Life In PHP: My experience

I decided to document my adventure here, since I wasn't able to find too much information on the partial hospitalization + IOP experience.

Partial Hospitalization: Day 1
*all names and identifying factors are made up for confidentiality

I was a little nervous about beginning the program. I woke up with nightmares and anxiety this morning about how horrible it would be. I wanted to cry and dang near had a panic attack three hours before beginning the program. BUT, I made it.

When I first got there, I had to go to a conference room. It was a little intimidating but various staff peeked in and said hello. They made it hard to be "anti social" lol. I met with the program coordinator, Aster, where she gave me an overview of the program, a folder and a I filled out a couple of symptoms survey.

Following her, I met with a nurse, Dahlia, who then gave me an orientation. We went through the folder and created a goal and affirmation for the day. She told me the rules and answered any questions, and I actually really liked her. Dahlia seems like the kind of nurse who is very serious about her job but the progress of her patients, motherly. She showed me around and the process of php.

I then left her and met Holly, my assigned nurse. Holly is hilarious and was a lot of fun to be with; she has a jovial nature. She did a full health work up and history on me and I think I spent the most time with her. She got the story of why I was there and was the easiest person to talk to.

Following her I met my psychiatrist, Jasmine. She made me feel super crazy lol, because I just felt like I was not making the least bit of since with her. She held on though, and worked with me to put words to my thoughts and we actually started to really get each other and made some good progress!

Then I saw a medical internist, Narcissus, who claims I have a thyroid issue and when i told him its been checked and cleared said to get it rechecked.

I did a drug test and weigh in. I'm not allowed to do alcohol/drugs but am allowed to be honest about it if I slip up (which I shouldn't). I'm being weaned off of caffeine and they would prefer me not to do my other recreational/self harm stuff so that they can get a good idea/monitoring of if things are helping me or not, etc.

Went to group.

Had lunch which was yummy. I kind of wanted some space, but wasn't sure where to go so that kind of irritated me, but Lily (later) told me some places I could go.

Went to another group.

Went to another group.

Met, Lily, my new, temporary, therapist. After the program I go back to T. She had already read everything in my chart and I didn't have to spend time regurgitating my story over and over again. I think I like her, but i'm not sure i'll be spending much time with her, the way the program is set up, one on one. Still she is basically my overall coordinator and the one I should go to for everything - so i'd guess she is pretty accessible.

Finally, it was time to go. The day seemed long but not in a "worn out" kind of way. Everyone worked together so nicely and I really feel like this is a good program. They truly cover all of their bases and really work with you and help you feel "in the loop". Now I have the whole weekend to ponder and then i'll start fresh on Monday. I didn't really get to know (no desire to) the other members and outside contact isn't encouraged (boundaries) so *shrug* that just isn't a priority for me at the moment. All in all it was a good first day and i'm pretty excited about the chances that this will be a beneficial program for me.

Thank you for the update. I have never participated in any of these types of programs so I found your update very informative.

Best of luck to you.....look forward to reading your updates.

I'm happy for you! I hope it helps you a lot.

Thanks Teal!!! It's nice to know there are good programs out there that are well set up. I hope it is helpful!!!!!

That sounds really neat, and I am interested in learning more. I haven't heard of this type of program, and I wonder if it is something I may want to consider looking into, myself...

I hope it helps.

You are lucky to have found such a concerned t and doc. sometimes these places are hard to get used to, but you seemed to overcome it all in such a short time, good luck

PHP: Day Two

Today was my first full day since I didn't have any scheduled intake stuff to do. The nurse (not Dahlia/Holly) weighed me and got my vitals for the week (lost 5 lbs. since Friday, but i'm at "my" baseline).

In the first groups, led by Lily, we did a weekend review/affirmation and goal setting and then open processing group. The group was small (~5) and I assume she is everyone in the groups individual T. Its basically like having a normal therapy session. There is no "set" topic and you're open to discuss whatever you need to process. One girl mentioned that she was agitated because I took her seat, but she worked through it. I did offer it back to her later, but she was fine. Now I just wonder if I should change seats tomorrow lol...

