“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.
A few days after I spoke to my mom, I talked to a new psychiatrist. I explained my history and told her I simply didn’t have the mental energy to pretend that I was okay. There were times that my heart would race all day and my mind would race at night. For days, I couldn’t eat or sleep. At one point, a therapist I had been working with told me to go to a behavioral health center for immediate help, and physicians there sent me to a nearby hospital. I spent a week in a blur of doctors, hospitals, nurses, and medications—with no resolution. 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.
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.
After three months in the outpatient program, I’ve come to a place of radical acceptance—the idea that when I stop fighting reality and finally accept the pain in my life, my suffering will end. After growing up with a mom who was clinically depressed and frequently suicidal, and a dad who lived across the country, I felt abandoned both physically and emotionally. Working through the trauma of that in weekly therapy could have taken years. But being in a full-time program gave me the time and space to really focus on healing. I was able to talk through my fears of having episodes with my mental health later in my life (what I experienced was frightening and the possibility of it happening again is paralyzing at times). I once heard that forgiveness means giving up the hope that the past could be any different. I like to think of radical acceptance like that, and it’s something I’ll continue to master.
Now that the program has ended, I’m keenly aware of how privileged I was to attend it. The fact that I had health insurance, a job that provided me with benefits while I was on leave, and an IOP near my home are not luxuries afforded to everyone. Part of the reason is that there aren’t a lot of IOPs in our country. These facilities don’t have an incentive to operate until patients—and, more importantly, their health-insurance companies—see their worth and are willing to pay for it. “They need to be valued as an essential part of a comprehensive mental health care system,” says Dr. Gold. “You don’t want people to be going in and out of the ER. You want to have the in-between—we need more of that.”
I, for one, am grateful I had the opportunity to care for myself with the help of an IOP. I’m currently in weekly therapy and seeing a psychiatrist in order to stay stable. I know that if I ever need to return to outpatient therapy, the option is there. “A lot of the diagnoses that people have … are chronic, so relapsing is something that happens,” Dr. Kuller explains. I’m also taking an anti-anxiety medicine that helps me when my body gets in a panicked state, and I’m more well-adjusted than I was a few months ago because of the skills I learned in therapy.
Keeping my mind healthy is a complex process. Some nights, I still lay in bed plagued by fear—the fear of my mind, an uncertain future, and memories I can’t forget. What brings me comfort is the realization I had during my program: I’m not a victim of my surroundings. With care, intention, and strength, I can change my reality. I can lean on my support system. I can create happy moments in my life. I can ease my mind, making my world a brighter place.