In the world of mental health care, we are most familiar with the outpatient model, which includes weekly or monthly visits to a therapist or psychiatrist.
Various longer-term programs are suited to specific issues, such as psychiatric hospitals for acute or emergency situations; residential programs for more intensive treatment than acute hospital stays; and rehab or recovery programs for addictive substances that teach sober living.
What are the alternatives for individuals who don’t fit the above treatment models? When weekly outpatient therapy is not sufficient for someone who is not a danger to themselves and not eligible for hospital admission but is experiencing great suffering in their functioning?
Or a patient recently discharged from residential care who may not feel ready to resume the full burden of life? And here in Israel, where more intensive mental health services may be needed for someone who is not fluent enough in Hebrew to participate in a local program?
These are but a few examples of patients who could fall between the cracks. What are their options?
An intensive and proven solution
An intensive outpatient program (IOP) is a highly effective and proven solution for individuals such as those mentioned above who suffer from emotion dysregulation, personality disorders and other behavioral health issues that challenge day-to-day functioning.
IOPs were originally introduced around 30 years ago as a cost-effective alternative to hospitalization and weekly therapy, and to ease the transition from more intensive levels of care.
An article in the journal Evidence-Based Mental Health (February 2021), followed participants in an intensive therapy program for individuals with borderline personality disorder and found “statistically significant improvements in the severity of symptoms.”
The authors concluded that intensive outpatient programs “demonstrated short-term efficacy, and offer a clinically sound and cost-effective alternative to both traditional outpatient services and more intensive levels of care.”
Such a program is also effective for individuals who need more than once- or twice-weekly therapy because those sessions do not provide enough time to cover what’s needed or aren’t frequent enough to maintain progress.
An IOP would also benefit those who have a hard time organizing themselves to practice between sessions and who are not functional enough to hold down a framework and find themselves unable to engage in productive activities.
An IOP is especially effective for patients who were transitioning back to daily life after a hospital stay or for those who required a higher level of care in a structured environment but were unable to participate in a residential program because of school, work or family obligations.
A study published in Psychiatric Services (April 2021) found that IOPs are clinically sound, cost-effective alternatives to traditional outpatient services and more intensive levels of care.
“These programs can be the treatment of choice for patients who may regress in more controlling situations, but who also require sufficient structure and support.”
A first in Israel for English speakers
Machon Dvir is opening an intensive and integrated outpatient therapy program for English speakers. The program focuses on dialectical behavior therapy skills training in a highly concentrated format designed to help participants learn to regulate emotions and increase interpersonal effectiveness.
Additionally, the DBT-based structure gives participants a sense of validation as they navigate their way back into their day-to-day lives.
As mentioned in the above article, “The program’s support, structure and emphasis on self-reliance can help patients stabilize their lives and grow in the community.”
Participants will learn and take part in:
● Life skills, to help them return to an optimal level of functioning in the world.
● Alternative mindfulness-based therapies integrating creative arts, yoga, movement and self-defense to aid in the development of self-efficacy, self-esteem and trauma recovery.
● Various other therapy groups aimed at enhancing psychological, behavioral and emotional well-being.
● Individual counseling throughout the duration of the program.
● Medication management.
A study on the efficacy of a short-term IOP in a private, natural setting for patients with severe anxiety and depression was published in ScienceDirect. The study found that participants experienced “statistically significant and clinically meaningful reductions in symptoms of anxiety, depression and suicidality... and a categorical decrease in anxiety and depression, from severe to moderate symptoms, in less than two weeks.”
Machon Dvir’s Intensive Outpatient Therapy Program hopes to fill the gap for patients who may otherwise fall between the cracks.
About the program: The IOP, under the direction of Dr. Tzachi Fried, PhD, and Dr. Sarah Reinstein, MD, begins Sunday, October 23, with sessions on Sundays, Tuesdays and Thursdays from 9 am to 3 pm.
The 12-week program will be held at Machon Dvir’s Ra’anana office, offering a calming and private setting with easy access to public transportation and parking. The program is currently open to 10 female participants aged 18 and up. Intakes will be processed on a rolling basis every three weeks. For more information, please contact Machon Dvir at 09-777-2527 or 02-625-2527.
The writer manages DBT clinical services at Machon Dvir. A clinical psychologist who made aliyah from New York, Dr. Fried specializes in helping adolescents and adults with behavioral and emotional difficulties, and has extensive experience treating complex and challenging cases using DBT and other treatment models.