I started my new intensive outpatient program (IOP) this week on Monday. It’s a dialectical behavioral therapy(DBT)-based curriculum. For those who are unfamiliar, here’s a brief breakdown of what an IOP is, and what DBT is. An IOP is basically what it sounds like – intensive outpatient therapy. Instead of going to individual, one-on-one sessions with a therapist once or twice a week, you go to about 8-12 hours of therapy per week, usually broken down over 3-4 days during the week. The therapy is primarily group therapy, where there is a group of clients and one or two therapists leading the group, and they usually either lead discussion or they provide psychoeducation (educate you on psychology-related topics). Some IOPs include an hour or two of individual therapy in addition to the group therapy, and some IOPs prefer for you to continue seeing your usual therapist (assuming you have one – if you don’t, they’ll usually help you find one). As for DBT, it’s a therapy that was created by a psychologist with BPD named Dr. Marsha Linehan, and it’s a skills-based therapy. It has a very specific curriculum that DBT programs are supposed to follow, and it being a skills-based therapy just means that you learn different skills to deal with various aspects of life, especially emotions and interpersonal relationships. The four foundational pillars of DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and the idea is that by learning skills related to each of these concepts, you become empowered to “create a life worth living” (the founder of DBT’s words, not mine).
When I started the program, I was really anxious about whether this was going to be “just another program”, where I go through it, and it helps for the time that I’m there and a little while after, but then the effects wear off and I’m back to needing to go to another IOP or residential program or end up hospitalized again. I’m so tired of that cycle, and I’m honestly afraid that I’m going to be stuck in a loop of going to an intensive therapy program for a few months, work for the rest of the year while having multiple rounds of severe suicidal ideation, getting hospitalized now and then, and then going back to intensive therapy, rinse and repeat. I’m so worried that I’m going to end up being unable to function normally in society, and that I won’t even be able to hold a regular job, much less live a life that looks anything like what I have pictured for myself.
I’m still worried about that, but I think there are a few things working for me here. For one, before starting the program, my private psychologist and I decided on a specific and “small” goal for me to work on while I’m in it. I say “small” in the sense that it is a fraction, but an urgent and important one, of the overall picture I’m working towards. There are so many things that I need to work on (it tends to overwhelm me when I start to think about it all), but we decided that I specifically will work in the program on figuring out how to regulate my emotions and just as importantly, my behavior, whenever I am in extreme distress and highly emotional. This has been a major problem for me in the past, and when I get that way, it can last for months at a time where my frontal lobe basically shuts down and stops working and even when I think I’m making a logical decision, when I look back once I’ve actually calmed down, I realize that it was actually a terrible decision. So what I’m working on now in the program is not necessarily learning how to make good decisions, but learning how to wait and deal with my emotions until I am capable of calmly making rational decisions. I think it’s a good idea for me to have this small goal to work on, because it is specific, realistic, and attainable, it’s actually important, and when achieving it will make me more likely to look back on the program and my time in it and to feel like I made useful progress.
Also, I actually really like my group leader, and there’s only one group leader leading all of my groups, which is different from a lot of programs, where there will be multiple different people leading a different groups. And, I feel like I’ve already started to learn things that I didn’t know before, which I honestly didn’t expect. I’ve been in so much therapy and read so many psychology books (not just self-help, but academic psychology books) that I was worried there wouldn’t be much new information for me.
I’m still worried about how useful this program will be to me, but I think I’m off to a good start. I think the key will be to stay engaged and to make sure that I actually practice the skills that we talk about in group. That’s been one of my main problems in the past – lessons remaining as knowledge and theory in my head but not becoming practical skills that I use in my daily life. So I think what I will focus on with my individual therapist in the program will be to work on how to implement the skills we discuss in group in my daily life such that the program actually is helpful and useful to me, and I actually make some progress in my therapy journey. I’ve made progress over the past few years, but it’s felt so slow as to actually make me feel like I’m stagnant and stuck, and the whole point of intensive therapy is to be able to make more significant progress in a shorter amount of time. Wish me luck!