The client’s consistent shoulder area and low back pain are partially related to the sedentary nature of her job. Using a standing desk has helped to reduce low back pain.The client self-reports bracing throughout her whole body, possibly as a mechanism to “hold it all together.” She has normal ROM in all joints with some tightness in her left hip. Her right hip is higher than the left.

She spoke in a soft, self-reflective tone. Her breath is shallow and a downward energetic flow. Beneath her outer calm demeanor, she expressed overwhelm and exhaustion from her past life experiences and her current work/life responsibilities. Use of a CPAP machine has improved her sleep quality, yet sometimes sleep is not restful for her. Vivid dreams are common, so she feels like her mind “never gets a chance to rest.”

There is a kind of sinking sadness, with a heaviness of heart expressed in the client’s comportment. Emotions around the death of her newborn daughter 13 years ago continue to affect her deeply. She spoke of being an empath, unknowingly carrying her client’s emotions for many years. Earlier in her life she self-medicates with alcohol, she’s over that now. In this phase of her life, she is committed to greater self-care. Working as a supervisor has lessened the emotional toll of her job. She and her husband are in couples counseling which is easing strains in her marriage. She enjoys learning. Tarot card reading is her current interest. She is interested in yoga philosophy.

The client enjoys walks in nature, with her husband and by herself. Connection to the divine via tarot card readings.

Social support. The client expressed a desire to develop meaningful friendships. Doing so has proved challenging, with minor successes since moving to the State College area nine years ago.

Her weekly meditation/journaling class is “non-negotiable” for the client. She has very strong observational skills, with a consistent practice of svadyaya.

o Patanjali’s Yoga Sutras: Tapas and Ishvara Pranidhana.
 Why & how using. Add to the client’s consistent practice of svadyaya to instill resolve and let go of personal effort.
 Yamas and Niyamas. To introduce client to the vast realm of yoga.
o Roche, Lorin, The Radiance Sutras, 112 Gateways to the Yoga of Wonder & Delight, Sounds True, 2014.
 Verses 41 and 42. Affirming and uplifting concepts to share with the client.

Radiance Sutras, Verse 41. Lorin Roche translation.
Breathing is the flow of the divine,
Where the rhythms of life turn into each other –
The eternal exchange.

Pour one breath into the other,
Outbreath into the inbreath
Into the outbreath.

Awaken to equanimity,
At peace in the play of opposites.

Verse 42.
With one sweep of attention,
Gather in the whole universe
And remember it
As your body of bliss.

The deep rhythm of life,
Pulsating,
Stir an ambrosia
Flowing and overflowing everywhere.

Drink the nectar
Of all-pervading joy
From the radiant cup
That is this very body.

o Include exercise guidelines and/or contraindications where relevant.
Ulnar impaction syndrome. Stay clear of bearing weight on the hands and wrists.
o Halifax, Joan, Being with Dying, Cultivating Compassion and Fearlessness in the Presence of Death, p. 14, Shambhala Publications, Inc, 2008.
 To help be at peace in the moment, “no matter what that moment brings.”
o Weintraub, Amy, Yoga for Depression, A Compassionate Guide to Relieve Suffering Through Yoga, Chapter Four, Fertilizing the ground-the healing principles of yoga, Broadway Books, 2004
 Compassionate introduction to the yamas and niyamas. Sighing breath.

None at this time. Thank you for reviewing my work Sue.

• 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.