• 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.

1. Rest in a restorative position with props under the head, the knees, over the eyes, etc. as needed. Set a timer.
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. Scan the body from the crown of the head to the soles of the feet, allowing yourself to relax. Reverse the scan.
a. Practice alternate nostril breathing or 3-part breath.
b. When your mind wanders, acknowledge the thought, let it go, then return to your breath.
c. When you’re ready, let go of the breath.
3. Reflection, while resting in this pose
a. Ask yourself, how might I find moments of peace today?

4. Slowly return to sitting then ask yourself (and post these questions):
a. When can I be mindful?
b. When will I choose to focus on one action – for example, putting on my shoes, washing the dishes, folding
clothes – being in the present moment, the here and now?

Centering
• Nadi Suddhi (2 mins.)
• Inviting space into the breath; + Dirga Swasam
• Santosha - explore acceptance and peace in the present moment, & Bhakti (Stuart Ray Sarbacker and Kevin
Kimple,The 8 Limbs of Yoga, pp. 36-37)

Gentle Chair Movements
• Neck & Shoulders (left bicep spasm during shoulder rotations w/ fingertips on shoulders)(Stopped movement)
• Cactus/forearms tgther in front to cactus; shoulder rolls; cactus to overhead to downward extended arm motion)
• Spinal Twist - to enhance mobility and stimulate blood flow, which can aid in releasing built-up tension around the
chest and torso.

Spine and Core on mat
• TT
• C/C – focused spinal segments; breathing 360
• Thread the Needle
• TT w/ L forearm on mat, R straight, R CARS (Controlled Articulation Rotations)

Standing (Supported) Poses
• Swinging
• Tadasana – focus, Santosha, breath-led arm movements
• Side bends

Supine Pranayama then Relaxation
• Dirgha Swasam –focusing on diaphragmatic breathing to fully expand the lungs and engage the full breath
capacity, improving oxygenation.
• Yoga Nidra for Deep Rest script
• Somatic Inquiry pausing to check in with the body, "How might I find moments of peace today?”

Closing
• Support parasympathetic response

Client reported that his worst level of pain was at a "4" on a scale of 1-10, 10 being worst pain imaginable, on the Pain Numeric Rating Scale. When asked, he was feeling a "2". He reported on the Fatigue Severity Scale that he agreed at a 7 on a scale of 1-7, with 1 disagree, 7 agree, that his motivation is lower when fatigued. Overall, he reported being easily fatigued, that fatigue interferes with his physical functioning, that fatigue causes frequent problems, interferes with carrying gout certain duties, and is considered among his three most disabling symptoms.

The client shared news about his mom who fell and was in the hospital. He was able to focus on his practice. His left bicep spasmed during shoulder rotations. He said it had never happened before. When he stopped moving, he massaged the pain which went away, he reported.

Presented the synergy between steadfastness (devotion) and inner contentment in achieving (spiritual) growth.

I again was surprised by a client's lack of upper body strength. I researched manuscripts that addressed pulmonary function and upper body strength. If I were to work with this client on a regular basis, I would continue to implement upper body movements as research shows that upper body strengthening may have a beneficial impact on pulmonary function parameters. (Singh VP, Jani H, John V, Singh P, Joseley T. Effects of upper body resistance training on pulmonary functions in sedentary male smokers. Lung India. 2011 Jul;28(3):169-73. doi: 10.4103/0970-2113.83971. PMID: 21886949; PMCID: PMC3162752.)

One of the best parts of yoga therapy for me is the ongoing learning aspect. It keeps the work dynamic, evolving, and deeply personal. Each client, each session, offers a new opportunity to deepen my knowledge, refine my approach, and grow both professionally and personally. This process of lifelong learning not only enhances my ability to support others, but also enriches my own journey toward clarity, balance, and insight.

We'll focus on practice and letting go. It will be our last session so I'll spend time with the client reviewing the koshas and their affect on him.