December 02, 2022
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Illustration by Brittany England
Starting an intensive therapy program can sound exactly that — intense. But in reality, IOPs are just another form of support that might be able to give you the environment and skills you need for healing.
“Seek help,” the phrase oft-regarded during the credits of documentary films, in news broadcasts, and in pastel letters on Instagram grids. I’ve heeded this advice with regard to my mental health issues, namely depression and anxiety, for at least a decade.
I’ve seen psychiatrists, couples counselors, talk and somatic therapists, cognitive behavioral therapy (CBT) practitioners, reiki healers, group therapists, mindfulness coaches, and more.
Over the years, some providers have been disappointing, and some phenomenal. I have my fair share of support (and thus privilege), and “seeking help” is not a new concept to me. If the willingness to ask for assistance were a proxy for cure, my mental health would be unparalleled.
But the body keeps the score.
One particularly average morning in late summer, I woke up early, heart pounding, and could not fall back asleep. Not thinking much of it, I slogged through the day and retired early, only for the cycle to repeat again the next night, and the next, and the next.
What followed were three weeks filled with rumination, paranoia, panic attacks, and the loss of much of my executive functioning — and alongside it, hope.
On one of these doldrum days, my outpatient therapist, whom I had been seeing weekly, checked in on me via text. I was not OK, and all I could muster was, “I need help.” A clunky and necessary interaction ensued where we both tried to determine what that meant. More. It just meant more.
He’d asked if I’d ever heard of intensive outpatient programs. I had not — which was shocking to me, someone who was no stranger to the rollercoaster of anxiety and depression and their associated treatment regimens. Leveling up to more frequent treatment seemed like my only option. My work and relationships were beginning to suffer.
As I would learn, intensive outpatient programs (IOPs) are a part of a spectrum of care for mental health, eating disorders, and substance use issues. The only points of the continuum I was aware of were one end as being some cadence of appointments with an outpatient therapist and the other end being hospitalization.
In between those polarities, among a few other options, are IOPs and PHPs or “partial hospitalization programs.” IOPs provide a variety of mental health services for a minimum of 9 hours a week for adults, and PHPs are outpatient services that include a level of care of 20 or more hours a week but not 24/7 support.
On the day of my intake call with a mental health center that offered an IOP, I was desperate and ready to go to the hospital. The specialist listened to me, fairly unfazed by even my darkest confessions. This practice of disclosure would remain a powerful one throughout my treatment and since.
Everyone I had recently shared varying degrees of my truth with, whether it be friends, family, colleagues, or my treatment team, had met me with nothing but “I want you to get better.” A far cry from the judgment and shame my inner critic had braced myself for.
The intake specialist recommended a mood and anxiety IOP, which consisted of group skills-based therapy, individual counseling, and psychiatric support. I could start the next day.
Knowing that more help was around the corner helped me hang on through what those of us with mental health conditions know is a painful, visceral agony. It feels like being eaten from the inside out.
My first day came, and besides backing into a dumpster in the parking lot, I was in good spirits, ready to collapse into the metaphorical bear-hug of treatment. Make me better already!
I was greeted by a friendly team, a room full of social-distanced chairs facing a giant whiteboard, and a daunting binder full of “skills” — endless sets of acronyms under headers reading dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT), two treatment modalities I had yet to be exposed to.
I would be lying if I said that the binder didn’t get me excited. Always a great student, I was thrilled by the prospect that these concepts were something I could study and learn. Maybe I didn’t need to view myself as broken, just under-skilled at this particular challenge. Maybe there was hope.
Each day we began with a check-in, which encompassed a rating of your mood on a subjective scale from 0–100 and your current emotions and struggles, your homework, and if you had any thoughts of self-harm or harming others.
Sitting with myself for just a few moments to discover the present yet confusing alchemy of emotions on any given morning was revelatory. I uncovered that there was usually some sadness mixed with groundedness, irritation mixed with enthusiasm, apprehension mixed with determination. And this acceptance mindset, I would learn, is at the heart of DBT. Both things can be true at once.
Week by week, through Socratic-style teaching lessons, process groups, mindfulness exercises, and medication management sessions, I began to feel depression and anxiety loosen their grip on me. I learned new practices and skills in a structured, visual way that worked for me.
I connected with others and allowed myself to listen and validate, as well as be listened to and feel validated in a judgment-free zone.
None of my feelings were crazy, and I was brave for coming here — I saw this so clearly in the relatable struggles of my peers.
I loved this expansive space to just be, though as I began to chart my moods on an upward trajectory over the weeks, I was eager to get some time back in my days to devote to things that filled me up — the things depression and anxiety had robbed me of.
It would be up to me to make mental health a top priority moving forward, as I’d learned to make it in the program.
On my penultimate day after about 6 weeks in the program, I was pulled from the group to conduct a private art therapy session. The gentle, handknit sweater-clad art therapist led me to a cart of pastels, markers, crayons, and watercolors. They asked me to fold a piece of paper in half and, on one side, draw what I was looking forward to upon discharge, on the other, what I was afraid of.
To some background Taylor Swift (my request), we doodled for an hour while they asked me questions about myself. I realized I was beginning to talk differently, using “and” instead of “but,” recanting my words and thoughtfully reworking them when they dripped of self-criticism.
At the end of the session, I explained my drawing. On the right side, I’d drawn a horse with a heart on its back, surrounded by rainbow-colored people, books, my dog Sidney, and the colors of a sunrise (and I held back my snark about my animal renditions with heaps of self-compassion).
While investing a great deal of time and energy into the program was what I had needed, I was excited to get back my peaceful mornings. To return to the barn where I volunteered, the book store, and my people. My values.
On the left side sat a ghostly figure on a couch, shaking. In the middle of a flood in the middle of a storm. Oh, throw in a plane, one of my long-time phobias and stressors, for good measure. The feeling of loneliness, of panic, and of isolation personified.
This picture illustrated what words could not: I was terrified of feeling again how I’d felt a few weeks prior, only next time would carry the shame of having wasted time and energy on this program. I would not just be mentally unwell, I would also be a failure.
All of these feelings, while still present and real, cleared a bit when I was able to spot them on the page. Right there was a slew of cognitive distortions: fortune telling, catastrophizing, future tripping.
I knew that while I would probably feel some form of that shadowy figure again, I had learned to be more proactive about my mental health. I could reach for my binder. I could safeguard my sleep, exercise, and nutrition. I could be mindful of my thoughts and diffuse or challenge them.
I could self-soothe or ground myself until I calmed down a bit. And then, I could choose an action that was opposite to the emotion I was currently feeling to begin to elicit new ones.
And if that doesn’t work at some point, for whatever reason, there is always more help. My counselor reminded me of this in my discharge appointment — people came back! I would move through seasons, and this would be a lifelong journey. One that I had learned to take ownership of rather than fight through my time in an IOP.
Medically reviewed on December 02, 2022
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