The ins and outs of IOP

IOP has been a strange experience, not at all what I expected. Yes, there were waifs and overweight people in the same room, although the bingers had their own program, so it was just Anas, Mias, and everyone in between. But people come and go in a flash – some are there for weeks, others drop in and out. Often it’s just me and one other person, or just me.

The Group Befuddle

While it might seem nice to have the entire focus on me (yippie), I expected more of a group experience like what I get with EDA calls, only in person and more intense. So I switched to come to some days as well as a few nights – days are with the PHP’ers. PHP’ers really get upset at mealtime and snack, and lucky me, my first day hanging with the P’s, they had a rough challenge snack, so they were mostly withdrawn and upset. On the up side, there’s a bunch of them, all adults like me, men and women, girls in college or taking a medical leave, and a few of us older folks. On the down side, it’s really hard to be hanging with people who are much sicker than I am. These folks do look like the afterschool movies, or are incredibly anxious (almost manic), or incredibly depressed and huddled in the corner or lying down under a blanket on the floor. That first day we did some silly act-out thing of our ED voices, and I felt I had to volunteer (overachiever) because the clinician was not getting much cooperation from the group. I couldn’t come up with the roles for my different voices, in part because I couldn’t separate out my voices (e.g. parents, ED, depression, overachievement, etc.) like two people did. So we acted it out with my playing the single mixed voice and another woman playing me. And lo and behold, the zombies awoke and said that’s how they felt – they couldn’t separate out the voices, but it was just one (the Bitch, as I call her). Weird experience, but it was nice that I connected with the group. Thankfully the group came out of its stupor another day.

At one point in IOP we had three of us, a nice little group, and we were starting to make headway, until one person moved back to PHP and one person quit. So now it’s just me again on nights, and with the PHP’ers during the day.

Structure

I love structure. To me, art time is an hour with powerpoint and excel, not crayons and markers. So I was excited about the structure of IOP. Which doesn’t really exist. Generally, I arrive, and we process. They call it “check in,” I call it drudgery. Then we process some more, and have dinner. We don’t talk about anything serious over dinner – we are with a clinician. Some clinicians are fun and it’s no big deal, but there’s one who acts like a warden and I can’t stand her. She followed me to the bathroom one day. Seriously, honey – if I wanted to purge, I’d find a way. Go buzz off.

After dinner, we… process dinner! And then usually we do CBT or DBT skills before we make a plan and then… process. I wanted workshops, group discussion, EDA-like meetings. Nope.

Vision of recovery

One of the reasons I went into IOP, besides the fact that I was restricting to 1000 cal/day and starting to freak myself out, was because I wanted to see what recovery would look like. I don’t know when I reached that point, but now I can sort of see it. I realize that most of my issue is around balance – not just food balance, but how I pace my day (more on that in a later post). The ups and downs of stress and crash were killing me – literally. Once I put the brakes on that, I could see how it would work for me. So for that goal alone (plus getting me back on meal plan), IOP was a success.

Tools

We have our toolbox, and it is CBT/DBT. I get the concepts, I get the tools, but again, they aren’t organized well so I don’t know what fits in what box which is what I want to work on as I get ready to leave. For the most part, I know what I need to do to keep the Bitch at bay. It’s incredibly hard, and I’m not ready to do it on my own, but IOP has been successful on that part.

Coordinated Care

This is where the program I was in didn’t meet my expectations at all. I thought I’d have a shrink, dietician, counselor all under one roof coordinating my care. Nope. Never saw the shrink, and he never looked at my meds. I met the dietician who is very nice but a horrible presenter (thank God we don’t have nutrition sessions anymore), but my dietician did my meal plan so pretty much everyone at IOP leaves me alone on that. My counselor, who is awesome, doesn’t have the time to be my therapist – that’s not what she does – she just checks in on me and keeps it personal. I’m expected to do IOP and still meet with my psychologist, shrink, nutritionist, and PCP. That was a big shocker, but it makes sense. We all need to draft our own teams – IOP just adds a boost to the process.

All in, IOP has been a good, not great process. I’m ready to leave, and next week when my therapist comes back, we’ll work out my transition plan. I hope to be done in the next three weeks. I had expected it to be more intensive, like really intensive therapy, and while at times it was a little, it really wasn’t overall. Perhaps that’s the program at Walden, or perhaps that’s just me. I’m a pretty intense person and I expect a lot of myself and of things I invest my time into. I don’t regret investing the time and energy into Walden, but I do wish they’d been more structured so I knew what to expect.

One last note – the average stay. I was told average stay for IOP was 4-6 weeks. That’s because a lot of people either quit, or move to PHP. When I finish, I will have been there about 12 weeks, which is a more reasonable estimate in my book. Had my “group” been better structured from the start (the first 3 weeks were useless), I think it could have been done in 8 weeks.

Surrender

This was my biggest reason for coming, and as you can see from above, since I critique everything, clearly I wasn’t surrendering. The fourth step has been hard for me, and I’d hoped that by buying in to IOP, I’d give up some of my control. I did, and I didn’t. But overall, I think I’ve accepted that I have a lot to learn that isn’t available on the internet, and my ED needs to be front and center in my life for quite a while. I can’t ignore it and I can’t treat it now and then. I have to take it seriously, and put my recovery first. Forcing myself to take the time for IOP made me realize that, and of all the lessons, that’s the most important.

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