Chloe S.CW: Mentions of suicide/suicidal ideation, depression, and self-harm.
Since I was in fourth grade, I’ve been enrolled in many different mental health treatments for my struggles with anxiety, eating, self-image, depression, trauma, and self-harm. Sometimes, I’ll mention something casually in conversation that might confuse someone who hasn’t been through treatment themselves. Their puzzled expressions remind me that while the conversation about mental health has come a long way, the discussion about treatment for mental health issues isn’t nearly as developed.
For many people, asking for mental health support can be intimidating. Throughout my life, there have been several instances where I needed a higher level of care, and asking for that was a challenge. It often left me feeling guilty as it felt like I was asking for more time and resources to spend on my mental health. Despite this, I’ve realized that asking for help is completely normal! Generally, asking for help is a process that people wouldn’t survive without. Sometimes we need to rely on others for a fresh perspective. Some people attend therapy as a way to achieve this, but ultimately it’s whatever feels most fitting for your particular situation. We go to the doctor when we’re feeling physically sick, so what’s the difference with going to therapy to improve the wellness of our thoughts and actions? Therapists give tools to clients and help keep them on track to use them in their everyday lives.
Individual therapy is becoming less and less stigmatized, but treatment programming still creates confusion and uncertainty during conversations about mental health. It’s important to know that it’s completely normal to need varying levels of help, and it’s also okay if you are uncertain about what treatment will be best for you. Starting a higher or lower level of care can be unnerving and scary, and if that’s a place you find yourself, I want to inform you of what basics to expect.
Intensive outpatient programs (IOPs) are a structured treatment option involving group and individual therapy, typically lasting several hours a day, a few days a week. I started my first IOP at 15, and I’ve been navigating various levels of care ever since. I’m 17 now, and I can guarantee that the programming I attended has helped me immensely.
I began my treatment in individual and family therapy after I tried to take my own life. As a result, I was brought to the hospital.
I learned through this experience that individual therapy wasn’t the best method for healing my personal wounds at that point, so I was recommended for an intensive outpatient program, and my parents were given a list of a few places to investigate. I began my treatment and soon after transitioned to their partial hospitalization program as I needed greater support. A partial hospitalization program (PHP) is a structured, intensive mental health treatment program that provides therapy and support during the day, typically 5–7 hours a day, 5 days a week while allowing participants to return home in the evenings.
I “stepped down” to their intensive outpatient program (IOP) after I was discharged (this refers to when you’ve gotten all you can from that particular treatment and are ready to transition to a less intensive level of care) from their partial hospitalization program. I returned to a new treatment in the fall of 10th grade at IOP.
In 11th grade, I started falling back into unhealthy habits, which led me to another PHP program, which I returned to in April that same year after my second attempt. Eventually, I stepped down to IOP both times, and eventually pursued another IOP program at a different facility.
An intensive outpatient program is a bit more involved than individual therapy. Each program operates differently, but most run in the afternoon or evening and can be 2-5 hours long per day for 3-5 days a week. All the IOP programs I’ve attended run 4 days a week with Fridays off. Depending on many factors, treatment in IOP can last anywhere from 2 to 12 weeks (or more based on the client’s needs). Most of the treatment programs that I am familiar with offer IOPs that last 8 weeks or more. That may sound daunting, and it may get tiring at times, but it can be incredibly helpful and rewarding. IOP typically operates in a group format, sometimes with individual sessions or family support if needed and available. I found myself thriving in the group environment when I had a group that fully supported and embraced me with kindness. Living with mental health challenges can feel very isolating, therefore, it is personally helpful for me to hear that others experience a lot of the symptoms and struggles.
Each program offers different types of support for clients. Some have psychiatrists or other specialized therapists, whereas others simply offer group therapy with a counselor. I always appreciated having my team all in one place when the program offered all the professionals needed for my personalized treatment plan.
