Intensive Outpatient Programs (aka it feels weird to get help)
December 15, 2020 3:21 AM   Subscribe

My psychiatrist recently suggested enrolling in an intensive outpatient program and I feel weird about it. Am I overreacting?

I have had depression for a long time and have floundered through the years going in and out of weekly therapy along with taking medication. The suicidal thoughts intensify from time to time, and there was a time a couple of years ago where I expressed to my then therapist a wish to be hospitalized (I was 20, unemployed, and very much wished I was dead). She discouraged the idea, saying that any time in a psych ward would likely only be scary instead of helpful. While I understood why she said that, I felt somewhat humiliated because the one person to whom I can express these kinds of thoughts seemed to think that I wasn’t suffering enough.

So despite over a decade of slogging it through and a recently worsening episode, and even though this is IOP instead of inpatient and it was my psychiatrist’s suggestion instead of mine, I feel like a bit of a drama queen. I’ve sucked it up thus far even if I haven’t always been functional, and I never made any real attempts despite planning from time to time with some detail. I just sometimes get the sense when I’m in the grip of a wish to to be dead that someday I’d be in the wrong place at the wrong time with pain so bad that I might actually do it.

I have a problem with growing up in an invalidating environment and it’s now my life’s work to take care of myself and recognize my own feelings. My parents and friends never understood what was going on and I’ve handled all of this alone with only one outburst every couple of years or so that isn’t acknowledged. Generally, no one made me feel like my pain and feelings were real, and I dismiss it all the time including this time.

So while I still have to get the logistics for this IOP straight, I’m afraid that 1) I’ll be around people “crazier” (who are suffering more in the ways movies about psych wards and alcoholics portray) than me and I will feel like my pain is nothing by comparison, 2) they will screen me and determine that I don’t need the program because my pain is nothing by comparison, 3) the few people with whom I keep in touch and update about my life will see it as dramatic and unnecessary, 4) my parents will laugh when I tell them the way they laughed when I was 10 and told them I wished I was dead, or 5) my parents will be angry at me for acting like I’m suffering when “everyone gets their lot” like my stepfather said when I tried to talk to him about how I was raped and was currently feeling suicidal.

My depression says, what if it doesn’t even do anything for you? What if the insurance doesn’t pay and you go bankrupt? Why do you care what happens to you? What if they hate you in there and think you’re whiny and ungrateful?

And I get sad all over again realizing that my parents were never able to properly respond to any of my emotional needs, that it’s a lot of work I would have to continue doing “all by myself”, that I might as well just kill myself because I’m never going to be happy or loved or have anyone actually care about me.

Should I be going to IOP? Does it sound like I’m suffering enough? In the spectrum of care it isn’t even all that extreme, but it would mean acknowledging that what I feel is real.
posted by hnl_u to Human Relations (12 answers total) 4 users marked this as a favorite
 
Yes you absolutely should consider this. Everyone deserves to feel okay about themselves regardless of how "bad' the starting point is, and this includes you.

It might also be helpful to realize that your needed treatment isn't more or less than other peoples', it's just different. Different problems require different approaches. You aren't stealing treatment from someone "more deserving," you're seeking the appropriate treatment for your needs.

You've had suicidal ideation on a repeated scale. That's not normal. That is not something you should be expected to live with or just buck up and deal with on your own. It's a serious problem in need of serious treatment.

Those that don't understand the importance of mental health care or the very real danger of your current state don't necessarily need to know what you're doing. If they aren't supportive then don't tell them. As to nobody ever caring about you ever again, strangers on the internet are taking the time to encourage you to get treatment and take care of yourself. That's not nothing!

It is worth confirming with your insurance that this will be covered before you begin. But don't feel the time is wasted if it doesn't magically turn you into the happiest person on the planet. Time spent in sincere attempt to take care of yourself is not wasted.

