How to Make the Most of IOP

So you’re stuck in Intensive Outpatient Treatment (IOP, for short). The top complaint I hear about IOP? That it’s boring, stupid, and a waste of time. Then why do therapists keep sending their clients to IOP?

I will share a secret with you that most people don’t know, including the other people in your program: the benefit of programming is the process, not the content.

What do I mean by this? Too many people focus on the content of the groups.

For example: “Today we’re talking about relapse prevention planning!”

This might feel like a yawn to you. You might think to yourself, “I could read this in a book or google this information.” Sometimes the information barely relates to you, or feels silly. The information is not the intervention.

What I want you to focus on is the process, not the content.

To wit, I had a young client who went through IOP. He met with me after one of his groups and said, “This girl drove me crazy today. I was so upset. For the first time in weeks, I wanted to go to the bar and get drunk. It was just too much.” He went on about how she was saying unhelpful things, and how the group facilitator failed to “correct” her.

(Is there someone in your program who is driving you nuts right now? For most people, there are always at least two or three.)

I asked my client, “What did you say while she talked, and you noticed yourself becoming angry?”

“Nothing,” he said. “What’s the point?”

“Well,” I said. “You’ve told me that this is what you do with your mom – you get mad and are filled with contempt, and you let her go on and on. You have been doing that with your ex-girlfriend, which is what got you in this mess – you got drunk and things spiraled out of control after you let her blow up on you. The girl in the group isn’t your mom or girlfriend, but I’m wondering if you can pause to consider what is stopping you from saying something. This group provides that opportunity to practice.”

A lightbulb went on. “Ok, maybe that’s true,” he said. “I guess I’ll start trying that.”

He started participating in the group process. A week or two went by, and he still felt unsettled. I asked him to tell me about what he was saying in group.

“Well, I give a lot of feedback now,” he said.

“That’s a start!” I said.

“Yeah, whenever people have problems, I give them advice,” he said. He shared with me that he had been providing them with advice that I had been giving him in session! Although I was slightly flattered, more than anything, I was very concerned.

“So, instead of saying something like, ‘the way this girl is talking is making me upset,’ you’re just giving them advice you hear from me,” I clarified.

“Yeah,” he said.

I confronted him. “Kind of like when I teach you a new skill, and you call up your mom and tell her that she should be practicing this skill,” I said.

“Well, yeah,” he admitted.

“Same old story,” I said.

“Yeah,” he said with a chuckle.

I then talked with him about the importance of letting himself be vulnerable in the group. The people in the group – even the ones who are annoying, or who seem crazy – are amazing gifts to us. They reveal archetypes and dynamics from our real lives that are keeping us sick. They show us how we interact with others in ways that are of disservice to us. They also show us the path toward healing.

If you consider the idea that depression is “anger turned inward” and that anxiety is “refusal to acknowledge anger,” there is a potent invitation here to find ways to express anger in a healthy way so that you are not carrying it like a toxic burden.

So, even if you are in a group where the facilitator is just lecturing you about relapse prevention planning, notice when you find yourself feeling dismissive or irritated. What is happening? How are you occupying the space? What is it that you are telling yourself about your relationship with others in the room? This is the real work. It is invaluable.

As for the content of each group, follow the adage, “Take what you want and leave the rest.” If there is a skill that is not relevant to you, it’s ok to let it go. Just make sure you end each day asking yourself, “What is the gift here, even if it is in rough packaging?” Each group provides a wonderful gift. Your only task is to open it up to see what is inside.