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My therapist has been trying to convince me to go into a DBT intensive outpatient program. I have been avoiding it because I am agoraphobic (I don't ever leave the house alone) and it's a hassle in terms of getting there. My disability attorney convinced me to do it because she said it would be very helpful for my case. I am scared though. 

Anyone have any experiences with IOP they want to share, good, bad, or ugly?

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I don't know how your IOP program is structured. The most helpful aspect of it for me was that I could express a problem I was having and then one of the therapists/social workers could help me right away with it (getting my pdoc to call me, placing me in a certain group therapy etc...) The major problem for me was that all of the talks and exercises are geared towards the majority of the people in IOP who are usually stressed about work or sad about a loved one dying or something similar. I am not minimizing their issues but there was no one to relate to about mania and psychosis or anything like that. I did not feel comfortable sharing in the group setting. 

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I've been in IOP four times. Three were CBT and one was DBT. The CBT IOPs were helpful but also hard for me. They were very process-oriented and I found it really difficult to be exposed to other people's pain without being triggered. I had to get up and leave the room a lot. And similar to what Ceremony said, there weren't a lot of people in the room who could relate to what I was experiencing, so I felt a little uncomfortable sharing. There were definitely benefits as well: structure, the support of a pdoc and a tdoc, a small sense of community (even though it was also a little alienating), etc.

DBT was a better fit for me. I did it for a year and half. I would still be in it if I could be. People may moderate it differently, but in my experience it was not process-oriented, it was run more like a class aimed at teaching DBT skills. I was told this is because in part DBT is designed to work for people who may be easily triggered and/or are highly sensitive. The people in my DBT group also had similar histories and dxs to me. We would learn a series of skills and keep track of our progress working with them. In group we would discuss our experiences with what we had tried and ask the group leader questions about how the skills worked. 

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25 minutes ago, CeremonyNewOrder said:

The major problem for me was that all of the talks and exercises are geared towards the majority of the people in IOP who are usually stressed about work or sad about a loved one dying or something similar. I am not minimizing their issues but there was no one to relate to about mania and psychosis or anything like that. I did not feel comfortable sharing in the group setting. 

Sorry you didn't feel comfortable sharing. I am worried about not fitting in too. I was in group therapy for anxiety that was like that - everyone's problems seemed, I don't know, I guess less severe than mine. I had the opposite experience the one time I was inpatient. I guess I'll just have to see what it's like. Hopefully it will be helpful for me, and if not, at least it will help my disability application.

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it takes time to get comfortable,a plus is knowing others out there suffer like u, u have some "peers" and are not alone, you also see a doctor at least 1x a week for med adjustments, thats a HUGE bonus, it took me 10 weeks in IOP but it got me liveable, im still all messed up lol and need therapy and cant shake the depression and sleep issues, and some things are coming back but i think its med relted, anyways give it a shot, they help

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13 hours ago, CeremonyNewOrder said:

I don't know how your IOP program is structured. The most helpful aspect of it for me was that I could express a problem I was having and then one of the therapists/social workers could help me right away with it (getting my pdoc to call me, placing me in a certain group therapy etc...) The major problem for me was that all of the talks and exercises are geared towards the majority of the people in IOP who are usually stressed about work or sad about a loved one dying or something similar. I am not minimizing their issues but there was no one to relate to about mania and psychosis or anything like that. I did not feel comfortable sharing in the group setting. 

This. 

I actually asked to leave IOP because I couldn't relate to anyone there. They all had minor depression or anxiety issues. I don't want to minimize their issues either but I don't know how else to say that. No one had psychosis or mania. I didn't share anything because I felt like a freak! Well when I tried to leave the Dr put me in the hospital the psych ward! Which I didn't appreciate at all! 

Now I basically do IOP continuously and indefinitely at my county mental health clinic. I do group therapy twice a week. Individual therapy weekly. Pdoc depends on how I'm doing. At least monthly though. I meet with my case manager at least monthly. Etc. 

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Yeah your experience highly depends on the group you are put in and how severe your symptoms. I'd think it would be more difficult if you are dealing with psychosis, hallucinations, delusions,  panic disorder, agoraphobia, social anxiety...I think there are more groups where people deal with straight up depression/general anxiety.

