Bhaktin and Karma

Goal for time with client: Client would like to work on relaxation, stress reduction, and maintaining her physical status in balance. She describes symptoms that indicate relative weakness in her trunk indicating a need to stretch and strengthen this area. Selected client: Client is a 66 year-old female. Client lives at home with her husband and one dog and lives in a small house in Hartsdale, NY. She has no history of serious drug or alcohol abuse. When younger she reports that in social contexts she would sometimes smoke cigarettes and drink alcoholic beverages, neither to excess. Client was born in Ecuador, she came to the United States when she was 25. She describes a rough upbringing. She was raised in Ecuador by her aunt who was both physically and emotionally abusive. She has two married daughters who live within driving distance. Client has been married twice. Her primary language is Spanish but she is fluent in English. She works as a physical therapist, currently employed in a nursing home. She is now thinking about retiring. Client suffers from thoracic scoliosis, curvature of the spine (right side), axis reflux, and a relatively mild sinus condition. Her scoliosis dates back to an injury she suffered at the age of 14. She reports positive self-esteem, good self care skills, and an organic, healthy diet. Client has been previously diagnosed with thoracic scoliosis, C shaped curve to the right side, by a Physiatrist. Her training and current work as a physical therapist has contributed to her being familiar with the symptoms which include significant back pain and stiffness. She has treated the syndrome in others from a more traditional medical rather than a yoga approach, she has previously used more traditional bracing and physical exercises to alleviate the pain. Her’s is a functional problem that is permanent. It is not unusual for the problem to worsen and the symptoms to become more severe with advancing age. Interventions are not likely to fully resolve the problem but they can slow or stop the worsening of the symptoms. She has not ungone surgery for the problem. Client has been attending yoga classes most weekends, on Sunday, for the past 4 years. In addition, she typically takes private classes roughly 2 times a month with me. She prefers restorative classes and in savasana she often falls asleep. She doesn't like to be touched in the class, when she is she often says,”don’t touch me” in a manner that suggests considerable anxiety about physical contact when initiated by someone else. How do you envision working with the client to incorporate your selected teaching? The major emphasis in the treatment is to work on strengthening and stretching her truck. I do and will continue to use bolsters and a strap in order to address this. Poses will focus primarily on the right side as this has been established as the area of primary concern. Interventions will also focus on improving the client’s awareness of the problem in order for her to know when the position reflects a more positive alignment. She will then try to maintain that posture for a brief period to strengthen the muscles on both sides of the spinal cord. This will not be done to the extent that she experiences significant additional pain. Pranayama exercises for this condition improve breathing which may be negatively affected by scoliosis. Breathing exercises can lead to a greater awareness of the corrected position and what it feels like to be in the corrected position. What branch(es) of IY will you use? How does each support your goal? Two branches of yoga that I have chosen for this client are bhakti and karma. Bhakti is chosen because this client has a great faith in God. She goes to church every Sunday and she has statues of Jesus all over her house. She often prays to saints during the day when things become challenging for her in her daily life. I chose Karma yoga because of its emphasis on action. Her job as a physical therapist requires her to help others who need to love and have compassion in their lives. Short notes on time with client: Client has been attending Yoga for the past 4 years. She enjoys chanting and also the mantras at the beginning of the classes and the end of the classes. She listens and recites Om and Hari Om. Since she began practicing yoga she reports that her mood improved and she found that her relationships with others have gotten better. Follow up suggestions for your client (whether with you or on their own): Reflection Did you apply your intended goals once you actually met with the client(s)? Yes. I also inquired how she is feeling, for example, if she is feeling physically depleted or tired, in order to get an idea as to whether she will want to or be able to do a hatha class. Her status on any individual day can affect which goals are addressed. Did you have to adapt anything in your plan? In a sense, all of my sessions with clients are adaptive. My individual classes are constructed on determining what the clients want to work on to address the presenting problem that session. I will make suggestions and then, in most cases, the client will have the final say in the choice of appropriate interventions. Private classes consist primarily of stretching exercises. This is my general approach. This client is knowledgeable regarding human anatomy, she is generally looking for strengthening. With her professional knowledge she has been able to teach me some details about movement and physiology. There is a mutual respect that is communicated. Due to the client's hypersensitivity to being touched, an adaptation is required that minimizes physical contact. When I do touch her, I do so after a gentle warning and each time I ask permission. In addition, she can sometimes arrive at the session in an irritated and angry mood. This may sometimes require giving her space to vent before beginning yoga exercises. If you are faced with the same situation again in the future, would you approach it in the same way? Why or why not? Summarize what you might change and why. Yes, I would do the same thing. The possible exercises and positions are laid out and discussed with the client before they are taught. The treatment and sessions begin with an explanation of what the various alternatives are, together we arrive at a decision on what we will do. The individual treatment is tailored to the client and what they feel comfortable doing