A Chronicle of I.O.P. (Intensive Outpatient) Group Therapy

By Jorie

Recently I wrote about a mental breakdown I had involving my bipolar disorder and a severe mixed episode with psychosis. As part of my treatment plan, in conjunction with treatment for my physical illnesses, I agreed with my psychiatrist to try IOP (Intensive Outpatient Therapy) in the form of a group setting as a substitute to being psychiatrically hospitalized.

This particular IOP program in my area, called Transitions, runs for 3 hours, 3 days per week. Yes, the definition of “intensive” really rings true here. It is broken up into sections where there are different themes led by different counselors throughout the duration of the 3 hours in a DBT (Dialectical Behavioral Therapy) style approach. DBT was developed in the 1980s and focuses on developing healthy coping mechanisms, learning mindfulness and awareness techniques, and applying these skills to daily life.

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(Via: www.blessingmanifesting.com/2016/10/why-i-love-dbt.html)

Below I’ve documented a journal of sorts to outline my experience with IOP and help open the eyes of others to raise awareness of one of the many ways you can seek help for mental health issues. One of my main goals as well is to stifle the notion that this is any type of “looney bin” or that we are “nut-jobs” (as a relative of mine put it).

So, without further ado, here is a first impression and detailed experience of my first week in the IOP group therapy program.

→ Day 1:

After a folder of information and study guides were delivered into my hands, I walked into the group meeting room apprehensively, guided by my sponsor therapist, M., with a gentle hand on the shoulder. Time seemed to slow down and I was anxious but in a hopeful way. My mom, fiancé, and friends had all mentally prepared me for this: “it’s going to be great,” they all said to me. In my gut I knew it would be. I was ready to make the most out of this.
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Prior to entering the group, I had sat down with my sponsor counselor, M., to talk about every gory detail of my past, present, and future life to make sure the Transitions program was a good fit for me. She determined that it was, of course.

Flash forward again to the meeting room. I stood in the doorway. “Hi everyone, this is Jorie!” M. said cheerfully to the group.

I’m typically extremely introverted, shy, and reserved in person. Once I feel I can relate to someone and feel they aren’t judging me too harshly, I open up a bit more. I was feeling a bit intimidated because I initially couldn’t figure out if any of these people even cared, much less would like me or get to know me.

I looked around at the faces. 8 of them, I counted. Some simply content, some beaming, and some sullen faces filled the room. All women. All ages. I wasn’t too much of an outcast, I decided.

Shuffling myself into the first seat next to the door, I hastily introduced myself, my mouth running miles faster than my mind was taking it. Who knows if I made any sense whatsoever; everyone else then went around and told me their names as well.

I organized them in my head, starting clockwise from where I sat, memorizing everyone’s names. This has always been a strength of mine: remembering faces and names. Hopefully they would become more familiar to me as time went on.

In the beginning, it all felt like a movie: the group full of misfits, coming together to do a mental health activity — all the different personalities present and stereotyped. Except we got to go home afterwards. And that’s what we did. Our first leader, A., led a few activities in body image and positivity, as well as appetite and eating properly.

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Of course, these are all problem areas for me. I found out very quickly that I wasn’t alone there, though. It seems everyone there had problems with either over- or under eating or just eating the wrong foods. However, some offered their knowledge on how they integrate healthy foods into their diets and one even gave the title of a book that helps with anti-inflammatory eating, something I surely can benefit from.

This girl, D., who gave that book reference, happened to be someone who suffers from many chronic illnesses such as myself, including RA. We hit it off instantly discussing our ailments and how we treat them. It was an interesting moment to meet a spoonie in real life, one who has similar issues that I have, both physically and mentally. I’m not as rare as I thought.

The second session of the day, led by a counselor named P. whom I’d seen last year for one-on-one therapy, consisted of talking about areas of our lives we can “fix,” meaning if we had the means to do so right at this moment, could and would we fix this problem? Most of the room focused on their anxiety, depression, loneliness, motivation, OCD, and other similar obstacles. My answer? I want to fix my chronic illnesses. I think I may have been the odd duck out on that activity, but luckily it was a private one.

By the end of the first group session I felt positive and already accepted into the small crowd. Sure, there were some tears as people shared their stories, a little bit of sadness coming out, but it didn’t bring us down. If anything it brought us together. There was a load of laughter during other stories.

But I noticed we all had this “thing” in common — this shadow or demon or whatever you want to call it — and that was really comforting. It was like a blanket covering all of us with warm, nodding knowledge of “I know what you’re going through, and I get it.

As I walked out, one of the girls, S., said to me, “I’m so, so glad you decided to be here. That’s the first step. Don’t forget that you are amazing.” This may only be Day 1, but I think I’ve quickly learned the true meaning of this group.

→ Day 2:

The room was a bit emptier than the last group session, but there were two new faces too. Maybe it was the rain. The feeling of gloom seemed to hang in the air around all of us.

Our counselor, M., opened with how our weekends went. “Who wants to share what they did this weekend?” she asked.

I decided to speak up; I’d actually done a few things this past weekend despite feeling pretty terrible physically.

“I went up on the parkway with my dad,” I mumbled softly. “It was beautiful—the leaves are all changed and then colors are bright. I took some pictures and walked for a while until I was too exhausted, then we came home.”

M. nodded. “That’s wonderful! I noticed the leaves here too…they are spectacular! So how are you feeling today?”

I thought for a moment, pondering whether I wanted to share any intimate information with everyone. I didn’t, not today at least. “I’m okay. Half good, half bad,” I settled.

Our themes for the day focused on self-soothing mechanisms such as baths, aromatherapy, and favorite comfort foods. We also discussed the dichotomy of left and right brain thinking.

