Tapas – accepting the chronic pain. W/ acceptance, there can be transformation enabling her to choose a response & how to support herself in the moment.

Secondary Practice – Chitta Vritti Nirodaha Discuss how yoga can enable her be with her pain – not let it overwhelm her. Cultivating Witness re her thoughts when experiencing discomfort.

Daily check-ins w/ pain 1 to 2 times daily, initially 3x per wk. Seated or lying w/ hand on heart & belly – deep breaths w/ body scan. After each check-in, notice if the pain has shifted, have her thoughts changed?
JAPA coordinated with breath to be practiced 2 – 3 x weekly.
When pain arises, “I am not this pain. My True Nature is Peace.”

73-year-old woman diagnosed with fibromyalgia and HBP. Facing acute, chronic stress at home with house-bound husband who can be verbally abusive.

My plan for client was to help her connect with her body in a loving and gentle way, as she tends to be self-critical and dismissive of her chronic pain. I also wanted her to truly embrace the belief that she is not her pain, nor is she being punished for some past wrong-doings. Lots of Mormon Church scarring.
Through Tapas and Equanimity - she can step back from her pain and observe it. Equanimity enables her to assume Witness State - accepting the highs and lows learning to ride the waves of pain and emotion - knowing that they come and go.

I presented Asana via an adapted (chair & wall) JAPA practice integrated with Pranayama. Asana for the gross body - needing support and comfort, as well as acknowledging strength and capability in spite of condition. Pranayama to support her NS, grounding into present moment and connecting with Prana. In addition, breathing practices to calm and soothe her discomfort while directing the breath to any areas where she's experience tension, discomfort, etc.
I then offered Svadhyaya for connecting with her True Nature. This was key for helping her to individuate from her chronic condition. All of these were based upon the Kosha model - moving from Gross to Subtle layers of her being.

Client was very open and insightful. She appreciated all we explored together. Sensed that the practices would be helpful during pain flare-ups as well as other moments when she's triggered. We talked about 'that self-critical voice'. Discussed ways to address it / respond when it showed up.

I recommended seeing an Osteopath and Naturopath. Osteopath for hands-on physical relief and a Naturopath for supplemental / dietary support re inflammation. I also encouraged her to set an alarm on her iWatch for daily check-ins - ideally, midday then at bedtime.
She enjoyed the Chair Yoga. I offered to return sometime to review the postures we practiced.

All in all, I mostly kept my original plan except for adjustments due to her uncontrolled HBP and time limitations. I think she found the mantra, "I am not my pain..." to be helpful. I encouraged her to create some of her own to use throughout the day to address whatever was showing up.
Client appreciated our discussion regarding Equanimity and riding the waves of sensation and emotion. She expressed doubt that she'd be able to ride the waves. I assured her it's a learning process: when you don't show up as intended, simply take note and recommit.

I had to adjust client's Asana plan when I learned that none of the BP medications were successfully addressing her elevated BP. That is, NO INVERSIONS and emphasized caution during Pranayama.
I learned that Active Listening is vital - especially when dealing with multiple conditions. Good to keep asking questions in case client has forgotten to share something.

If faced again with the same situation in the future, I am confident that I'd mostly approach it in the same way. Always a good reminder to listen, listen, listen. While I often come over-prepared ready to present more than our time allows, I feel more confident that I can shift gears and modify the session as needed.
We made a good connection and I felt she truly benefitted from our time together. I trust she'll put some of these practices to use in her daily life.