidananda has been president and spiritual head of SRF/YSS since 30 August 2017. The board consists of monastics with lifelong vows. Monks and nuns of the SRF Order lead classes and retreats and offer spiritual counsel.

2. Framework

This section has two parts: the organisation's own course structure, which the client follows with SRF/YSS, and the therapist's parallel structure, which is [synthesis].

2a. The SRF path as published

[source: SRF Kriya Yoga Lessons page; SRF Lessons and programmes page; SRF techniques page]

Ananda's published teaching sequence for a single meditation sitting is: Energization Exercises to relax the body; Hong-Sau to quiet the breath and focus the mind; Aum to turn attention further inward; then Kriya once body and mind are settled. Experienced practitioners may vary the order. [source: Ananda, The Sequence of Meditation Techniques]

SRF states the Energization Exercises take about fifteen minutes. SRF's public pages do not give daily practice schedules. [source: SRF techniques page]

2b. The psychotherapist's parallel structure [synthesis]

No source gives a therapy session count or format for working with Kriya practitioners. A workable structure:

1. Assessment: presenting problem, spiritual history, where the client is on the path (Lessons student, Kriya initiate, member of SRF/YSS, Ananda or another lineage), practice amount, meaning, community, and any meditation-related difficulties. Move on when the role of practice in the problem and in the client's resources is clear.
2. Collaborative formulation: decide with the client whether practice is a resource, a neutral background, a source of difficulty, or all three. Move on when there is agreement on how practice will (or will not) be discussed in therapy.
3. Treatment proper: the client's usual evidence-based treatment, with client-led integration of practice-derived values and resources, and monitoring of practice-related effects.
4. Consolidation: relapse prevention that includes how the client will notice and respond to practice-related difficulty, and who in their tradition they can turn to.

3. Guiding principles

• Client-led, consent-based integration [synthesis]: the client decides whether and how their practice enters therapy. Meaning: ask, do not assume, and record the client's preference.
• Respect the confidentiality pledge [source: SRF techniques page]: SRF teaches the techniques under a pledge not to divulge them, to keep them unaltered and to prevent self-appointed teachers. Meaning: never ask the client to describe or demonstrate the Kriya technique; work with effects and meaning, not method.
• The therapist is not a guru, Kriya teacher or minister [synthesis]: technique questions go to the organisation's monastics or authorised teachers. Meaning: say "that is a question for your teacher" and help the client get there.
• Attribute, do not adjudicate [synthesis]: concepts such as prana, Aum, guru, Self-realisation and mahasamadhi are described in the client's own terms. Meaning: use the client's language; do not argue for or against the tradition's metaphysics.
• No health claims become treatment claims [synthesis]: SRF says Energization reduces stress and that Kriya lets heart, lungs and nervous system slow down naturally; SRF cites no clinical studies for these on that page. Meaning: physical symptoms and medication questions go to the client's doctor.
• Breath safety [synthesis]: Kriya is described by SRF as a pranayama technique. Meaning: the therapist neither teaches nor modifies breathing techniques from the tradition, and does not prescribe breath work drawn from it.
• Adverse effects are real and not rare [source: Farias et al. 2020; Cheetah House VCE]: meditation-related difficulties occur, including in people without prior mental-health history. Meaning: ask about them routinely, without alarm.
• Trauma sensitivity [source: Treleaven 2018, publisher description]: attention, arousal, relationship, dissociation and social context shape whether practice stabilises or destabilises a trauma survivor. Meaning: keep the client within tolerable arousal and treat dose as adjustable.
• Power awareness [source: The Union; Hinduism Today]: guru-disciple relationships carry power, and at least one Kriya-lineage organisation has been found liable in court in connection with sexual misconduct. Meaning: listen for coercion without presuming it.
• Ecumenical neutrality between organisations [synthesis]: SRF and Ananda have litigated over Yogananda's legacy. Meaning: do not take sides between lineages; follow the client's affiliation.

4. Intervention inventory

Because the Kriya technique and the SRF meditation techniques are taught only through the Lessons and initiation, the therapist does not teach any of them. The inventory below is (a) the public outline the therapist needs, and (b) the psychotherapist's own procedures alongside the practice. Items marked [synthesis] are this guide's clinical guidance, not SRF teaching.