You mention doing a DBT program, which I did and I found to be excellent (it was given through a private practice psychiatrist though, not in a hospital). It was very structured, a small (8 person) class where you are given worksheets and practice different skills, mindfulness meditation, do "homework exercises" and talk about about how the skills went each session, and other group members provide feedback. I liked that it was more of a structured class with hands-on techniques/skills, and less an "open forum" type discussion where you just go around the circle and talk/analyze our feelings or whatever. It felt more useful and productive and less pressure on each individual to disclose your personal history.

Edited by Blahblah

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I've had a wide range of experiences.  I agree with the general consensus that a lot of times it's oriented toward depression and anxiety.  That said, in mine there have been a decent number of people who were coming off a hospital stay, so there was at least that similarity/severity.  At the most recent one I was a part of, there were others dealing with PTSD, but none with bipolar disorder.  I had to make up my own mood rating scale because there's was designed for depression.  But it was still reasonably worthwhile--it gave me something to do and some skills.

One place that I went to had a heavy focus on art therapy and other expressive therapies.  That said, it also had OT, a weekly mindfulness thing, and some general skills-related sessions periodically.  In that one, I met with the psychiatrist two to three times per week, though they said I was too drug-dependent and not skills-oriented (I'm sorry, but I can't mindfulness myself out of mania).  I also ended up in the hospital fairly shortly after that experience, as the medication that they had put me on sent me manic. 

The other didn't have nearly as much in terms of types of therapies and was more geared at giving people something to do.  I'm sure they called it (and billed it) as therapeutic, but I didn't see a ton of therapeutic work going on.

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Everyone who has experienced being psychotic while in IOP hit the nail not he head for me. I felt the odd one out and I kept trying to leave anyway because I was certain I wasn’t sick anymore. It just seemed like a big waste of time to me. Nothing to help me combat the psychosis. 

BUT... I think if it is depression or anxiety you struggle with, it offers a lot of constructive exercises for dealing with that.  

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Thanks for the insight, everyone. It's been helpful. It sounds like it can be a real mixed bag, and depends on the program you get.

Right now my big problems are severe depression and anxiety. I am not struggling with psychosis or mania (although I have in the past), but I can relate to concerns about what level the people the other people are at. I recently quit group therapy for anxiety because it seemed like everyone else's anxiety was much "less severe" than mine. I didn't want to share because I felt like a freak. On the other hand, my one inpatient experience (when I was a teenager) was the opposite. They put me in the adult ward for the night (no adolescent beds) and I felt like everyone around me was much more seriously mentally ill than I was. It's important to have a good fit.

I guess I'll wait and see. My therapist put in the referral today. I hope I will get a lot of it of it to help me, but if I don't, I'll just keep reminding myself that it will help my disability case, and at least that's something.

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I’m not sure where you are but if you are in the US make sure the outpatient program is in network with your insurance, absolutely sure (two opinions if you can), because you can get stuck with a big bill. I contested mine because I was told it was in network by the program and supposedly the insurance company told them it was too, but it wasn’t and I ended up with the hospital trying to charge me around 24 grand (I didn’t have to pay in the end but it was a LONG process to get there). I will always double check something like that now, not just ask at reception and depend on the answer given to me. I will personally make sure myself by calling the insurance company directly. 

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1 minute ago, saintalto said:

I’m not sure where you are but if you are in the US make sure the outpatient program is in network with your insurance, absolutely sure (two opinions if you can), because you can get stuck with a big bill. I contested mine because I was told it was in network by the program and supposedly the insurance company told them it was too, but it wasn’t and I ended up with the hospital trying to charge me around 24 grand (I didn’t have to pay in the end but it was a LONG process to get there). I will always double check something like that now, not just ask at reception and depend on the answer given to me. I will personally make sure myself by calling the insurance company directly. 

Thanks. This is a really good point. I forgot to even ask because I was so nervous when I called. I know the hospital takes my insurance, but I will double check on the program specifically. 

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My experience with an IOP was super positive, though I've heard IOPs vary.  I would try to get a sense of the particular program's reputation before committing.  DBT skills, when I remember to use them, are SO helpful.  Regarding agoraphobia (I'm in hiding right now), I took low dose Ativan before attending.  I'm going to use a combination of medication and DBT skills to take my dog for a walk (not easy for me).  You're brave for looking into this.  I see this was in February.  Did you end up doing the IOP, @Byron-Black?    

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