By Jen Kohlenberger
So you just completed PHP/IOP… Now what?
Partial Hospitalization and Intensive Outpatient Programs change our daily routine and lifestyle dramatically. Whether in the programs for a few weeks or for several months, these programs interrupt our life– that’s kind of the point. What we were doing up until this point wasn’t working and things needed to change significantly.
Humans are attracted to familiarity and consistency because it provides predictability and safety. That’s why committing to starting a PHP/IOP program and sticking with it can be difficult. It’s nothing like what we’re used to. But while PHP/IOP is difficult and a little scary to adjust to at first, many people adjust quickly and this new routine becomes familiar and safe to them. Ironically, then the idea of going back to life outside of treatment seems unfamiliar and scary. Just as we have to adjust to starting PHP/IOP, we also have to adjust when we transition back to life outside of treatment.
This is why the discharge plan is so important. Transitioning slowly and methodically, incrementally decreasing the amount of time spent in treatment, and being supported along the way both by providers and our family/friend support system– all of this sets the tone for our future success. At this point, it is crucial that we continue to take ownership of our health and stay committed to the life-long journey of healing. There are many things that will help us stay on track while we continue the journey.
Routine & Maintaining a Schedule
Studies show that daily routine has many benefits for our mental health. PHP/IOP have an established structure and routine that is required to follow. However once out of the program, your schedule and routine will be ultimately up to you to maintain. Sometimes we are resistant to routine because it seems boring, but efficient and effective use of time actually creates space in our day to do more of the activities that we consider fun. Remembering the benefits of routine can help us stay committed to it.
Benefits of routine include:
- Promotes healthy habits
- Supports healthy relationships
- Reduces the propensity to relapse
- Encourages better sleep
- Regulates circadian rhythm
- Reduces anxiety
- Promotes self-efficacy
It’s important to maintain flexibility when adjusting to a routine. If you don’t stick to your routine perfectly one day, that doesn't mean you’ve been completely derailed. Try again tomorrow. Give yourself grace and remember that implementing and adopting healthy habits takes time.
Returning to life after PHP/IOP requires the ability to deal with stress more effectively than you did before. One of the best ways to handle stressful situations is with proper use of coping skills.
Coping skills must be included in your routine because they only work effectively if they are practiced. Consistent use of coping skills builds resilience and helps us to tolerate, process, and minimize negative thoughts, emotions, and body sensations associated with stress.
Your support system is a network of people who will surround you as you continue your journey. It should consist of people who care about you and want to provide you with support while cheering you on.
There are different types of support that we can receive and provide. Different types of support include tangible (i.e. getting a ride, assistance with moving), emotional (i.e.listening, showing empathy, sympathy), informational (i.e.news sources, exercise instruction) esteem (receiving praise, being respected) and belonging (community involvement). It may be helpful to identify what type of support each person in your support system provides. This can help us set appropriate boundaries and healthy expectations with each relationship.
Support systems help keep us from isolating and can hold us accountable.
Accountability can help prevent you from slipping back into bad habits and from forgetting the good habits you’ve picked up in the program. While in treatment, there are many people around you helping to keep you accountable – peers, case managers, and other providers. When you leave treatment you have a lot more room to make decisions on your own without anyone checking in on you. This is where your responsibility and commitment to personal accountability becomes crucial.
Accountability requires honesty with friends and family members, specifically the select people you choose to confide in and ask for help during this transitional time. It’s important to choose a few people who are familiar with your treatment plan, who can check in on you regularly, and who you can reach out to if you are struggling. Oftentimes coping skills don’t come to mind when we are in distress, so at least one person in your network should know the coping skills that work for you in order to remind you what to do if you feel out of control.
Keeping yourself accountable can be more challenging, but it can also be the most rewarding. This requires being honest with yourself about what aspects of your healing are difficult for you to maintain and making the decision to prioritize your wellness. It may include recognizing relationships and environments that do not align with your path to wellness and require setting boundaries to protect your progress.
It’s important to note that holding yourself accountable does not mean punishing yourself when you get off track. There will be bad days and good days and it’s important that you love yourself through both. Have self-compassion and grace, and remind yourself that the reason you’re doing all of this work is because you are worth it and you deserve to be healthy.
Part of your discharge plan includes planning the transition from your case manager to another therapist. While sometimes you can continue to see your case manager as your therapist outside of PHP/IOP, more often you will be referred to another therapist who can continue the work with you moving forward. Ideally, this person will be well-informed about your mental health journey thus far, and will pick up where you’ve left off, seamlessly. Realistically, it may take a few visits to get acquainted with this new person and feel comfortable with them.
It is also possible that the first therapist you go to after treatment will not be the right fit. That's ok. Your mental health journey is a marathon, not a sprint, and it is an investment of both time and effort, which will continue to pay off as you heal. Finding the right therapist for you in this next chapter may take a few tries. The important thing is that you don’t get discouraged and stop going. It’s ok to tell a therapist that you don’t click with them, but it’s also probably a good idea to give it some time before you make that decision. There are many different therapists with different approaches and if you’re diligent in your search for the one who can help you in this season, you will find them.
Regular visits with your provider are necessary to manage any medications you may be taking. Over time, your provider may suggest increasing or decreasing dosages, or adding or eliminating certain medications or supplements when appropriate.
If you have been on a regimine for some time and no changes are being made, your visits may become less frequent. Sometimes people start to feel better and wonder if they need to continue taking their medications. On the contrary, if you are feeling good, that probably means your medications are doing their job. It is crucial that you do not take medication management into your own hands. If you have any concerns about side effects you are experiencing or you want to modify your intake, it is imperative that you discuss this with your provider before making any changes. Do not increase or decrease dosages, or stop taking any medications without consulting with your provider first, as this can be detrimental to your health and well-being.
Whether it’s dietary supplements, pharmaceutical drugs, or a combination of both, when it comes to mental health and how these impact your mood and stability, it’s best for you and your provider to make decisions together.
Life outside of PHP/IOP can seem overwhelming and scary, but you’re ready for it. You wouldn’t be out of the program if you weren’t. Believing in both your ability and worthiness of experiencing wellness is half the battle, and you are surrounded by people who can remind you of both in case you forget. You are more capable than you’ve ever been, and you’re equipped for whatever lies ahead.