4.1 The public outline of the four SRF techniques (therapist knowledge, not instruction)

• Purpose: to understand what a client means when they mention a technique, without asking them to break their pledge.
• Steps (what SRF publicly says each technique is for; no method is given here) [source: SRF techniques page]:
  1. Energization Exercises: psychophysical exercises, about fifteen minutes, that SRF says use breath, life force and concentrated attention to direct energy through the body in turn, preparing for meditation and developing "dynamic will power".
  2. Hong-Sau Technique of Concentration: withdrawing thought and energy from outer distraction to focus on a goal, a problem, or the Divine within. Ananda describes it as quieting the breath and focusing the mind [source: Ananda sequence page].
  3. Aum Technique of Meditation: SRF describes it as experiencing the Divine Presence as Aum, "the Word or Holy Ghost" underlying creation.
  4. Kriya Yoga: SRF describes an advanced pranayama in which the life current is revolved up and down the spine. Practice details are restricted to initiates.
• Example language (illustrative): "I know Kriya is taught under a pledge, so I won't ask how you do it. What I'd like to understand is what it's like for you and what it means in your life."
• Watch for: the client offering technique details out of politeness or anxiety; gently decline. If the client is teaching themselves Kriya from unofficial sources (books, videos) rather than an authorised teacher, note it and explore, without encouraging them to bypass the organisation [synthesis].

4.2 Spiritual and practice history

• Purpose: to place the practice in the client's life and in the formulation; use at intake with any client who mentions Kriya, Yogananda, SRF, YSS or Ananda [synthesis].
• Steps [synthesis]:
  1. Ask which organisation or lineage and whether the client is a Lessons student, a Kriya initiate, a member of an ashram or monastic community, or reading independently.
  2. Ask about amount and pattern of practice: daily sitting, long group meditations, retreats, recent changes.
  3. Ask what practice gives them (calm, meaning, devotion, community) and what, if anything, has been hard.
  4. Ask about the guru relationship and the client's community: who they turn to, how decisions are made.
  5. Ask how they would like practice handled in therapy (see 4.4).
• Example language (illustrative): "Some people find their practice is one of their main supports; for others it's complicated. How is it for you right now?"
• Watch for: reluctance that may reflect the pledge rather than avoidance; recent intensification before symptom onset; isolation from non-practising family.

4.3 Cultural Formulation Interview with the spirituality, religion and moral traditions supplementary module

• Purpose: a structured way to elicit the client's cultural and religious understanding of the problem, help-seeking and expectations. The DSM-5-TR includes the CFI and a supplementary module on spirituality, religion and moral traditions [uncertain: not verified].
• Steps [synthesis]: use the core CFI questions about the client's definition of the problem, causes, supports and expectations of help; add the spirituality module where practice is relevant; record the client's own terms (guru, Kriya, Self-realisation). Do not reproduce module items to the client from memory; use the published manual.
• Example language (illustrative): "How do you and the people in your spiritual community make sense of what's been happening?"
• Watch for: explanations of distress in terms of karma, spiritual testing or insufficient devotion. Explore these respectfully; they may be sustaining or self-critical.

4.4 Client-led integration of the teachings

• Purpose: to use values and resources the client already holds (for example SRF's emphasis on balanced spiritual living, or a Kriya Lesson titled "Plan of Life for the Kriya Yogi") within ordinary evidence-based work [source for lesson titles: SRF Kriya Yoga Lessons page; integration method: synthesis].
• Steps [synthesis]:
  1. Get explicit consent to bring the teachings into therapy; record it.
  2. Ask the client which teachings or passages from Yogananda's writings matter to them now; let them bring their own text rather than the therapist quoting.
  3. Link those values to treatment goals (for example values-based activity scheduling, self-compassion, acceptance).
  4. Review whether the integration helps; drop it if it becomes a source of self-criticism.
• Example language (illustrative): "You mentioned your Lessons talk about balance. What would a balanced week look like for you, given what's going on?"
• Watch for: the therapist steering towards a preferred interpretation; the client using teachings to shut down emotion ("I shouldn't feel this"); signs that the client feels judged as an inadequate disciple.

4.5 Working with the confidentiality pledge

• Purpose: to protect the client's religious commitment while still assessing effects of practice [source for the pledge: SRF techniques page; method: synthesis].
• Steps [synthesis]: ask about timing, amount, felt effects and meaning, never about method; if a technique seems linked to distress, ask the client to consult an SRF/YSS monastic or authorised teacher about it; if the client wants the therapist to talk to the teacher, obtain written consent first.
• Example language (illustrative): "You don't need to tell me what the technique involves. Can you tell me when you practise and what you notice during and after?"
• Watch for: guilt or fear about having said too much; reassure that discussing effects does not breach anything the client has not chosen to share.

