• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.

I feel like every session I am making adjustments and adaptations. Depending on the level of tamas at the start of the session, I might incorporate more standing asana, with the support of a chair or the wall. I check in with participants during the practice, and if I feel that any of the practices I'm offering are creating an "overdose" effect to psychotropic medications, I will change my plan. With clients who present with a high level of tamas, sometimes I have to verbally cue them and repeatedly check in to "keep your eyes open," and I will often add larger movements with the arms, as well as more neck extension/looking up.

For all clients, their main goal is to manage depression to where they can separate themselves from thoughts of self-harm and implement tools for self-care. In being able to answer my question of "What is one thing we did that you can use for your self-care?", I felt this was progress towards that goal.

At the start of sessions, clients would report musculoskeletal pain, most often in the low back and upper trapezius and neck areas. Often clients had limited mobility and were initially unable to stand fully erect. At the end of each session, participants reported a reduction in musculoskeletal pain, and improved overall range of motion in movements. Clients would also comment during asana practice on sensations they were feeling in their bodies with movements, especially joint freeing practices.

Clients were mixed when it comes to energy level. Some would report feeling energetic, others with very low energy. Clients reporting low energy at check in would report feeling more alert and energized, yet calm at the end of practice. Clients with higher energy at the start of practice would still feel energetic and report increased calm overall at the end of practice. Clients struggled with deep breathing, some reporting awareness of the fact that they would "forget to breathe" at times. Increased abdominal movement during dirga swasam was observed in all participants on some level.

Clients often presented tamasic, and even shared feeling "depressed" and "down" at the start of practice. At the end of practice, clients would report feeling "better," "good," "relaxed," and "calm," also sharing that they looked forward to the next session.

Most clients presented tamasic at check in, and many seemingly disconnected from the vijnanamaya kosha.

When clients shared a spiritual orientation with me, I would do my best to acknowledge the importance of their spiritual practices, and support with a wisdom teaching. I will say the hospital emphasizes more of the physical practices (asana, pranayama) in their requests for their patients.

As previously mentioned, anecdotal feedback included feeling "good," "calm," and "relaxed." Often facial expressions were much different at the end of practice than at the start - with clients smiling, and many offering verbal thanks/appreciation for the practices.

I did not give ongoing weekly homework. At the end of each session I ask participants to identify "one thing we did" - whether an asana, a pranayama practice, a mention of a wisdom teaching - that they can use every day for self-care. Once they share their one thing, I tell them that is their homework.

Honestly nothing. I have certain practices that I know are going to be supportive, but I hold my plan loosely every week, waiting to see who arrives in the space.

I have never asked the lead Yoga Therapist about the hospital's protocol with a new patient on this floor. My personal homework is to do that - to see if there are certain psychotropic drugs often administered to the majority of patients, as well as what other therapies are offered. I've felt like more of a silo - going in to offer what many of the medical staff see as "exercise." I would love to be able to have conversations with some of the staff about how yoga therapy tools can support on a much deeper level.

Yes. I always feel a little depleted afterwards, but I look forward to the opportunity every week.