Some programs offer multiple groups with different focus topics, such as art, yoga, trauma-focused, music, cognitive behavioral therapy, or dialectical behavioral therapy. Cognitive behavioral therapy (CBT) is a structured, evidence-based form of psychotherapy that focuses on identifying and changing negative thought patterns and behaviors to improve emotional regulation and problem-solving skills. Similarly, dialectical behavioral therapy (DBT) is a specialized form of CBT designed to help individuals manage intense emotions, improve relationships, and develop skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. I love creativity, so the art groups always brought me out of my shell and made the hard days brighter. You can expect a group of individuals who can surround and support you in times you need it, and connect with you as they may have shared lived experiences. I formed many friendships at IOPs that I will hold near and dear to my heart forever. IOP can equip you with skills, knowledge, connection, and support. I found that many of the coping skills I acquired from the IOPs I’ve attended can help me in my everyday life, especially in school environments.
A partial hospitalization program (PHP) is another step up from intensive outpatient programming. This program consists of daytime programming that typically lasts 5-7 hours, 5 days a week. Once again, depending on the client’s needs, the program can last anywhere from 4 to 12 weeks. I typically needed the PHPs I attended for 2-4 months. A day will typically begin at 8 or 9 am, and last until 2 or 3. This can differ, but most start later in the morning considering how some clients can struggle with waking up. This program will consist of Friday treatment. Once again, PHP typically operates in a group format, with individual sessions and family therapy sessions. I feel that PHP group therapy helped me feel more connected to my peers. We spent most of our day together, so I formed many deep bonds much like peers at school do. For me, being surrounded by people who understood what I was going through (or aspects of it) encouraged me to find people like that outside of programming, and helped me feel safer and more secure than I could at school (where I struggled with bullying and anxiety even walking in the building).
Most PHPs have some type of health specialist such as a psychiatrist on site to meet with clients at least once a week. The PHPs I’ve been to have family therapy as needed based on the client (once a week or every other week), individual sessions once a week and as needed, and a weekly/biweekly check-in with a psychiatrist or nurse practitioner. Family therapy was helpful at PHP for me as I could return to the group and decompress if the session was heavier.
Some of the things you may do at a PHP during your treatment include group meetings, art, music, yoga, mindfulness, experiential, and CBT/DBT therapy. I found experiential therapy to be helpful, adapting the therapy to “fun” and interactive activities committed the skills to memory more than just learning facts. These approaches are typically structured as a schedule, with each group taking up an allotted time. I also appreciated having a schedule, to keep the habit of sticking to a schedule fresh in my mind, it helped me retain a sense of “normalcy.”
If you are still school-age when attending a PHP, a teacher may work with you to accommodate your studies and help you develop a plan with your school so that you stay on track. There is usually an allotted time for schoolwork or school discussion with the teacher. Lunch is also worked into the schedule, as the PHP operates during the day. One of the PHP programs I attended helped us with our eating struggles; we ordered lunch once a week, packed twice a week, and made our lunch with ingredients they bought twice a week. I attended a few PHPs, and each time, they helped me through the challenges I was facing at school. I formed deep connections and bonds with many of the other people there, some of which I contact and continue to connect with now. Asking for PHP is not a sign of weakness, it simply proves you are in tune with yourself, and you are aware of what you need to improve, and that shows real strength! PHP can equip you with skills for school, daily life, and for continuing down a healing path.
Starting PHP and/or IOP can be substantial changes to adapt to. You may have to alter your daily routine or ask others to accommodate your treatment. Sometimes relationships may shift during treatment, but you shouldn’t be worried because a good friend won’t budge. You may feel tired more, and you have to be able to be patient with yourself and give yourself more grace.
During treatment, you will do a lot of introspective work that can be draining. You are being vulnerable for long portions of your day. It’s important to show yourself kindness if you make a mistake and to practice self love when you are worn down. Communicate what’s going on in your life if you feel like you’re ready to. You don’t owe anyone any explanation, but if you feel like you are willing and want to help someone close to you understand what you’ve been wrestling with, embrace that. You are extremely strong, no matter what point in your recovery you’re at. Treatment is nothing to be ashamed of; be proud that you were strong enough to fight for yourself. Hopefully, having a better idea of what you may be walking into will help ease your nerves. You deserve to heal. Good luck, but you won’t need it, because you’re already lucky to be as strong as you are.
If you or anyone you know is struggling with substance use or an emotional crisis, help is available. Text or call 988 or chat 988lifeline.org to speak with a caring counselor 24/7.
Andres
Sammantha
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