Conditions manifest uniquely in each individual. Work with an individual, not a textbook definition of a condition/disease.

Facilitate the client's ability to consistently practice yoga for Multiple Sclerosis. Create a yoga sequence that addresses the client's goals of building leg strength, improving balance, and actively resting. Teach and record the sequence. The client practices with the recording 2X a week for two weeks. We meet to assess benefits of the practice.

Female, 72 years old, married, retired. Diagnosed with Multiple Sclerosis at age 62. Mother of two adult sons. Grandmother caring for her grandchildren on demand, particularly her toddler grandson who has Sturge-Weber Syndrome. She receives specialized medical care for MS, a three hour drive from her home. She is experiencing weakness in her legs, balance challenges, and fatigue. She participates in group yoga classes approximately once a week when not traveling or caring for her grandchildren.

The plan was to meet with the client, learn her wellness goals, and learn how Multiple Sclerosis is affecting her. The client specified which yoga poses and techniques she finds helpful and which she does not. Based upon this information a yoga practice was to be designed and recorded for her use. The client’s suggestions provided the framework for designing her session. The recording supplemented her weekly group practices when she was not able to attend real-time. The client kept track of how often she practiced yoga. Email contact was made to check-in and receive feedback. Another in-person meeting was planned to discern if the recordings motivated the client to practice yoga more consistently than before yoga therapy and if they served her goals and needs.

Raja: Tapas, Svadyaya, and Ishvara Pranidhana. All of these limbs of yoga were necessary for the client to persevere, keep practicing-even when she wanted to stay in bed, to reflect upon her experiences, and to connect with a source of inspiration beyond her own capabilities.

Jnana. Viveka-discernment. Over the course of the yoga therapy sessions, the client gained greater wisdom about her health condition and how her actions either serve or detract from her well being.

Related to MS. The client does not experience flare ups. Her condition is more of a slow, ongoing decline in muscle tone, strength, range of motion, and stability. Her eyes are not affected by the disease and she does not suffer from pain related to MS. She is concerned about her leg strength, balance, and slowing the progression of the disease to the best of her ability. She is increasingly aware of her need to rest and schedules her days for activity in the mornings. From the retelling of her personal encounters, comments casting her as frail, weak, and unable are particularly off-putting to her. That’s understandable! She is determined to remain capable for as long as she can. Her mental faculties are strong. She is socially engaged with friends and family. She looked forward our yoga therapy sessions together.

Keep up her regular yoga practices in group classes and on her own. Include rest as an authentic, valid yoga practice. Keep a record of the frequency of her practice and possibly include journaling along with practice accounting.

The intended plan was implemented and adjusted as noted in the section below.

The yoga practice recordings, our check-ins, and our in-person meetings were all motivational to the client. In her words, “Yoga gets me out of bed in the morning. Some days you just want to pull the covers over your head and stay in bed.” She increased the number of days per week she practices yoga from two or less to three or greater. From her own observation, she maintained her strength and balance on par over the period we worked together. These goals were achieved as were her goals of resting and practicing yoga more frequently. Please see descriptive documents uploaded to the platform.

The process took longer than planned. I made two recordings rather than one as planned: an active practice an another focusing on rest. (See uploaded documents.) Each recording was 30 +/- minutes long, a manageable time to fit into her travel and childcare demands. With this change, more follow-up meetings were held. This was beneficial in cultivating greater trust with the client, enabling her to open-up, revealing new details about her health and how the practices were serving her.

Lessons learned.
Keep the lines of communication open with the client. Don’t make assumptions. The client was practicing more often than I realized, exhibiting greater fortitude than her gentle manner suggests.

Be more aware of subtle body language. Gestures and movement can be just as or even more descriptive than words.

I would approach the working with this client in the same way.

The client learned the yoga practices in the recordings, so she could lead her own practices without my guidance.

The client became more keenly aware of the best time of day for her to be active and when it is best for her to rest. She now refrains for overdoing more often. She made suggestions for future recordings such as including upper body strengthening using hand weights, becoming a creator in her wellness program.

I would schedule weekly check-ins and suggest the client journal. This would enable her to reflect and put her yoga practice in the context of her family life. I would spend more time working with the client as she practiced yoga. This would help me to refine the practices I design for her.

The plan was implemented and adjusted. Extra time with the client served to build trust, allowing me to gain insight into her symptoms and outlook relevant to living with MS. She increased her weekly yoga practice frequency, even while traveling. She acknowledged her need for rest and suggested new yoga methods for future practice recordings. Building a trusting client relationship rang true in the TCA process.