We practiced a mindfulness activity that involved being aware of your current emotion, and it (surprisingly) did help. And later were taught how to apply some of the mindfulness stuff to our lives. It actually turned into a tearful session for some and the lesson could totally apply to everyone's circumstance.

We had another group on building our support system, which was a bit bigger (~11). This was hard for me because I wasn't sure how to build such a system when I have no desire to build a relationship with anyone. One of the other patients really did not seem to like this topic, and the T eventually had to remind us that it is up to us to decide to apply the skills or not.

I got pulled to do a lengthy assessment because they want to "re"diagnose me. So i'll be meeting with a psychologist at some point to discuss those results. The test was easy but some questions I didn't know how to answer because they were to me more "yes or no" questions instead of "rate". Like one of the statements was "I have never taken anything that was not my own." As a small kid, I stole gum like 4 times (not like from my mom, like from a strangers purse at church, another school mates desk/bag, etc.) They are all petty incidents but they make the statement a simple "false" for me. So, I don't know if that black/white thinking exaggerated my sanity/insanity scale...

At lunch, I found Lily and told her that I was having a hard time trying to figure out if i'm supposed to be talking to her or T. Technically, i'm T's patient but i'm not seeing her while in the full program; so they prefer me to process as much as possible in group. I am okay with this because Lily is both my temporary T and group leader.

I'm used to being able to write T, and process any thoughts, and without seeing her now I'm kind of like "what do I do". Lily did tell me, in a gentle way, that I was allowed to write her too; that it was okay. I don't necessarily want to write her (because i'm going to try to be more open in group) but it did feel good to know that I don't have noone (as opposed to someone) to talk to.

We discussed my level of suicidality (?) (which was increased today) and came up with a safety plan. She wants to involve my family (not in the plan, but in my treatment) but I'm not open to that so she said we'll take one day at a time.

We had another group that focused on spirituality. They don't tell you a religion or anything to choose, but they do consider it a part of your well being as a whole. It was basically like story time highly applicable to the fact that all of us were there, and at a very low place in life.

My appointment with Jasmine got rescheduled to today (I guess it was tomorrow) and she did a med review. She also told me that, for my safety, they had called the pharmacy and cancelled all refills on medication I had. I completely support that decision and feel relieved that they took me seriously and that I no longer have that option available.

Lastly was recreational therapy, where we played another fun game. And now, i'm back home again until tomorrow morning. I am ready to go back tomorrow and learn more skills. I actually am sad that I have to switch to the IOP program next week (not their rule; I have to work) and I am also going to practice opening up in group if I can move past the anxiety.

All in all, another good day.

What type of games do you play?

We played a word game before, and today we played a game that was like an auction and we placed bids on our values (as in ethics).

I think it is great that you are willing to share your experience.
You will never know how many people will benefit from your words.
I also find writing things out very beneficial.

I do have a question though. What is IOP?
I know IP and PHP, but I am not sure of IOP?

Thanks I hope that my experience will at least shed some insight on options for other people. I mean, I guess if it turns out badly then maybe not haha, but I seriously don't see that happening. This program in two days has given me more joy than I have had in a while. I also feel safer being there than at home acting on my impulsive behaviors. IOP (Intense Outpatient Program) is the step after PHP. You go to the same program for a minimum of three days a week and only go half day/until lunch.

Hi Teal-

Are there any "gaps" during the day where you are just hanging out or do they have activities throughout? Sounds like a great program. I hated inpatient because there were hours upon hours with nothing to do--it made me more lonely and I think it made me more depressed. Your program sounds so good, like they thought of everything.

I've had the opportunity for PHP three times. The first one was beneficial, the 2nd I despised, and the third I never showed up for.
It is a great alternative to inpatient hospitalization.

PHP: Day Four

Today was day four of the program. I didn’t really feel like writing last night for whatever reason. Yesterday was a pretty good day. We had the normal daily affirmation, goal setting and open processing group with Iris (Lilly’s backup). There were some people who really needed to do some digging, so we focused on them that day. She offered, of course, that anyone could talk if they needed to about whatever, but I was fine.

