• 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.

Continue to practice Ahimsa, rooting deeply in this practice to create a solid foundation and reduce self-inflicted pain.
Practice PT exercises daily, plus legs in the chair and legs up the wall.
Practice Mountain pose daily with emphasis on proprioception.
Practice the Metta Prayer of Lovingkindess first towards self and then to the Universe.

Centering/Guided Awareness
Discussion of Yoga Sutra 2.9 (Fear of death/annihilation) and Ahimsa. We discussed tapas again and how false identification with the ego (body-mind) causes pain.
Joint Freeing while seated in a comfortable chair, incorporating toe extension from PT
Adapted sun salutations while seated
Mountain pose with proprioception
Foot ankle rocker mobility standing with a chair or by a wall for balance
Theraband plantarflexion while seated on floor (if body can tolerate this) or lying down with legs up against wall
Knees to chest while lying supine, gentle rocking to release tension in back and lower body
Rectangle breathing to help extend exhalation
Contract and Release using the Mitchell Method
RAIN (Recognize Allow Investigate Non Identification) Meditation to help the client learn to ease emotional suffering and confusion, as well as to release some of his identification with the body-mind
Rolling Om chanting ending with Metta Prayer of Lovingkindness

The client arrived at this session and said that the podiatrist wanted to do another surgery on the foot, this time for a bone spur that has developed on the proximal interphalangeal joint of the second toe. The doctor said that since they shaved down the tip of the big toe, the second toe has started to shift because of the pressure. The client does not want to have surgery. I encouraged him to get a second opinion, perhaps through a referral to a community doctor. I also encouraged him to go back to the PT with the CT scans, which the PT had not seen before when making the PT plan. I was able to review the CT scan which was taken as the client was standing. A bone spur is visible and pronounced. I reminded the client that he was left in a walking cast/boot for almost a year and perhaps that alone could have caused the spur to develop, but that it’s important to get a second opinion from the individuals I recommended about whether or not pain can be eased without surgery.

The client admitted that he has not been doing his PT exercises and that even though they don’t hurt him, he’s not doing them because he feels like he’s being compassionate to himself by giving himself a break. This led to discussion about Ahimsa and how not doing his exercises isn’t compassion, but trying to prevent pain which may instead prolong the pain. He has identified that he has a relationship with pain that is an attachment to it and need to follow up with him therapist to work through some of what surfaced in our sessions. He has progressed a lot with self-understanding and his physical pain has reduced since we’ve started seeing each other. There is more to be done here, so I’ll invite him back to yoga therapy with me in the Fall.

The client really had some emotional breakthroughs throughout our sessions together. I was glad to see a release of long-held past trauma in a past session. I was also glad to see that the client was standing up for himself regarding more surgery, when in the past he would have been compliant without questioning the doctors. He has been regularly seeing a former therapist since our session when he shared a serious traumatic event, which gives me confidence that he’ll continue to seek mental health help to work through trauma. The client has reduced the number of activities he’s doing to try to “eliminate past trauma” as a result of our sessions and is now primarily focusing on meditation and deep breathing, with some asanas as he’s recovered from his recent rectal surgery.

I believe that I created a brave space for the client to identify and more clearly identify his emotions. He said throughout that he was grateful for the sessions and in our last session said that he felt like the “weight of the world” had been lightened. I would have liked to continue to see him more, but I also think the space between sessions will give him some time to work with his therapist on what’s surfaced.

No plans for a future session.