• 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.

Session #1:
1. Rest in a restorative position with props under the head, between the knees, over the eyes, etc. as needed.
a. Center by taking deep inhalations through the nostrils, and long exhalations through pursed lips.
b. Let go of your breath when you feel ready.

2. Reflection: Remembering ahimsa, do no harm - which includes you, ask yourself,
a. What does it mean to take care of myself?
b. How do I do that?
c. How can I better nurture myself?

Updated assessment - (physical, alignment, knee)

The client had left knee surgery at the end of November 2024 and is fully recovered. After a three-and-one-half months break, she resumed playing soccer 2-3x/week for 2-3hrs each time. She attended physical therapy twice weekly during the interim. She was in Vegas for a soccer tournament, hiked for 3 days.

MML also reported that she was burnt-out by the end of 2024. She reported that she is working too much and needs more trainers. She was franchisee of the year; her husband is retiring in June of 2025. She stated that she is too busy, is exhausted, and continues to take on too much. She is overwhelmed with work and family. "I am never alone at home," she told me. From the moment she walks in the door, she is engaged by a family member. "I'm overloaded with one annoyance after the other," she shared.

I asked MML about any major life events that occurred since we last saw one another in my yoga studio. She reported that she began her gluten-free (GF) diet in June of '24 (in addition to lupus, she has a diagnosis of Celiac Disease). She's lost twenty pounds since then. "GF options are difficult when I'm out and about. I end up eating yogurt and fruit a lot," she told me. Her son was married in CA in September. She had her basement redone during her recuperation from surgery. Her younger daughter moved downstairs to have her own space, save money, and get away from her sister (their rooms were directly across from one another upstairs).

When I had asked in an email (sent her a list of options from which to choose), one of her top choices was to improve her endurance. As we (SM and I) discusses, I asked this follow-up question:

What are you hoping to achieve when you say that you wish to improve your endurance?

She stated that she wishes to improve her mental endurance. Through soccer, she's covered physically endurance-wise. She wants to learn ways to handle her life (and I'm thinking fatigue).

My Recommendations to her were, for example, to practice:

o Mental training exercises such as positive self-talk and meditation to help better handle stress.
o Breathing techniques implemented throughout the day, taking time for herself.
o Proper sleep hygiene. Sleep and rest are essential for optimal recovery and energy replenishment.

She agreed that these were great recommendations. When asked when she'd implement them, she said she didn't know, she was just too busy.

I reviewed the measurement tools we'd be using, then completed the: NPMS; PANA; FSS; Sit & reach, before we centered.

Centering in a supine position with supports - bolster under knees, rolled blanket under neck, head resting on blanket, hand towel over forehead, eyes, ears, sides of head, and a blanket covering her body. All tucked in, with gentle hand pressure on her forehead sliding to the sides of the head. Then with very gentle pressure, 'pushing' her shoulders downward to the floor. Her tense shoulders moved nearly 2" down to the blanket/floor/earth. We spent a good 15 minutes scanning the body, using the breath, relaxing kosha-by-kosha, letting go.

I brought Ahimsa into the relaxation, and throughout the session. Repetition of the affirmation, too.

She'd asked for a more active session as she was going to play soccer after her session. I knew this in advance and had prepared some therapeutic movements provided by my yoga therapist.

Pelvic lists –moving the hips while maintaining a straight leg, strengthening the lateral hip muscles, contributing to balance and stability. (add one block)
• This movement engages the muscles on the outside of the standing leg, particularly the gluteus medius, piriformis, and gluteus maximus.
• Why it's important:
• Hip Strength: It strengthens the lateral hip muscles, which are crucial for balance, stability, and walking efficiency.
• Balance and Stability: By engaging the muscles on the standing leg, it helps improve balance and stability, which is important for everyday activities.
• Foundation of Walking: It's a foundational part of the gait cycle, where weight is shifted from one leg to the other during walking.)
Tadasana - Promote grounding, improve posture, cultivate balance and stability.

Neck loosening movements
Side bends w/a flow, add spinal twist leading w/arms.

Sukhasana or butterfly - find a comfortable position for knees:
Wide-stretched arms, thumbs back, breathe 360 focusing on chest to Eagle – breathe into back to Eagle backbend.