4.6 Screening for meditation-related difficulties

• Purpose: to detect challenging or adverse experiences early. A systematic review of 83 studies found an overall prevalence of adverse events of about 8.3%, most often anxiety, depression and cognitive anomalies, and noted they can occur in people with no previous mental-health history [source: Farias et al. 2020, PubMed abstract]. The Varieties of Contemplative Experience study (over 100 interviews with Western Buddhist meditators and teachers) mapped challenges across cognitive, perceptual, affective, somatic, conative, sense-of-self and social domains [source: Cheetah House VCE page; Lindahl et al. 2017]. That study sampled Buddhist practitioners; applying it to Kriya practitioners is an inference [synthesis].
• Steps [synthesis]: at intake and periodically, ask about each domain in plain language: unusual perceptions (lights, sounds), body sensations such as currents, heat or pressure, sleep change, fear or panic, low mood, changes in the sense of self or reality, withdrawal from others, loss of motivation. Ask when it started relative to practice changes and retreats.
• Example language (illustrative): "Sometimes meditation brings up experiences that are hard to handle, like strong body sensations, fear, or feeling unreal. Has anything like that happened for you?"
• Watch for: hyperarousal, dissociation, insomnia, and energy-like body sensations, which the client may interpret within the tradition's language of life force in the spine. Hold both readings open.

4.7 Grounding and dose reduction

• Purpose: to lower arousal and destabilisation when practice-related difficulties appear [synthesis, informed by Cheetah House resources and Treleaven 2018].
• Steps [synthesis]:
  1. Name the difficulty as something that can happen with meditation, without blaming the client or the practice.
  2. Agree a temporary reduction in length or frequency of formal sitting, or a pause, and suggest the client discuss this with their teacher or an SRF/YSS monastic. Do not modify or prescribe the tradition's breathing or energy techniques.
  3. Increase grounding activities: walking, physical tasks, time outdoors, regular meals and sleep, social contact.
  4. In session, use externally anchored attention (naming objects in the room, feeling the feet on the floor, eyes open) rather than inward focus.
  5. Review at each session; return to fuller practice only as the client and their teacher judge.
• Example language (illustrative): "Let's think of this like adjusting a dose. Turning practice down for a while isn't failing; it gives your system room to settle."
• Watch for: the client feeling a reduction is spiritual failure or disobedience; worsening despite reduction, which calls for medical or psychiatric assessment. Working signs: better sleep, fewer intrusive sensations, return of ordinary functioning.

4.8 Trauma-sensitive adaptations

• Purpose: to keep a client with a trauma history within tolerable arousal. Treleaven (2018) organises trauma-sensitive mindfulness around attention, arousal, relationship, dissociation and social context, with 36 modifications [source: Treleaven 2018, publisher description]. These were written for mindfulness, and applying them to Kriya practitioners is [synthesis].
• Steps [synthesis]: map the client's window of tolerance; ask whether inward focus or long sittings bring up traumatic material; encourage choice (eyes open, shorter sittings, movement) within what the client's teacher permits; address relational and social factors such as hierarchy in the community; treat trauma with an established trauma-focused therapy, with practice kept as a resource only where it stabilises. Trauma-sensitive yoga is covered elsewhere in the guides (Domain IV).
• Example language (illustrative): "If closing your eyes and going inward brings memories flooding back, it's OK to keep your eyes open or stop. You're in charge of that."
• Watch for: flashbacks, numbing, dissociation, and the client overriding their limits to meet a practice ideal.

4.9 Telling spiritual experience apart from illness

• Purpose: to avoid both pathologising religious experience and missing psychosis, mania, depression or dissociation. DSM-5-TR includes a code for a religious or spiritual problem (Z65.8) for when such a problem is the focus of clinical attention and not better explained by a mental disorder [source: ICD-10-CM Z65.8].
• Steps [synthesis]:
  1. Take a careful timeline: practice changes, retreats, sleep, substance use, life stressors.
  2. Assess functioning, insight, sleep, mood, risk, and whether experiences are shared and understood within the tradition (ask the client and, with consent, a teacher).
  3. Screen for features that call for urgent assessment: sustained loss of sleep, grandiosity, fixed beliefs not shared by the community, command hallucinations, inability to care for self, suicidal thinking.
  4. Refer to psychiatry or the GP when these are present; continue to respect the client's religious framing.
• Example language (illustrative): "In your tradition, how would a teacher understand what's happening? And how is it affecting your sleep, work and relationships?"
• Watch for: the therapist's own bias either way. Working signs: a shared, non-judgemental formulation and appropriate care.

