Intensive Outpatient Program
The treatment format used at Evergreen Psychotherapy Center for traumatized children, families, adults and couples is Intensive Outpatient Psychotherapy, or IOP.
The intensive, outpatient program involves 30 hours of therapy for 10 days; 3 hours per day for 2 weeks, with a break on the weekend.
Terry Levy co-developed this treatment modality to provide help for children and families needing specialized services unavailable where they live. For more than 20 years, families and couples have traveled to Evergreen from every region of the United States and from other countries to receive therapy for attachment-related trauma.
The people who commonly seek treatment through the Intensive Outpatient Psychotherapy (IOP) programs at Evergreen Psychotherapy Center:
Children and families Many families seeking treatment are adoptive families that include children with histories of maltreatment and interpersonal trauma from foster care in the United States or foreign orphanages. However, families only with biological children also participate in the IOP. Interpersonal trauma and a breakdown in family functioning occur due to many factors, including medical problems of children and/or parents, postpartum depression, parental mental illness and/or substance abuse, abuse and neglect, absence due to military deployment or incarceration. Attachment problems, PTSD, depression and acting-out behaviors are common in family members.
Adults as individuals Individual adults with histories of maltreatment, compromised attachment and relationship failures participate in the IOP. They typically present with PTSD, depression, anxiety, substance abuse and other self-destructive behaviors — and with severe attachment disorders in childhood and adulthood. These adults usually have been in outpatient psychotherapy on a number of occasions, but are in need of a more intensive therapy format for positive change to occur. Mental health professionals identify this need and refer these individuals and/or couples to our IOP program.
Adult couples The IOP also serves couples who are in committed, romantic relationships and who are experiencing individual and interpersonal problems that create destructive patterns of attaching and relating. The IOP focuses on learning new, healthy and fulfilling ways of communicating, problem-solving and managing conflict. The goal is to both heal from personal trauma and develop secure adult attachment relationships with trust, intimacy, need fulfillment, honesty and safety.
This short-term, goal-oriented, intensive treatment approach is highly effective in facilitating positive change for resistant, traumatized children, for adults with histories of interpersonal trauma and for traumatized family systems.
The IOP procedure offers many advantages and benefits.
Families leave their well-established routines and habitual patterns to focus on personal and relationship change for two weeks that are truly a “healing journey.” This commitment of time and energy heightens their sense of purpose, focus, and determination to achieve goals and improve lives.
The IOP format is a constructive context in which we observe, assess and modify individual behavior and family dynamics. Parent-child, marital, family-of-origin and sibling issues become apparent in daily therapy sessions, and while discussing experiences out-of-session. Family members practice and learn new behaviors, coping skills, parenting concepts and methods, and ways of communicating and problem solving. These new behaviors, skills and patterns of interacting are reviewed and reinforced each day in therapy sessions, and family members are encouraged to continue the process of change by repeated practice following therapy sessions.
The consistency, momentum and intensity of daily therapeutic experiences increase motivation, reduce defenses and enhance therapeutic rapport. Well-established defenses are difficult to penetrate in traditional once-a-week outpatient psychotherapy, especially with traumatized individuals who are reluctant to reveal deeper emotions and are fearful of vulnerability. Defenses are more likely to be lowered in the intensive format. Motivation and hope are enhanced as goals are set and achieved, and family members have a sense of master (from “victim” to “survivor”). Trust in therapists increases as children and adults perceive these helping agents as knowledgeable, supportive, understanding and helpful.
The fourth benefit of the IOP approach is “family togetherness,” opportunities for new, positive and enjoyable experiences. Traumatized families rarely have positive interaction in their day-to-day lives. Even though therapy is emotionally challenging and painful at times, there is ample time for families, couples and individuals to have satisfying and fulfilling experiences. We encourage entire families to come, including siblings. Fathers, for instance, who are typically away from the family working, are now available to the spouse and children. Family members can learn and grow together, creating an enhanced level of intimacy and connection.
The IOP model entails the possibility for continued positive growth and change during follow-up therapy. Intensive therapy fosters self-awareness; facilitates emotional, behavioral and interpersonal change; incorporates parent training and trauma therapy; and “opens the door” for conventional, outpatient therapy to be more effective in the future. Referring therapists are invited to participate with the family in the IOP, which results in better follow-up treatment, and also provides training and supervision to those mental health professionals.
The IOP uses a treatment team of four therapists. The team approach allows for greater observation and feedback, which results in more effective assessment and therapy. Male and female therapists provide diverse input, role models, viewpoints and opportunities for transference. The treatment team also is advantageous and necessary during various therapeutic interventions. For example, one or two therapists will communicate with the child, while other treatment team members offer support and guidance to parents observing via closed-circuit TV. Another example is one therapist role playing a family member (e.g., “birth mother”) while other therapists help the child or adult process their emotions regarding past interpersonal trauma. The treatment team is also a support system for family members and therapists. Working with traumatized individuals and families can be stressful, and the supportive nature of the treatment team prevents “secondary traumatic stress” in helping professionals.
The “Two-Week Intensive”
The intensive focuses on the following areas:
Child: address trauma, attachment disorder and negative working model (negative belief system and self-image); learn prosocial coping skills (communication, anger-management, problem-solving), respect, responsibility, resourcefulness and reciprocity.
Parent-Child Relationship: enhance secure attachment, including trust, affection, intimacy, communication and reciprocity; reduce anger and negative patterns of relating.
Family Issues: address negative relationship patterns, including sibling issues; enhance stability, support from inside and outside the family, and a climate of hope, joy and positivity.
Parenting Skills: learn the specific concepts, skills and attitudes that are effective with the attachment disordered child (angry, oppositional, mistrustful, controlling, deceitful).
Parents: address historical and/or current issues that are unresolved and prevent effective functioning; including family-of-origin (prior loss, trauma, attachment difficulties) and marital/relationship problems.