“I Need IOP (Intensive Outpatient), but I can’t do groups!”
Written by: LaMarcus Yates, MS, IOP Therapist
How often do we hear from potential IOP patients that they cannot or will not do well in groups? I would say around 80% of the people that we do intakes on start out with a strong hesitation to groups. There are different reasons for their early assessment of what groups will be like, but regardless of the reason, my job is to make them comfortable trying it because I know that in the end they all leave IOP saying how much they liked the group process.
When I first became an IOP Therapist, it amazed me how many people fear social interactions. Now, I expect it when they come to the assessment. When I think about it, most of us as adults have the ability to choose our social settings. Therefore, most of us choose settings where we either know everyone or some just don’t socialize at all unless absolutely necessary. The absolutely necessary times are usually in settings where we feel obligated and have no other choice, like work meetings, church, shopping, restaurants, etc. However, even that has changed in the past few months due to COVID-19. So what can I do to make this person comfortable in a space they’ve never been in and then open up to these strangers and disclose their most inner thoughts and feelings?
I always tell new patients in IOP to give it until the second week of groups to assess how they feel about it. It usually doesn’t take that long, though. Most people are ready to make friends by their 2nd day of groups, but we highly discourage making friends while in treatment due to its highly negative impact. Think about it, it could be so easy to focus on new relationships and avoid or neglect to work on what you came to treatment for. In the therapeutic world this is called distractions. Nevertheless, it feels good to be around people that think, feel and hurt like me. It feels good to finally be in a space where I can disclose my own insecurities or irrational thoughts and not feel judged by it. The most common phrase I hear is, “Wow! I never knew there were so many other people going through what I go through or worse.” “It feels so refreshing to know that when I talk you can relate to my story or you know not to give advice because we really don’t want it at the time.”
I have found in my experience as an IOP Therapist that groups can be the most effective form of treatment. First and foremost, it helps those coming to treatment for social anxieties and personality disorders. Extreme fear of social interaction can lead people to avoid social situations, even if it means losing a job or contact with family and friends. IOP is a safe place to overcome that fear that may give you a sense of relatedness that one may have never had. For some, group therapy is better than individual therapy and often less expensive. Group therapy is also useful for people that isolate or that have a debilitating fear of social situations, mostly because it helps them practice interaction with others. The very thing causing their anxiety.
Cognitive Behavioral Therapy (CBT) is the leading method of treatment used in IOP. CBT techniques help people change thoughts and perceptions related to situations that cause anxiety. Group members test beliefs like “I’m going to look stupid!” or “I don’t know how to ask if my thoughts are rational or irrational.” Before and after exposures, they are asked to evaluate which thoughts were helpful. Then, shown better ways to approach the situation.
In my summary, group therapy (IOP in this case) provides benefits that individual therapy does not because you are with others working towards the same goal, you feel less isolated. It combats negative thoughts about self-worth. Social skills improve. As you get and give feedback, you learn to see yourself from a different perspective. Practicing exposures to the social situations you fear, in a safe place, lets you improve step-by-step. A step-by-step process prevents members from trying to do too much, which only reinforces the anxiety. Members volunteer to use the strategies as they feel ready. Members report back to the group on how they implemented the strategies in their lives. Group members are comfortable supporting and helping each other, reinforcing what they are learning as individuals. You learn from others. Watching someone else work through their fear motivates you.