Balancing logic with emotion is not a strong point for me. That’s part of the reason I’m in IOP to begin with. I need to learn the skills of using my logical, analytical brain in synchrony with my sensitive, creative one. It’s hard, for sure.

I left that group feeling positive again, and looking forward to the next one. This was only Day 2 but I can tell that DBT is helping me more mindfully notice my thoughts and actions combined with my mental illness.

As we talked about in the group, and actually is a central concept of DBT as a whole: we have a choice — we can stay miserable in our lives, or we can do something to change the situation whether it be fixing the problem, learning to live with it (aka “it is what it is”) or changing our emotional outlook.

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→ Day 3:

Today was not a good day. As I wrote in a previous blog, I saw a terrible doctor who “gave up” on me recently. This happened the day before and I was still reeling over it, even though I’d come to accept his words. I was still sensitive, it was still a fresh wound.

A., the first counselor for the day, went around the circle to check in with everyone on how they’re doing. She does this each time she heads the group for the day. The intention is just to get an idea of how everyone’s week is going and how we may be using our skills or how we could improve on that. I also really enjoy hearing people’s stories, what they’re doing, and how I could be using the skills the way they use them.

When A. reached me, my eyes had already welled up with tears. I knew I wasn’t going to get through this story without crying. I told the group about the awful doctor, how rude he was, how he told me I was at the end of my rope and I’d have to “live with it” and there’s nothing he can do.

By the start of IOP group today though, I’d had time to do a lot of reflecting, as evident by the writing of that blog post. I actually used some of the skills I’d learned there already, and I was consciously aware of this.

A. realized this as well as she applauded me for being so honest in my story. “I’m so proud of you for telling us, thank you for sharing,” she said in her soft, sing-songy voice. “Jorie, you used your skills wonderfully in this situation,” she added.

And I had; I knew I had. I had come to realize that this doctor was not going to control me. He was not going to be the one to tell me I had run out of hope, because I hadn’t. In this situation, I chose acceptance but I also chose to change my emotional viewpoint, shifting my focus to being hopeful rather than giving up. This is a big skill in DBT — saying, “it is what it is.” AKA: “Radical Acceptance” and using my “Wise Mind.” 

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For the rest of the group timeframe, I felt a little stronger mentally. Everyone supported me. I was told by one girl, C., that she felt I was extremely strong for enduring what I am with my health. Another, R., told me the story of her congenital health issues and how she overcame them.

The people in this group are more than mental health comrades; they can relate on several different levels and it’s wonderful to have the support of not just my mental illness but my physical illnesses as well.

We focused on mindfulness and gratitude practices for the remainder of the time and were prompted to come up with something we are thankful for that corresponded with each letter of the alphabet. It was a difficult exercise but I did it and once I finished I felt so much better about my life in general. I realized I am truly blessed, which brings me back to my mantra: “find the blessing in disguise.”

Well, I found 26 today.

→ Day 4:

The last group meeting of the week: I made it. I feel victorious, as though I’ve reached the end of a long marathon on a hot summer day. IOP group is draining to say the least, and for someone with a chronic illness it’s even worse to endure 3 hours of an intense mental health therapy for 3 days a week.

But alas, I made it. And I love it.

Even better, one of the girls, D., brought cookie butter for the group, and one of the girls I’d grown close to, S. was graduating. A bittersweet day.

We did a few activities to begin, namely passing around a devotional with intentions written on each page. Mine talked about how the body, mind, and soul connect. We also touched on a few different themes, such as how to make our home a sanctuary, being mindful of our feelings toward our bodies, and expressing gratitude in everything we do.

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Now the biggest thing I’ve started to realize about IOP is that I have already been equipped with most of these skills and concepts for a long, long time. Anyone who knows me well, knows that I’m a huge believer in the power of mindfulness and being aware I practice it every. Single. Day. So… what has gone wrong in my head?

Honestly after reflecting on all the studies we’ve gone over for the past week, I’ve realized I’m in a rut of “practicing what you preach.” I’ve had a hard time attaching the meaning of all these thing to myself, and instead go around helping others and being that shoulder to lean on or that listening ear.

I have always been someone who loves to help others; it’s just part of my nature. But IOP has put it all in a different perspective for me: I’m in dire need of helping myself and putting myself first.

As one of our counselors, D., put it, “you have to love yourself before you can love somebody else.” It sounds like a broken record (and also immediately made me giggle and reminded me of RuPaul’s motto: “If you can’t love yourself how the hell are you gonna love somebody else? Can I get an amen?”). But it’s true.

 

Looking to the future…

So, at the end of this fourth session, I’ve drawn several conclusions about myself and being in group therapy. Here are my top 3:

1. I’m getting a lot out of this but only as much as I put into it—and I’m trying really hard to put all my mental effort into this. It’s draining as hell. I come home and all I want to do is just sleep, sleep, sleep. But I know it’s important for me to get better. So I’m showing up, being vocal, and going home to consciously practice the skills we discuss.

2. I can learn and grow from hearing other people’s stories. This is something I’ve known for a long time but it has been reiterated to me. There are individuals from all walks of life in my IOP group, and you know what? I absolutely love it. I love these broken but beautiful people. They have shown me that I’m not alone, that we all mess up and go through bumpy patches, but ultimately we’re here in this life for some reason and part of it is to be both student and teacher.

3. I’ve realized that my constant “why me?” is slowly turning into a “try me.” I’m learning how not to identify with the struggle itself as a part of me but rather letting the struggle just be and changing my emotional reactions, especially being more mindful. “It is what it is,” says DBT.

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