I have had a pretty peaceful last couple of days actually. I really do think a lot of it has to do with them cancelling my prescriptions. The truth is, I don’t want to kill myself – I just have a hard time living. I’m still in the process of trying to find a reason to live; and because I’m not finding those reasons so easily, it felt like those pills being so available were almost taunting me. As if life was basically handing them over to me saying – “get it over with already.”

The skill session we had was on “Radical Acceptance”. It’s pretty easy in theory, but not so much in action. She did a couple of exercises that demonstrated us having the choice to not stay in an uncomfortable, disturbing and unchanging situation, but choosing to remove yourself from it and put yourself in a position that allows you to do what is best for me.

After lunch, we had a session with a dietician. She taught us how to read the nutrition label and gave us a handout on the ingredients and percentages you should look at on the label, etc. It was a pretty mundane session but not bad.

The last session was like an orientation session where we were informed of all the things the program had to offer, etc. And I absolutely hated it. Somehow, it turned into a gripe session and everyone was complaining about how they want smaller groups, more individual therapy time, etc. etc. etc. And I just got soooooo annoyed. I could barely sit still today as it was, but by this point I was physically holding myself in place. People went on and on and on about how you can’t really be honest because of mandatory reporting and how they didn’t have enough time to talk in group, etc. etc. By the end, I had my face literally buried in my blanket and was humming to myself (which, I realized was probably rude, so I made myself be quiet).

I just did not enjoy it, so afterwards, I went to Iris’ office and told her that I will never ever go back to that group again –I would literally skip it if I had to. She reminded me of the affirmation I selected for the day (I choose to enjoy this moment), and reminded me that I had a good day before that.

After I left Lilly called me. She said that Iris told her about our chat and she wanted to follow up to see if there was anything unresolved that I needed/wanted to talk about (which I didn’t).

One of the discharge planners called me in the office and said that they like for us to schedule a few sessions with our regular counselor as a transition out of the program and back to them. She tried to call T’s office to schedule but they don’t allow others to schedule for us, and I had to be on the phone with them to give them permission. In the end, though, my schedule isn’t going to work out that way, so I will not be seeing T until after I’m discharged from IOP.

My family doesn’t know I’m in day program, but my aunt does (because I had to have an emergency contact. She asked me how the program was going. I told her a little bit and she said that at least I’m not “that bad off” with the depression like some people and I should be “okay” soon enough. I don’t really like that statement. It feels dismissive and invalidating but I can’t really be mad because like we are taught – other people are not mind readers. I wear a mask around most people (family included) and I have to accept that as the consequence of my choice to remain a private person.

I’m feeling kind of tired (physically) these days, but it could be the meds, early morning or a combination of everything. They track that too though, so if that becomes an issue, they’ll address it.

Today’s skill was a DBT lesson on asking for what we want and standing our ground. This is the one that I will need to practice the most – and the lack of this skill is a big part of how I ended up in the program in the first place.

We had a group on identifying our values and another on recognizing the things we like about ourselves and the people we have in our life (support system) that can help us treasure those.

The treatment team met today, and as planned, I will be switching to IOP on Monday for a projected two weeks. I'm sad to go, but I'm trying not to focus on that part now and just enjoy and soak in what I can now.

I'm glad things are going okay for you!

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I'm glad PHP is working out for you.

Can't count the number of times I've been in PHP, then IOP when I lived in Calif.....most of the time it was a good experience. Most of the time it was my transition out of inpatient hospital in the first place.

The last time was 10 years ago (wow, time flys) at the year anniversary of my mother's death & all the trauma I had gone through. Don't remember much other than there was a sweet older man in the program who had been a WWII pilot......the stories he told was just like I was there experiencing it with him.....but I was in such a bad place, the first day driving home & ended up depersonalizing several times & ended up getting in 2 rear end accidents within 30 minutes of each other in all the stop & go traffic. I realized just how unsafe it was for me to drive in the condition I was in & had to make arrangements to get there by their van but they wouldn't drive way out to where I lived so had to arrange to meet the van at outside my mother's house that I was still having problems going back into go get it ready to sell.