4.10 Coordination with the client's teacher or organisation

• Purpose: SRF says its monks and nuns offer spiritual counsel; technique and practice questions belong to them [source: SRF Lineage and Leadership page].
• Steps [synthesis]: only at the client's request and with written consent; agree what will and will not be shared; ask the teacher about practice adjustments, not about technique details; keep clinical decisions with the clinical team.
• Example language (illustrative): "Would it help if you asked a monastic about slowing down for a while? I can help you think about what to ask."
• Watch for: role confusion (the teacher acting as therapist or the therapist as teacher); pressure on the client to keep difficulties private.

4.11 Routing health questions to the doctor

• Purpose: SRF attributes stress reduction to Energization and physiological slowing to Kriya [source: SRF techniques page]. These are the organisation's claims; no clinical evidence is cited on that page. Kriya is not presented here as a treatment for any physical disease.
• Steps [synthesis]: ask about any physical symptoms during practice (dizziness, palpitations, faintness, chest discomfort, headaches); route them to the client's doctor; never advise on medicines or suggest practice in place of medical care.
• Example language (illustrative): "Those dizzy spells are worth checking with your doctor. You can tell them what you practise in general terms."
• Watch for: a client stopping prescribed treatment in favour of practice; refer and document.

4.12 Scrupulosity about practice, vows and the pledge

• Purpose: some clients develop obsessive doubt about practising correctly, about having broken the confidentiality pledge, or about being an adequate disciple [synthesis].
• Steps [synthesis]: assess for obsessive-compulsive patterns (repeated checking, reassurance seeking, mental reviewing, excessive repetition of practice); if present, offer exposure and response prevention adapted with the client's consent, and, where the client wishes, consult their religious authority to establish what the tradition actually requires so that exposures stay within it. Clinical guidance from bodies such as the IOCDF on scrupulosity should be consulted [uncertain: not verified].
• Example language (illustrative): "It sounds like the doubt keeps asking for one more check. What would your teacher say the tradition actually asks of you here?"
• Watch for: reassurance from the therapist or the teacher becoming a compulsion.

4.13 Exploring the guru relationship and screening for coercive control

• Purpose: SRF describes initiation as establishing a guru-disciple relationship [source: SRF Kriya Yoga Lessons page]. Most such relationships are experienced as supportive; the therapist also needs to recognise misuse of power [synthesis].
• Steps [synthesis]: ask how authority works in the client's community; ask about money, work, sex, isolation from family, pressure not to seek outside help, and punishment for questioning. Know the documented record: in 1998 a San Mateo County jury found Ananda Church liable for fraud, intentional infliction of emotional distress and negligent supervision by its founder J. Donald Walters (Swami Kriyananda), in a case arising from sexual misconduct allegations, and awarded punitive and compensatory damages; the church then filed for bankruptcy [source: The Union; Hinduism Today]. This concerns Ananda, not SRF or YSS.
• Example language (illustrative): "Do you feel free to disagree with people in your community, or to take a break, without consequences?"
• Watch for: secrecy demanded beyond technique confidentiality, sexual contact with a teacher, financial exploitation, control over relationships. Safeguarding and reporting duties apply as in any other setting.

4.14 Leaving, changing lineage and religious trauma

• Purpose: to support clients who leave SRF, Ananda or another Kriya group, or who move between them. SRF and Ananda were in litigation over Yogananda's name, image and writings until the SRF suit was dismissed in 1997 [source: The Union]; rivalry may affect clients [synthesis].
• Steps [synthesis]: validate loss of community, identity and practice; separate the client's own spirituality from the group's demands; process grief and anger; rebuild social support; treat trauma symptoms with established methods.
• Example language (illustrative): "You can take your time deciding what, if anything, you want to keep from those years."
• Watch for: guilt framed as betrayal of the guru, fear of spiritual consequences, isolation.

4.15 Screening before retreats or intensive practice

• Purpose: SRF and YSS hold retreats and long group meditations [source: SRF Lessons and programmes page, Online Meditation Center]. Intensive practice may raise risk for vulnerable clients [synthesis].
• Steps [synthesis]: before a retreat, review recent symptoms, sleep, medication stability and history of psychosis, mania or dissociation; make a plan for what the client will do if difficulties arise (who to tell on site, when to stop, whom to call); review after the retreat.
• Example language (illustrative): "Before you go, let's plan what you'd do if things got hard while you're there."
• Watch for: sleep loss, euphoria, confusion or fear after retreats.