Finally, you use the phrase"my depression says." Speaking from experience, depression is a huge liar and you should just put it in a box and ignore it's toxic commentary. Go and take care of yourself, it's not too much to ask and you aren't being selfish or silly or ungrateful any of those other things your depression is telling you.
posted by The Librarian at 4:15 AM on December 15, 2020 [13 favorites]


None of your arguments against this seem all that compelling to me, a person who is not living in your depressed mind.

Probably some of the people in the program will be in rougher shape than you, and some will be in better shape. Hopefully all of you will be able to benefit from the treatment, because treatment for depression is not reserved for only the people who are in the absolute most pain, it's for anyone who is likely to be helped by it. Like, if you had Stage 4 cancer, would you look at someone with Stage 2 and be all, "Ugh, who does she think she is, getting chemo and radiation? *I'm* the one who needs chemo and radiation!"

On the parents/friends question: just don't even tell them if they're going to be assholes about it. If you can't conceal that you're doing *something* (like if you live with your parents), you can say your outpatient program is a new job or volunteer opportunity (it's even kind of true! your job is to take care of yourself!). I'm not saying "hide this because getting treatment for mental illness is shameful," I'm saying, "based on your past experience, telling these people is likely to be more trouble than it's worth." Not everyone needs or deserves to know everything going on in your life.

On the insurance question: the program will call your insurance company and get pre-approval. The program doesn't want to get stiffed, which is what will happen if you can't pay and go bankrupt, so they will likely be pretty proactive about this. You should be able to know whether insurance is going to pay for it before you get there. But also, heck, bankruptcy is not the end of the world.

You don't sound like a drama queen. You sound like someone in a lot of pain who needs help.
posted by mskyle at 4:35 AM on December 15, 2020 [23 favorites]


Yes you should absolutely go & get this treatment. It's designed exactly for you, and you are someone whose intrinsic worth & value as a human being mean that you deserve that intervention as much as anyone else in there - all of whose clinical suitability has already been checked by professionals.

You're not making any of this up. It's real. Your experience is valid, and your descriptions of it are accurate. You have experienced all of those things. What you've described here is more than a lot of mentally-healthly people will have to deal with in an entire lifetime.

It is entirely to your credit that you're continuing to seek useful help, even in the face of so much invalidation & denial in the past. That must have been so hurtful. I know from experience how hard it is to access help when you're in a poor state of mental & emotional help - the barriers are set so high, and often it seems like so much work to push through them. But you're still pushing & advocating for yourself. Don't give up! I'm cheering for you, from over here in internet-stranger land.

I really hope it turns out to be the help that you need. Good luck!
posted by rd45 at 5:00 AM on December 15, 2020 [3 favorites]


I know five different people all in very different situations (mentally, emotionally, age, financial status) who have done these programs, and every single one of them said it was extremely helpful and did not regret doing it. Mental Health services can be really hard to access in a timely and efficient manner and what a program like this does is get you all of the things you need to get back on track in a condensed period of time. You get daily group therapy, med check up, wellness check up every day for two weeks. It is a very different sort of thing than a psychiatric ward where the point is generally to keep people safe (and very few psychiatric wards do that.)
posted by momochan at 5:47 AM on December 15, 2020 [4 favorites]


I understand how you feel because you you wrote it so well and clearly, remarkably eloquent. You have a gift for expressing yourself, but your depression is not letting you see out of the hole your in and it’s making you feel scared and stuck, coming up with reasons not to go to IOP. I have done two over the span of 10 years, most recently this past October. It was so helpful for me and I was sad to have it end. It took a couple or so sessions to get the hang of it, how to discuss my feelings and relate the days topic to my own issues, but then it became easier and easier. People start and end on any given day, and each person brings their own experience into the discussions. I hope you go
posted by waving at 7:26 AM on December 15, 2020 [4 favorites]


I did IOP once, for one day. They discharged me too early from inpatient (thank you insurance company) and the night after IOP, I bounced back into the hospital. The services the IOP patients got there were identical to the services inpatients got. There were several group therapy session, art/music/pet therapy and med management. So your first psychiatrist was dismissive to your needs and did you no favors. Can psych hospitals be scary places? Oh hell yes. But the majority of my extensive experiences were positive.