That is so awesome that they are teaching DBT skills in one of the PHP groups. That was one thing that I have found the most valuable after leaving Calif & my bad marriage was that my psychologist suggested their DBT group so I put 2 years of myself into that group. It was the best thing I EVER did.....& for the last 2 years I've been going to the "next step" DBT group for those of us who have made it through the 2 years....keeps us refreshed weekly on our skills & it's turned out that my previous psychologist retired & my DBT group leader took over the position as being my psychologist also....though I only meet with her about once a month privately. DBT stills are the most valuable skills I have ever learned even at my older age.

Your PHP program sounds like it's really set up to work well compared to the experiences I've had.....glad to hear that it's gone well & hope that your IOP will continue in a positive way.

Hey Growly, the "gaps" are usually between 5-15 minutes apart. It's enough time to use the bathroom, check your texts, grab a cup of coffee and settle in for the next thing. It really is a great program. And our group did discuss the "free time" that inpatient has and how the true healing comes from this type of program while the other is more focused on keeping the patient safe.

Also, thanks krminnj & Breadfish. I'm glad too.

Eskielover, I'm sorry that you've had the need to be in PHP but I am glad that it's been beneficial/a good experience most of the time. I never really thought dbt skills were so valuable but I have to admit that those are the things I have been using most out of the program. I may actually look into a dbt group, now that because of you I know there are some available!

PHP: Final Review

Yesterday was my official last day of partial hospitalization. Over the next two weeks I will go (not everyday) to IOP. I will attend the groups and planning, up until lunch and then be done for the day. At first I was like noooo! But I realize that I actually feel way stronger than I did before. I've kind of paralleled my growth with other people and I don't know how they do it but these people can stabilize you quick. Lily makes a point that PHP is like triage. They take the broken bone, put it under the skin, wrap it up and send us out into the community to continuing recovery (which is a process).

I met with the psychiatrist (my official psychiatrist, Joy, who was on holiday when I started). I kind of like Jasmine better because I just feel like she doesn’t really know me and I can appear fine and she’ll be like “ok”! Iris says it’s because I’ve already built a connection with Jasmine.

I also met with the psychologist to review my test results. I scored highly in suicidal thoughts, depression, isolation, thinking and alcohol/drug usage. We determined that I don't have an alcohol problem (which I knew) and that I scored highly on the drug use based on history. I do wonder when he sends records back to my doctor if they'll list me as a prescription drug abuser...

He said I appear to be very sociable but both his assessment and my test scores indicate that I’m very isolated which he believes stems from distorted thinking. My scores show me as a thinking type of depressive, which means I’m always in my head and tend to have depressed thoughts. I presented as a very unassertive person who doesn’t like to start conflict and I self harm as a way to avoid.

I opened up in group the other day. Iris (Lilly was absent) said “Ahhh. Now we have somewhere to begin.” When I told Lily I opened up she was like .

My anxiety has gotten better. Lily stopped class one day to tell them that my sketching and lack of eye contact wasn’t me being rude, but managing my anxiety. They have now gotten used to my constant moving/jitters as well.

When you come in the program, you create a treatment plan. I never got one, and I think it was mainly because they were trying to figure out how to treat me. I really was a mess when I came in. But, now that I’m more level headed we have come up with a plan for treatment for the next two weeks.

I wrote another '1' on my suicide intent scale, and Iris pulled me in her office. I told her they were being extra, I could have chosen a five, I rolled my eyes and huffed and puffed but we still met lol. I ended up crying and she said I was confusing her by the end, . Eventually, we decided that I was trying to say “I do not have a plan to go home and do “x” but if the conditions were right, I wasn’t sure that I would choose not to.”

I did end up taking some medicine that night (that I did not disclose to them) but that medicine ended up being really hard on my body (I ended up having uncontrollable seizure like spasms for hours) so - lesson learned. Iris decided that I needed something to distract my urges and she gave me a copy of a mandala to work on (which I did and it did help).