4.16 Boundaries, self-disclosure and referral

• Purpose: to keep the therapist in a clinical role [synthesis].
• Steps [synthesis]: avoid dual relationships (for example practising in the same centre as a client); consider whether and how to disclose your own religious commitments, guided by the client's welfare; build spiritual and religious competence through training (professional competency frameworks such as Vieten et al. 2013 exist [uncertain: not verified]); follow your professional ethics code [synthesis]; refer to SRF/YSS monastics or the client's own teacher for practice questions, and to clergy or spiritual directors of other traditions if the client is exploring.
• Example language (illustrative): "I'm not a teacher in your tradition, so I'll stay with how this is affecting you, and we can think about who in your community could guide the practice side."
• Watch for: the client seeking the therapist's spiritual approval; the therapist enjoying the guide role.

5. Handling problems

The organisation's published pages do not address psychotherapy problems. All guidance in this section is [synthesis] unless a source is given.

• Stuck client who believes more practice will fix everything: acknowledge the value of practice; ask what their teacher or the Lessons say about balanced living (SRF names balanced spiritual living as a Lessons theme [source: SRF Lessons and programmes page]); agree to run both practice and therapy tasks and review outcomes together. Illustrative: "Your practice matters to you. Can we also try one thing outside it this week and see what helps?"
• Resistance because therapy feels secular or disrespectful: name your respect for the tradition, state that you will not judge or teach it, and offer client-led integration (4.4). Offer referral to a therapist who shares the client's tradition if they prefer.
• Overwhelm during or after practice (panic, body energy, unreality): use grounding and dose reduction (4.7), screen for urgent features (4.9), encourage contact with the teacher (4.10), and route physical symptoms to the doctor (4.11). Adverse effects can occur in people without prior mental-health history [source: Farias et al. 2020]. Cheetah House offers consultations and support groups for meditators with difficulties and trainings for clinicians [source: Cheetah House VCE page].
• Non-adherence to therapy tasks because of long practice hours: problem-solve time with the client's values; never set practice targets yourself.
• Rupture over the therapist's view of the tradition: acknowledge the misstep, clarify your role, return to the client's own language; repair before continuing.
• The client asks the therapist to teach, check or correct their technique: decline warmly, cite the pledge and the teacher's role, and help the client prepare questions for an authorised teacher [source for pledge: SRF techniques page].
• The client has learned Kriya from unofficial sources: explore how and why; note that SRF teaches the technique only after the Lessons and initiation [source: SRF Kriya Yoga Lessons page]; neither endorse nor shame; encourage contact with an established organisation of the client's choice if they want guidance, and monitor for adverse effects.
• Disclosure of misconduct by a teacher or community member: listen, assess safety, follow safeguarding and mandatory reporting duties, and support the client's choices about reporting; offer trauma-informed care (4.13, 4.14).
• Guilt about leaving or doubting: normalise ambivalence; separate the client's spiritual life from group loyalty; avoid labelling any group as a "cult".
• Spiritual emergency versus illness unclear: keep both possibilities open, increase monitoring, involve psychiatry when risk features appear, and document the reasoning (4.9).
• Family conflict over the client's commitment: offer joint sessions focused on communication and respect for autonomy; screen for coercion in either direction.
• Therapist's own reactions (fascination, scepticism, shared affiliation): take to supervision; manage self-disclosure and dual relationships (4.16).

Sources

Web sources:

• Self-Realization Fellowship: Kriya Yoga Lessons
• Self-Realization Fellowship: Lessons programmes
• Self-Realization Fellowship: Kriya Yoga path of meditation techniques
• Self-Realization Fellowship: Lineage and Leadership
• Yogoda Satsanga Society of India: 150th Anniversary of the Revival of Kriya Yoga
• Ananda: The Sequence of Meditation Techniques
• Hinduism Today, May 1998: Evolutions
• The Union: Clarification about departed Ananda founder
• Cheetah House: The Varieties of Contemplative Experience (VCE) Study
• PubMed: Adverse events in meditation practices and meditation-based therapies: a systematic review
• Miami University Campus Store: Trauma-Sensitive Mindfulness (publisher description)

Books and papers cited:

• Farias, M., et al. (2020). Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica, 142(5), 374–393. doi:10.1111/acps.13225.
• Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, R. K., & Britton, W. B. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLOS ONE, 12(5), e0176239.
• Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing. W. W. Norton.
• Yogananda, P. Autobiography of a Yogi. Self-Realization Fellowship (first published 1946 [uncertain: not verified]).

Marked [uncertain] in the text: DSM-5-TR Cultural Formulation Interview and its spirituality module; IOCDF scrupulosity guidance; Vieten et al. 2013 spiritual and religious competencies; other Kriya lineages descending from Lahiri Mahasaya.

ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances