Many people, when embarking on this wonderful journey of life, may find themself needing therapy. But what level is right for us.
Outpatient Therapy is sort of like our first line of defense. At this level, clients are normally stable, meaning they are not actively suicidal and tend to have limited passive suicidal ideation. There is no risk to others and very minor risk to themselves. Here, clients can work on an individualized treatment plan at their own pace* with their provider and really make improvements long term as well as talk all the details of trauma and experiences that might not be appropriate at a group level. The cadence of therapy usually is at once a week at most unless there is an event that has triggered needing a couple more sessions at the therapist's comfort level. Clients tend to drop down to two weeks, then three, then one month, then as needed and so on. Outpatient is not crisis management, but rather a longer term support as the client is able to safely handle crisis at this level. I put an asterisks* at pace because the pace may be dictated by insurance (those turdnuggets), but for the most part, if it is a decent plan, it should be okay.
Some outpatient therapists might offer a weekly coping skills group about an hour to an hour and half long for those needed some additional support.
Intensive Outpatient Program, normally, meets about 3 times a week for 3 hour sessions and is done in a group environment. They usually last 5 weeks and no more than 8 weeks. This is for an intensive dive on coping skill management and usually encompasses a check in, processing utilizing the skills taught each week, and then a teaching on a new skill and application. Here, clients have been struggling with pretty intensive passive suicidal ideation or consistent intrusive thoughts or behaviors that have led to persistent depression that can't seemed to be kicked at the outpatient therapy level. I definitely recommend IOP for individuals struggling with persistent mood struggles and maladaptive behaviors as you can really learn some great crisis management skills and the consistency of meeting with a group 3x a week while going through these tough moments can really help support our needs more than what an outpatient level therapist can provide. IOP programs normally do not include med management and if that is a route one is taking, that will have to be sought outside of this program. Group rapport will be limited and conversation's monitored as to stay on topic to not trigger other's in group.
Partial Hospitalization Program, this one sounds like a client is hospitalized, but it is not. PHP programs normally are intensive 2 week program that normally last no more than 4 weeks. Though I have seen some programs that have gone to 8 weeks, insurance normally kicks off after 2. This level of programming normally is considered a direct step-down from inpatient hospitalization. Often individuals who have had a major crisis that have needed inpatient support will then step down to this 2 week program that is roughly 6 hours a day from Monday-Friday. This will include a continuation of med management within the program and additional skills and process groups. This normally get's the client ready to integrate into their normal day to day with then stepping them down into IOP for continued support. Group rapport will be limited and conversation's monitored as to stay on topic to not trigger other's in group.
Inpatient Hospitalization- this is where we are triaging. The client is in major crisis and cant keep themselves or other's safe. There is usually an act of some sort or a plan to act without abiding by a safety plan. The main goal of inpatient is stabilization. They may be detoxing and depending on what from that can be life threatening and so the client is there to be monitored until they are no longer a harm to themselves or others or at medical risk. Stable in no way shape or form is synonymous to good or happy. I dont want to sugar coat this bad boy. It may not be one flew over the cuckoo's nest, but very rarely is it a spa like experience at the Ritz. Patient's are often shocked at the lack of therapy in this environment and how people are divided on the unit. There may be a couple of mental health groups or occupational therapy opportunities on the unit, but everyone is usually mixed regardless of diagnosis meaning the level of the group's meaningful impact may vary. Inpatient is a medical approach to behavioral health. They are looking to get the client in, medicate them fast, and observe them just long enough to ensure they are no longer a danger to themselves and others, and you are out of there. This is not where a client would go into the depth of why they are experiencing the things that they are. So if we have found ourselves at this point, it is truly because we are unable to use any distress tolerance skills to manage the crisis we find ourselves in and need this level of support. I, personally, try my best to utilize other levels of care prior to this one; however, also see its necessity in times of true distress. Inpatient stays often last at most 5-7 days; however, can last up to 30 days in severe cases.
Residential Rehabilitation Programs- This is where we are still in crisis and need an extended program to manage meds, utilize group therapy, individual therapy, and even family therapy. There are different variations of residential treatment facilities that tend to have an overall focus like eating disorders, substance use, or behavioral health. These programs can range from one month to six months and will often step clients down into a PHP/IOP program. Residential program vary in terms of if they are covered by insurance and many are private pay. Some may be court mandated. Some of these programs can also include state hospitals that offer longer term care.
I have not included support groups in "levels" of therapy, because though many groups are therapeutic, they are not always run by a licensed provider and do not necessarily fall under that category of a level of therapeutic care.
Just like all things. Research. Not all therapists, programs, hospitals, residential facilities are the same. My biggest recommendation is research. What is your goal? What are you needing support in? And once you know, what does the program offer? IOP programs that offer the weekly groups, but dont offer an individual therapist each week might not be the best fit. Working that in tandem, I, personally, find that system more helpful. If you are just out of inpatient- did they give you a med provider referral to maintain your medications? Waitlists can be super long- so going into PHP while you wait- to ensure you have a med provider (if that is the route you are taking) might not be a bad move. RESEARCH.
You got this friend.
L-A