It’s been a very busy week but I can see a lot of progression. Its amazing how effective six full days can be. I found myself naturally saying my affirmations (which we've been doing daily). Joy says that moving to half days will be a good transition into figuring out how to structure my days/life outside of the program. I go three days next week, and four the following and then i'll resume seeing my own T.

Thanks for posting your experience! I think I'd be more open to partial hospitalization based on your experience--although I know not all programs are equal!

I think you are helping other people too who may be wary/afraid of partial programs. Knowing what might happen is half the battle.

Thanks Growly. I, too, know that not all programs are equal but I would tell anyone in this area about this one. I know someone who drives an hour both ways daily to attend. I've always been afraid of any kind of program like this, and I definitely didn't want it in my medical charts. But - there comes a point when you have to put your pride aside and ask for help. Everyone was surprised when I started that I wasn't referred to the program and chose to come on my own, but its the best decision I could have made and I'm sure if I keep practicing the skills the beginning of a lot of life changes for me.

IOP: Week One

I worked the last three days and it went so much better than before. Lily was saying today that both she and I knew that I was not in the right state of mind last week and shouldn't have been working. However, this week was much better. I was actually surprised because Lily, Holly and Joy all expressed concern about how it would go. It's nice to see that they genuinely cared and that I was able to report complete victory.

Today I started the first day of the Intensive Outpatient Program (IOP) whic is the same program but half days. I know it's only two groups and lunch less, but the day seemed to fly by! I blinked and it was time to go!

Saw the "not Dahlia/Holly" nurse today, for my weigh in and vitals, all of which were fine and then saw Holly today, for medication education.

Today I also saw the new/official psychiatrist, Joy, again. I liked her a bit more today, lol. She asked about work, medication symptoms, etc. Today was one of those "hyper teal" days that I mention occasionally, and I think she thought I was on drugs. She said "do you regularly have this much energy, because you're all over the place right now?" And it was true. I basically responded to everything like:



Lol, it was a relatively funny question to me, followed up by a polite "It's time to take another drug test."

I told her about last weeks overdose, and she seemed pretty concerned about the symptoms I had from it (the uncontrollable muscle spasms/jerking). She asked about my intent, when it was, etc. Not sure why I confessed but - thats why i'm there - to surrender myself from myself and get some help. So, no regrets.

She asked me to throw out the xanax and gave me a new prescription for Vistaril. She said it is a non-addictive anti-anxiety med and she would rather me come completely off the xanax since its addictive and I have some "past substance/prescription abuse behaviors". I told her I was all for it if it works! So now I have that for "anxiety and agitation".

I met with a dietician, because I told her how my appetites been raging lately. She told me of some foods to choose and agreed that my weight right now is fluctuating pretty funkily.

Our skill today was boundaries, which I totally needed.

We have two new people in the class. One is nice and the other is still in the "I hate the world" phase (we all go through it, it's okay).

I can feel myself getting better and better, and the suicidal thoughts at this point have pretty much disappeared (*knock on wood*). I wasn't sure that I was ready for half days but, again, these people totally know what they are doing.

I'm enjoying applying all of my skills. So far they've all worked for what I have used them for and I find theres more power in being able to apply the skills than peoples response (empowering me to kind of be responsible for my own actions).

So that's all for today and tomorrow. Feeling good.

I have enjoyed reading your experience, you seem to be getting a lot out of these programs which is great

That is actually a DBT skill under distress tolerance....called....what other...."Distraction"....that is probably my most used skill of all.

Thank you for sharing your experience....it does bring back good memories.....I was blessed to have a really good program especially in the private mental health hospital before it closed.....I'm sure it will help others who may be wondering what to expect.

Ah, I see. The distress tolerance class is actually the one skill that Lily, the psychologist, the pDoc and the nurse all want to make sure I take before I leave the program as they believe that this and impulse control are the biggest contributing factors for me being there and not being able to deal with overwhelming emotions.

I'm glad that you, too, had a great experience. I've also enjoyed being able to document and validate my experience and hopefully, help others as well.

Hi Teal,

How are things going???