Intensive outpatient treatment (IOP) is a step down in level of care when a person is at a place in their eating disorder recovery where they do not need more than 3 hours per day of supportive care.
Most facilities offer an IOP program across the nation, as well as worldwide. IOP typically includes 3 hours up to 7 days a week of group therapy and supported mealtime . Outside of IOP time, you see your nutritionist, therapist, and psychiatrist for weekly sessions.
While in IOP, participants can stay in their career or school responsibilities and learn to manage everyday life while focusing on continued recovery from their eating disorder.
Groups each day, and throughout the week, vary and have differing focuses. Typically, IOPs will have body image groups, expression or art therapy groups, cognitive behavioral groups, stress management groups, dialectical behavioral therapy groups, self-esteem groups, nutritional education groups, and family groups.
IOP can last anywhere from 2 to 6 weeks for someone seeking this level of care, depending on the benefits through your insurance carrier, or out-of-pocket ability to pay for eating disorder treatment.
The Initial Eating Disorder Assessment
When deciding to enter into treatment, you will first be asked to make an assessment appointment to see if you meet the criteria for IOP, as well as what your insurance benefits cover.
The initial assessment session lasts up to 2 hours and the coordinator will get your vitals and weight prior to leaving. They will explain their program and go over the rules and outline of the program with you. During the assessment, the clinician will verify your diagnosis of anorexia nervosa, bulimia nervosa, or binge eating disorder.
Once accepted to the IOP program, you will have an initial session with your IOP therapist and dietician. You will also be asked to get a medical report from your primary physician, including current labs, past records and insurance benefits.
What to Expect on Your First Day of IOP
When you first start IOP, it can be challenging. It is like being the new kid on the first day of school. Participants in IOP are at all stages of their eating disorder treatment and may have been there weeks, months, or days prior to you starting. This does not mean that groups vary based on the individual, but rather the individual makes the group relevant to where they are.
You are expected when you show up for IOP to have your meal packed according to the meal plan set in your nutritional therapy session. Facilities vary on the order of groups and meal times, but most tend to do 1 hour of group, 1 hour of meal, and 1 hour of group before ending the evening. Most IOPs are held in the late afternoon or early evening to accommodate those who work during the day.
Once you arrive and your meal is put away, you can settle into the first group. Most programs will have the same group each week at the same time so there is some structure and consistency each day when you attend. This helps you to grow and learn within each group focus as you progress in your treatment.
Groups are discussions and activity-based in IOP. Members are asked to participate and contribute to group. Clinicians on staff at the eating disorder treatment facility help run groups and facilitate the agenda for each hour.
Typically on your first evening, members are asked to introduce themselves, what they are in the IOP program for, and to share something about him/herself. Most programs are co-ed, but depending on location, most are female
Once meal group has started, participants cannot begin to prep or eat their meal until it is checked by the clinician in group to ensure it meets the nutritional meal plan set. If it falls short, they will ask you to supplement with what the facility keeps in house and it will be noted for your treatment team to address, if need be.
Most facilities also have a limited number of reheat allowances for food and are on alert for any rituals or eating disorder behaviors. If a member is engaging in these, they will be redirected in a respectful way. If a member is not able to comply, then they may be asked to leave for the evening, depending on the severity of the behaviors or comments made.
Often during mealtimes, the group will have light-hearted conversation or play a word game to pass the time and distract from the food. Once meal group has started, members might not be allowed to go to the bathroom in an effort to prevent purging or other compensating behaviors. In some cases, bathroom visits are not monitored at this level of care since an individual who is attending IOP is assumed to be able to manage this without supervision.
The last group of the day will typically include a focus around what is set for the program schedule.
Working Toward Your Eating Disorder Recovery
Most days in IOP are similar to the first day, except that you will grow as a person both individually and within eating disorder treatment. You will see your outpatient therapist, nutritionist, and psychiatrist outside of IOP hours, so be ready to talk with your school or work if needed to allow for time to make necessary treatment.
Be ready to attend all days IOP is offered the first week or two you begin. As you progress through the program, you will ‘step down’ in IOP to lesser days until you discharge from the program. Most programs do a small graduation ceremony for your leave, which is often emotional and moving.
In conclusion, IOP can be extremely beneficial for those who are ready to take charge of their recovery from anorexia nervosa, bulimia nervosa, binge eating disorder, or other forms of disordered eating. It can be a challenging step, but a rewarding one as you meet others who share in your story.
You gain a new support team through other members, new insight from your treatment team, and internal progress as you move toward eating disorder recovery.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:: Intensive Outpatient Treatment offers a unique treatment resource during evening hours. (n.d.). Retrieved June 11, 2017, from https://eatingdisorder.org/treatment-and-support/levels-of-care/intensive-outpatient-program/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on August 26, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 26, 2017.
Published on EatingDisorderHope.com