“I just want to hurt in a way people will understand,” I said between sobs while on the phone with my mom. It was about 1 a.m., and I was completely overwhelmed by the idea of returning to work the next day. Three weeks earlier, I had started to experience anxiety, insomnia, and other symptoms, and sought the help of a psychiatrist, who put me on medication for anxiety. I took a few weeks off work to recover, but on the eve of my first day back, I knew that the prescription hadn’t helped.
It’s scary when it feels like your mind is working against you, but it’s terrifying when professionals can’t give you a reason why.
After listening and asking questions, the psychiatrist suggested something new: an intensive outpatient program. It sounded extreme, but at that point it also felt necessary. After she gave me a referral, I called around to a few places and decided to undergo therapy at an outpatient treatment center in Old Bridge, New Jersey. The program would last eight to 12 weeks, depending on my progress, and my insurance would cover most of the cost. I felt guilty that I would have to take a medical leave of absence from work, but I reminded myself that taking care of my mental health was just as important as taking care of my physical health.
Intensive outpatient programs, or IOPs, are typically used as a way to ease someone at an inpatient facility back into their day-to-day life or to prevent a person with progressively worsening symptoms from having a full-blown crisis. Andrew Kuller, PsyD, a senior clinical team manager at McClean Hospital’s Behavioral Health Partial Hospital Program, says the programs are available to a wide range of patients. “We really don’t rule people out if they’re too ill, unless they need to be hospitalized,” he says. “We’ll take patients who, for example, are actively psychotic, so long as they’re not at risk for harming themselves or for getting harmed.”
The intake session for my program included a lot of paperwork, a two-hour-long conversation with a new psychiatrist, and another conversation with a licensed counselor who became my therapist during the program. During the first few weeks, I was supposed to attend group therapy five days a week, from 10 a.m. to 3:30 p.m.
My first day, I was understandably nervous. I sat down in a room with about 10 other people, ages ranging from late teens to middle-age. The groups weren’t based on a diagnosis, so it didn’t matter if a person was suffering from anxiety, depression, or bipolar disorder—we all received treatment together. Once the COVID-19 pandemic started, we began attending groups via Zoom, but the format remained the same.
Every day during therapy, we would give a “check-in.” This meant we would rate our emotions (on a scale of one to 10), give a word to explain what we were feeling (such as happy or frustrated), and choose a goal for the day. We’d also say if we wanted to “process,” which meant talking about whatever was on our mind with the group. This may all sound simple, but acknowledging my feelings—not to mention talking about them with others—was something new for me.
The easiest way to explain it is that before I got sick, I would go through life absentmindedly. I’d be in the shower thinking about a meeting I had later or riding the bus to work but planning what I’d make for dinner that night. How many moments did I spend in the moment? Not enough. I didn’t give myself space to acknowledge my feelings and work through them. I’d push down negative feelings, hoping that if I just ignored them then they’d go away. The first thing I learned in group therapy is that I couldn’t move on from my pain. I had to work through it.
Psychiatrist Jessica Gold, MD, an assistant professor at Washington University in St. Louis, explains that attending an IOP can be similar to going to school: “You learn skills to better cope and manage whatever is going on with you, [to get] a better understanding of what’s going on,” she says. “That is something that IOPs can do really well, in part because there’s a lot of psychoeducation.”
In my program, we used dialectical behavior therapy (DBT) as part of our treatment. This emphasizes regulating emotions, being mindful, and learning to accept pain. It was originally used to treat borderline personality disorder, but now it’s used to treat a wider range of psychiatric disorders. It aims to teach you how to live in the moment, develop healthy coping skills, regulate emotions, and improve relationships. I have an entire notebook full of DBT exercises, healthy coping skills, and reflections. In my group sessions, we’d focus on worksheets, and I took notes from all of the sessions. I could write hundreds of pages about DBT skills (seriously, there’s even a workbook), but I’ll just focus on what I found especially helpful.
First, I learned that if I woke up lethargic and depressed, I had to acknowledge those feelings. I’m also supposed to look for a way to regulate my mood so it doesn’t affect my entire day. One of my favorite tools is called “opposite action,” which is deliberately attempting to act the opposite of an emotional urge. I might feel like staying in bed and embracing negative thoughts, but instead I’ll write down 10 things I’m grateful for and eat a breakfast that will make me feel nourished and give me energy. It’s about changing my knee-jerk response from an unhealthy reaction to a healthy one that will directly affect my behavior.
Another DBT skill called “interpersonal effectiveness” has helped me improve my interactions with others. It’s not like I didn’t know how to talk to my friends and family, but I learned how to engage in conflict in a way that maintains self-respect and doesn’t escalate a situation. Before my program, I thought that asking for help was a sign of weakness, and that negatively affected the way I interacted with others. But I’ve learned that’s false; asking for help is a sign of strength. I’ve also figured out how to prioritize my own well-being, rather than sacrificing my needs for the sake of others.