You said, "My depressions says..." You are very cognizant of what's going on. That's in your favor.

Like waving said, it does take a bit to figure the whole thing out. Group therapy can be intimidating at the beginning. All these new people and such. Know that you can not say anything that first day. I clearly remember at one hospital being told I had to speak and getting pissed off. I told the leader, "I have trust issues. And I don't trust you further than I can throw you right now. Please let me get my feet under me." And I was ready to at least introduce myself by the end of the session. Seeing how that person facilitated group gave me the confidence in them to try.

I hope this helps some. You deserve and need this treatment. Your feelings were invalidated repeatedly, especially by the psychiatrist. Hopefully this will be a positive experience for you. I wish you the best.
posted by kathrynm at 7:50 AM on December 15, 2020 [4 favorites]


I personally found IOP really distracting and not helpful; but I was there because more because of a trauma-related diagnosis. I found both IOP and inpatient incredibly counterproductive because of the programs lack of knowledge of how trauma operates. You mention some trauma, so keep that in mind when auditing programs you have access to. I found group therapies and group skills classes INCREDIBLY difficult to engage in. Clearly YMMV.

Have you looked into rTMS? Psychedelic assisted therapy? Ketamine infusion therapy? I mean, all these get expensive and have a time commitment, And are only sometimes covered by insurance. But they can be quite effective, and usually relative fast to see results.
posted by furnace.heart at 12:54 PM on December 15, 2020 [2 favorites]


An IOP seems like a great fit for you and it sounds like your therapist agrees. Don't second guess whether you "deserve" to be there. That's your depression talking.

However, every patient is unique, every IOP is unique, and not every modality is right for every patient. I, for one, found my experiences with inpatient admissions much more traumatizing than helpful and if you are anything like me that might have been quite good advice coming from your therapist a decade ago. Again, interpreting that advice as "you aren't suffering enough" is the depression talking. Because if my experience was anything to go by, the admission very well may not have relieved your suffering and would have only increased it, and it sounds like your therapist at the time agreed with that.

At the end of the day, all your feelings are valid, even if they are distorted. Your suffering is just as valid as anyone else's and there's always going to be someone out there who has it worse. You have to focus on you.
posted by zeusianfog at 1:29 PM on December 15, 2020


I had a very mixed experience with IOP-- it definitely allowed me to process some stuff that never would have come up in one-on-one therapy; however, some of the other participants did have very difficult and chaotic lives and did tend to view my problems as less significant, which was... kind of hurtful and invalidating! So it was... intense. I think it really depends on the people you get in your group, which is a crapshoot.

What if the insurance doesn’t pay and you go bankrupt? I don't think this will be an issue. I'm incredibly bad with handling finances and paperwork and I was afraid of this too but the program more or less kicked me out when my insurance stopped covering me. YMMV though.
posted by coffeeand at 3:48 PM on December 15, 2020


I see you working hard to take care of yourself! Sending you love and encouragement, as someone who has walked a similar path -- it's difficult stuff! I'm sorry you've had to deal with some awful experiences and reactions - that shit sucks.

Am I overreacting?

A lot of what you wrote is about how the people around you have minimized what you've experienced, and how you're trying to take it seriously and get better, but worrying if it's really serious enough. I think objectively, thousand foot view - NO WAY ARE YOU OVERREACTING! You are working hard on your issues, even as you battle the waves that come. That's exhausting, difficult work, and you are absolutely right to consider the options in front of you, and they are precisely appropriate for what you've described. The only issue as others have described is just making sure that it's the right tool for the job for you personally.