Side twist, R arm down, L arm alongside ear – L shoulder to forward/R back, open shoulders – Breathe 360 focusing on L side. Repeat opposite side.

Marjaryasana-Bitilasana - Improve spinal flexibility, massage the organs, stimulate digestive system. Focus breath on different focal segments of spine.

TT – L forearm down/R arm straight then arcing up and back hold on 3rd.

To proposal lunge L knee up, R knee down- block between hands, R arm reaches forward, then arc to heel/floor – hold on 3rd.

TT - R forearm down, repeat on this side.

Supported Balasana - Resting pose w/ bolster and blanket to calm the mind and relieve stress.

Sphinx –legs mat distance apart; look over shoulders.

Konasana (seated) – adding gentle overhead twist, to center, to gentle FF

90/90

Viparita Karani - Restorative inversion at wall with prompts, guided imagery; improves circulation, reduces swelling, promotes relaxation. 15 minutes, allowing the benefits of the inversion to unfold.

With band at thighs, weighted eye pillows on feet, blanket over torso, hand towel over eyes.
Guided through 360-breath to reduce stress, calm the mind, support overall well-being.
to
Guided resiliency relaxation with my own adaptations while in viparita karani: https://stargazercounseling.com/blog/guided-meditation-script-resilience

Closing

The client's left knee replacement was successful. The right knee will also undergo surgery. Client arrived looking tired. She shared that she was still doing too much, spoke of work and home life which continues to overload her. An example is that her husband is leaving for 3 weeks in late June, and she'll have her friend's young adult son staying with her. Her daughter (25), and this young man (27-ish) both have cognitive disabilities. When asked if she'd bring in extra support to help her while her husband was gone she said her younger daughter (23) would be there. I know that this daughter works full-time. Staff is concerned with yet another burden she's putting on herself. This would have been a fine time to have one less person in the home. She said she's helping her friend.

She seemed to enjoy beginning in a supine position during centering. She asked for a more active session. I introduced ROM shoulder and hip movements ending with a long Yoga Nidra.

The client continues to overbook and overwhelm herself. When asked what her plans were regarding her lupus, she said she was handling it on her own. There was no new doctor involved. I will address this again, focusing on her mental health.

I am concerned about what I consider to be a disregard for her health and well-being. Is it denial? Is it avoidance? Yes, the soccer helps the body and mind, but is it also putting stressors on her overall well-being. She described, for example, a fellow teammate (my client was a sub in a match) who wasn't playing well. She appeared significantly disturbed by this person's behavior and lack of soccer skills which I believe would be disruptive, interfering with the benefits of playing. This is a reflection I kept to myself.

Agreeing to have the young man in her home while her husband, her support, is gone, doesn't make sense to me. I know the young man, I met him as a teenager with troubles. I ask myself why she's putting this additional burden on herself. Her younger daughter won't be that available to help, and has voiced to me that she doesn't enjoy 'hanging out' with her sister or this man.

I hope to find a way to readdress the overall situation of on-going fatigue brought on by her lifestyle choices and diagnoses. I would like to then delve more deeply, specifically asking what activities are planned, if there's transportation or volunteering in place, who will take over transporting her daughter with disabilities to/from work and activities, what the plan is for meals, etc since the husband who is responsible for that, will be in CA. I know that I must tread carefully posing the questions in a manner that doesn't make the client defensive.

After observing the client's fatigue on her face and body, and based on her responses on the Fatigue Severity Scale (55 out of a possible 63, with the only 1 (disagree) on a scale of [1-7, disagree agree] being "Exercise brings on my fatigue (FSS), my concern deepens. A total score of 36 or more suggests 'that you may need further evaluation by a physician.'

I hope to find a way to readdress the overall situation of on-going fatigue brought on by her lifestyle choices and diagnoses. I'll explain the gentler approach to our sessions so as to allow her to give herself permission to relax and let go.

Based on the FSS, I plan to implement more gentle, relaxing, self-nurturing sessions. The client asked that I continue to offer affirmations/intentions. After our check-in I will offer (15 minutes-ish) supine centering, followed by mindful joint movements and asanas - nothing vigorous. I will implement a long Yoga Nidra including progressive relaxation, breath work, guided imagery. Throughout the practices, we'll return to the affirmations and raja yoga.