By Heidi Green, PsyD, Staff Therapist
The Intensive Outpatient Program (IOP) at PCS is designed to provide intensive, outpatient treatment for multiple symptoms over the course of one week. Clients see approximately five to nine different clinicians with varying therapeutic approaches during treatment. Generally, thirty hours of individual/couple sessions and about twenty-two hours of group sessions occur over the course of the IOP. This multidisciplinary approach treats individuals experiencing acute interpersonal or psychological distress whose symptoms do not warrant long-term residential treatment. Techniques include equine therapy, eye movement desensitization and reprocessing (EMDR), psychodrama, exposure therapy, mindfulness training, dialectical behavior therapy (DBT), gestalt therapy, hypnosis, emotionally focused therapy, cognitive therapy, and psychoeducation. The underlying theoretical framework of the program is based in a family systems model and extensive therapeutic work surrounding early childhood experiences and family of origin dynamics is employed.
The majority of clients who participate in the program choose a one week IOP, although clients may choose to stay in the program for up to three weeks. Determinations about length of program for each client are initially made at the time of intake. Revisions can be made after treatment begins if the client, the treatment team, and their referring therapist (when applicable) are in agreement that extended treatment is warranted.
After an individual contacts PCS and is determined to be a good fit for the program, a case manager is assigned and an intake is scheduled. Clients are asked to complete an intake before they arrive so therapeutic goals and a personalized treatment program can be designed before their week of treatment. The role of the case manager is to complete the intake, serve as a liaison between the referring therapist and the IOP team throughout treatment, ensure all required documents are completed and write a treatment summary at the end of treatment.
As stated, PCS utilizes a number of therapeutic techniques, some of which are program requirements to be completed by all clients. These required exercises include the making of a trauma egg, a genogram, and completion of a personality assessment. Additional tools which are used when appropriate include completion of a wellness contract, a clarification packet, and developing an offense cycle. The trauma egg is a timeline of all traumatic events the individual has experienced in their lifetime which includes emotions they experienced during and after each event, messages they received from others about the event and how they processed or coped with what occurred. The wellness contract identifies and categorizes a client’s triggers, problem behaviors, and healthy coping skills. It serves as a guide for avoiding and coping with triggers when they are presented and utilizing healthy alternative behaviors in everyday scenarios. A genogram is a family map which identifies the roles and personality traits of each family member and includes a brief description of the relationships between family members. This tool is used to identify unhealthy patterns and themes within the family and can help clients develop an understanding about the etiologies of some of their dysfunctional beliefs and behaviors, especially as they pertain to interpersonal relationships. Clients complete a clarification packet that helps them gain insight into their maladaptive behaviors by identifying motivations and desired outcomes. The offense cycle identifies behaviors the client has engaged in that have been offensive to self and/or others. These may include drug and alcohol use, sexual acting out, self-injurious behaviors, rage or passive-aggressive communication. Finally, personality test results are used to explore how the client shows up in the world, how they are perceived by others and how their behaviors may be interfering with healthy functioning.
In addition to standard therapeutic sessions, IOP clients also participate in twenty-two hours of group therapy throughout the program. Group therapy sessions, which range from one to two hours in length, include an introduction and wrap-up group, equine therapy, two sessions of psychodrama, communication group, mindfulness, two sessions of compulsivity group, healthy balanced person group, anger and forgiveness, boundaries group, codependency and a Get Real group, an adult play therapy group which encourages healthy spontaneity as opposed to unhealthy impulsivity.
Clients participate in approximately thirty hours of individual therapy during the course of their week long treatment program. Clients are assigned to treating therapists for completion of required exercises and additional methods (such as EMDR) are assigned as part of a personalized program designed after the initial intake. At the midpoint of each week the therapists convene for a staffing in which the client is present as a silent observer. If there is a referring therapist, they are also invited to participate in the staffing via telephone. The group of therapists briefly shares their experiences of the client including progress and areas which require continued work. In the clients’ therapy session immediately following the staffing, the therapist will initiate a debriefing. The therapist allows the client to share their feelings about and interpretations of the discussion in the staffing and assists the client in addressing any pertinent thoughts or emotions that came up for them as they observed the discussion.
Upon conclusion of the program, clients participate in an outtake session which includes a review of the client’s perceived gains during treatment and areas for continued growth, as well as their perceptions of the program. In addition, the initial treatment goals are reviewed to identify those that were effectively met and follow-up treatment plans are reviewed and/or developed. If a client did not have an outpatient therapist at the time of admission to the program, referrals are given for continuation of care. Case managers conduct a follow-up session with clients approximately one week after program completion to provide support regarding successes and challenges following discharge.