I did two intensive outpatient programs, at 15 and 23 (I'm 31 now). My mindset around the time of the second one in particular was quite similar to what you're describing. In retrospect what helped was that (1) the program exposed me to DBT, which opened the door to more trauma-informed modalities of care, (2) it was an environment where I could tweak some medication stuff with more active supervision, and (3) I got connected with a helpful therapist afterwards to continue what I learned inpatient with focus and care. Also honestly it was a time that I felt down and desparate and impulsive and it was an affirming ACTION I could take when I felt totally stuck in my day-to-day life not working -- I had a similar relationship to ideation and impulsivity as you did. I'm grateful the program played that role for me. And it's been 8 years and I haven't come close to returning (though I'm still working on my stuff!)

The other thing I'd zero in on (though it's not mutually exclusive) is your current supports right now. Does your psychiatrist provide therapy/do you see a therapist? If so, do they feel supportive and consistent? If not, perhaps that might be another helpful thing to throw back in the mix (I noticed you mentioned "then therapist" earlier). When I entered my program, I had a really inconsistent care team (just a psychiatrist and a weird med mix). I wouldn't have articulated it this way at the time maybe, but in retrospect, I didn't feel like my struggle was being "seen" and managed appropriately. I would say that it wasn't the IOP program itself that provided long-term support so much as getting plugged into new therapy options and rejoining that process with new focus and energy. This isn't to say "go find a new therapist instead of pursuing IOP" at all -- I'm just hoping to give you a picture of what that time felt like and what longer-term healing looked like in retrospect.

Nthing to make sure to find trauma-competent practitioners and programs. It makes a world of difference, as a PTSD/C-PTSD pattern of "worthlessness" for example may look similar to clinical depressive patterns, but actually respond fairly differently to treatments (the key with trauma is often somatic methods, EMDR, etc.)

You absolutely, absolutely deserve to be figuring out this journey of healing! Fuck anyone's reaction! I believe in you <3
posted by elephantsvanish at 4:20 PM on December 15, 2020 [1 favorite]


I’m afraid that 1) I’ll be around people “crazier” (who are suffering more in the ways movies about psych wards and alcoholics portray) than me and I will feel like my pain is nothing by comparison,

This probably will happen, and it sounds like you probably will feel that way, and that sounds like a good thing to use an IOP to work on.

My experience in programs like these is that some people fit "crazy" stereotypes more than me (severely disabled by symptoms, homeless, recovering from mania or psychosis) and some fit them less than me ("popular," socially successful, high-prestige job, good at hiding symptoms). There were people in both camps who were genuinely suffering, and people in both camps who were really kind and empathetic to me. There were also jerks in both camps.

FWIW, I second the person upthread who suggested looking for a trauma-focused or trauma-informed program. That won't change any of the stuff I've said, but it will mean that the people struggling in different ways than you are more likely to be struggling with the same things.

2) they will screen me and determine that I don’t need the program because my pain is nothing by comparison,

Then avoid downplaying your symptoms. You are suicidal. Just reflecting on your situation makes you think "might as well just kill myself." You are worried you will make a successful attempt someday. Your psychiatrist agrees and thinks you need a higher level of care. If you say that stuff in a loud, clear voice without hedging, a program that has room for you would be very unlikely to turn you away.

3) the few people with whom I keep in touch and update about my life will see it as dramatic and unnecessary,

They might, and this is super real, and it's another thing people on psych wards and in IOPs talk about a lot in my experience. It's really, really common for people in your situation to be struggling to figure out how how to discuss it and how patient to be with people who are jerks about it.

4) my parents will laugh when I tell them the way they laughed when I was 10 and told them I wished I was dead, or 5) my parents will be angry at me for acting like I’m suffering when “everyone gets their lot” like my stepfather said when I tried to talk to him about how I was raped and was currently feeling suicidal.

Your parents can get fucked. I'm sure I should put this more kindly, but they sound like miserable people and I hope the full consequences of their actions bite them real hard in the ass.
posted by nebulawindphone at 7:54 PM on December 15, 2020 [3 favorites]


For me, an IOP program was the start of learning that I can do things to help me be in the world better than I had been. It was the start of learning to manage depression rather than be helpless within it.

Tell your fears to shove off. Find a way to address your practical concerns and go for it.
posted by kokaku at 5:38 AM on December 16, 2020


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