Body awareness

Over a 4-week period, practice a series of chair asanas at a minimum of three times per week for 20 minutes each time to gently lessen the restrictions in the neck and hip joints, and the lumbar, to reestablish a fuller range of motion and reduce stiffness.

Female, 69, caucasian, diagnosed with osteoarthritis, obesity, pre-diabetes, depression, general anxiety disorder. The client is retired, and has been sedentary been for years. Client has participated since March 2021 in weekly 30-minute online Chair Yoga classes with me. She has shared that 2-4 days per week for 3-5 minutes she practices the neck exercises she's learned in class. She is married, has no children, a cat, and spends her time reading, playing challenging brain games online, does crossword puzzles, cooks. She has seen a licensed clinical social worker for years, only recently reducing sessions to once every two weeks. Client wishes to relieve morning stiffness and joint pain, and increase her range of motion. She enjoys Chair yoga and feels it is a safe form with which to begin. Moving up and down from the ground deterred her in the past from establishing a physical yoga practice but Chair Yoga removed that barrier. She experiences shortness of breath when walking; has a limited range of motion when moving her neck as well as limited rotation at waist when turning. She doesn't exhibit a fair reflection of her eating habits. She seems to find it difficult to commit to an exercise program. Option is to propose assisting with developing a sadhana practice. Client

Private online sessions twice a week. Poses vary each time, options for comfort and safety visually shown and verbally described. Ongoing verbal cues to increase breath awareness as well as her own position in space, resulting in client repositioning her body. Clear prompts provided to directly focus on tuning into the interoceptive body sensations that arise during each exercise and the benefits. Sessions: 5 mins centering; 20 mins chair asanas with props, 5 mins breathing and meditation.

Hatha yoga, to include asanas, breathing, meditation. Through chair poses that addressed the vertebrae, core, and hips; breathing techniques, and brief meditation, attention was directed to inner and outer body awareness. Breath awareness played a central role, as did routine asana repetition, which led to her refinement of noticing, and discriminating and discerning the physical sensations. The combined use of breath and body throughout the practice was used to develop an awareness of proprioceptive and interoceptive sensitivity. Breathing was integrated with movement, resulting in a flow of energy to specific body parts. Bringing awareness to the benefits of breath control evolved into greater self- and emotional regulation. Through the asanas, greater range of motion and tension release was achieved. Brief meditation with slokas rounded out the practice of breath, body, and mind.

Client very engaged during practice and discussions. Props and modifications of poses were to accommodate range of motion and size. Twice Client showed signs of uncomfortableness during asanas and was asked to pinpoint pain. Asanas were adjusted and Client was reminded to pay attention to her body sensations.
Client was asked if she felt that paying attention to body sensations was helpful, unhelpful, or not relevant. Client was positive in her responses and noted that her way of relating to her physical body had changed. She noted a new awareness in her daily life; when mindful, her place in space, body holding, and internal sensations became more apparent. She shared how her newfound awareness led to a more 'present' self-regulation of her emotions. She reported feeling "looser" after each session, and was able to recreate that feeling during home practice.

Client is spiritual and interested in yoga beyond the asanas. She was encouraged to continue to integrate proprio- and interoceptive practice in her daily life and to live with intention. As Client articulated a need for mind/body self-care in her relationship to self and because of her spousal situation, support for ongoing reflection in the form of journaling was advised. Sessions will reconvene in September; encouraged continuation of practice even if 5-minutes at a time, while in car, on dock, at picnic table (vacation).
Gifted "Golden Present" & "Meditations on Intention & Being" for inspiration, living-kindness and mindfulness as Client expressed the need to effect positive changes in her life.
Client seemed sad and helpless about current marital situation. I strongly supported continuation of cognitive behavioral therapy and her art as outlets for change and creativity.

The intended plan was implemented and the goal achieved. Client was able to focus on the external and internal factors, express this verbally, and make deeper-going inquiries. Yoga helped her optimize her proprioception as she practiced balance and safety in a variety of poses. Range of motion increased, stiffness decreased. As she developed interoceptive awareness, she experienced a stronger sense of identity. Brief centering and meditation was successful.
What was triggered during after-session discussions was the desire to go beyond the Annamaya kosha to explore more deeply Pranamaya and Manomaya koshas. She expressed desire to learn about breathing techniques, stagnant energy, how to experience greater vitality and an energetic connection to herself and nature. Also, the idea of exploration of thought forms, mental activity, and her awareness of thoughts was raised.

Variations to standard props were given. F.ex. using a rolled up blanket instead of a bolster under the feet; or a tome instead of a block. When client grimaced, immediate change in range of motion or asana was required. I needed to monitor length of sessions so as not to exceed allotted time as next client was scheduled. In the future, I will schedule an additional 'check-in' session of 15-30 minutes to address client's needs/desires to redirect the focus of the sessions. Offer the ability to extend sessions by 15 to 30 minutes in order to add in-depth teaching of breathing and meditation. New sessions with this Client will be longer to address pranamaya and manomaya koshas. Thirty minute sessions were not sufficient time-wise to address deeper exploration of yoga philosophy.

Scheduling-wise I will space Clients further apart. This will allow a Client to extend their sessions without disrupting the next Client's schedule. Once my schedule fills up, I will rethink timing.
During intake, I will spend equal amounts of time on the koshas to better determine what the Client may be interested in beyond the physical. This client seemed to have some unexpressed trauma in her life. At times, there was sadness and trembling. The allotted time did not allow exploration of deeper emotions and pain.
I believe the Client (also per her assessments) was very satisfied with the practice. Unscheduled text check-ins asking about her day and what she had accomplished seemed to encourage more practice. I will make this a 'service' I offer all clients. Those who do not want this can tell me; most have enjoyed the extra care and consideration.