IOP? (triggering: SH)

I recently self-harmed a couple of days in a row. I am doing okay now, but it makes me wonder if I need more treatment to try and course-correct before I slide downhill into emotional turmoil and dysfunction. I've been at this point many, many times before and it's all too easy to spiral down and get more entrenched in my negative coping mechanism.

There's the possibility of an IOP, and I'll discuss it with my therapist. I've done IOP many times. In my town there are two main hospital systems I have been to that offer IOP. Both have their good and bad points. However, I am not thrilled on the idea of an IOP because they're going to try and put me in a DBT-based group. One hospital system always puts me in DBT after the initial assessment, even after I tell them I don't want to be in DBT. I am very familiar with DBT and learn nothing new in these groups; in fact I get quite bored, even though I do participate and pay attention. I quit the last two times I was in it and they actually asked me not to come back for at least a month to work on my "therapy interfering behaviors."

At the other hospital system I did a more generic IOP, which was a little boring, but overall okay. However, they let me know if I were to come back my insurance would want me to be placed in the DBT group because that's what they feel is best for me. Even though I feel they are more friendly at that IOP they only have one time slot (10:00 am to 1:00 pm, where as the other IOP has several time slots, starting at 9:00 am and going all the way to ending at 9:00 pm) and transportation there would suck; now that I've moved it's on the other side of town.

So I don't really know what to do. I don't want to be bored in DBT. I don't think it would help. But I don't really know what my other options are. On top of all of that, of course, I'm worried about being exposed to people again because of coronavirus. I was in an IOP when COVID started and they would take our temperature every day and we had to wear masks, but I'll still be nervous, especially because I'll also have to take the bus to get there. I haven't taken the bus in months out of fear of the virus.

What do you think I should do?

[Arabesque- golfing girl.]

Hello Eli,

I am so sorry about this and hope that you will be okay soon. When we self harm it can make us feel so many different things and however you are feeling is okay because people do this for different reasons. You said that you we're going to group and that is great and I'm sorry that you get bored when you are doing this. Would you be able to talk to the person who is running this and let them know that and see if they can help you so that you are not feeling like this and hopefully the group can help you. I know that sometimes when we are in a group it can be hard to open up about what we are going through and sometimes it can be hard to listen and be in the group because we have other things on our mind. If you are okay with talking, would you be able to talk some so that you are trying to get into the conversation with the other people who are in the group, then maybe you will not feel like you have before. I know that it can be hard opening up about ourselves, but maybe you can say a few things if you can and then the next time add a little bit more. I hope that you will be okay soon. Sending you hugs to help you.

[Celyn]

Sorry for the late reply. Have you talked with your therapist about this?

Relapses in self-harm can happen, so if you are doing okay now and don't believe DBT would help, then you may just want to try watchful waiting- just wait and see if you can cope by yourself and if you notice things start getting worse, then you might want to try DBT.

If you did opt for DBT, then which IOP to go for would be down to your personal preference. I think being anxious about COVID is understandable, more so if you have to catch the bus. It might help to know that so long as you (and hopefully others) are wearing masks, avoiding touching things/washing hands, keeping socially distant and not spending too long in the company of others (not sure what you've heard but in the UK, they reckon about under 15 minutes) then your chance of catching COVID would hopefully be low.

Since you aren't finding DBT helpful, I'm wondering if there are other options that might be better suited to you? I'm not sure what it's like in your area but ideally DBT might include access to a therapist that you can call whenever you need to for the duration you are in treatment (ideally, I know that it doesn't work like this due to different set ups of DBT). This might help with self-harm relapses and easier access when thinking of COVID.

Hey y'all. Thanks for your replies.

My self-harm ended up escalating pretty badly and as a result I am now inpatient in a medical hospital. It's uncertain when I will be released, as that largely depends on my body's healing. However, after speaking with the social worker and psychiatry team here at the hospital, we all decided PHP or IOP would be a good option for extra support once I am out of the hospital. They left the choice up to me which one I felt was best.

I talked to a friend I've been in treatment with at a certain hospital and she told me IOP is actually all virtual now. PHP is in person, but it's divided into two groups of six and everyone wears masks. I like the idea that IOP is virtual, but after my recent episode landing myself in the hospital I wonder if seeing other people and having closer contact would be beneficial.

I still don't know if I would be placed in DBT. Probably. The self-harm is a very Borderline thing to do and they'll probably see that more than anything else. But I guess I can talk to them about it. I'm just still not sure what to do.