Intensive outpatient therapy (IOT) is a comprehensive treatment approach that offers a higher level of care than traditional therapy. It targets a wide range of issues such as depression, eating disorders, and substance abuse, as well as other conditions. With intensive therapy, people attend a center several days a week for a few hours at a time while continuing with their regular day-to-day lives.
What Is Intensive Therapy?
Intensive outpatient therapy, which encompasses a broad range of approaches and disciplines, is more rigorous than standard outpatient psychotherapy but less intensive than inpatient care. It aims to provide continuity of care in a safe and supportive environment, offering psychotherapy and integrated group treatment to establish support mechanisms, teach coping skills, and improve overall functioning.
IOT encompasses a wide range of therapeutic interventions and services that can aid people with symptom management, relapse prevention, and developing a healthy, balanced, and independent lifestyle. The nature of psychological care and duration can fluctuate considerably depending on the facility a person attends, their health insurance provider/payer source, and their mental health needs.1,2
Group therapy sessions are at the core of IOT, addressing self-defeating or addictive behaviors, emotional regulation, constructive problem-solving, and stronger interpersonal relationships.
Additionally, many IOTs are likely to include:1,2
- Individual and/or family counseling (30-50 minutes with an assigned primary counselor)
- Psychiatric care
- Medication supervision
- Adjunct coordinated services (like transportation and case management)
Intensive Therapy vs. Traditional Psychotherapy
Traditional therapy places more emphasis on self-management and applying new coping skills to daily life, whereas intensive therapy provides a more structured and rigorous level of support. IOT also entails more time in therapy requiring nine or more hours per week of direct mental health treatment. Individuals not only benefit from therapy but also from being in an interactive group setting where peers support and validate one another.
What Can Intensive Outpatient Therapy Help With?
Intensive therapy is a form of rehabilitative therapeutic approach useful for a variety of populations and age groups struggling with mental/behavioral health issues or substance misuse. It enables people the flexibility to maintain their daily responsibilities while receiving an inpatient-type of treatment on a part-time basis.
IOT is typically well-suited for individuals who are seeking to achieve changes in self-defeating behaviors, strengthen coping skills, and establish a healthy living environment. It can also offer assistance beyond mental health care, integrating enhanced services to help address individual problems such as adult education, childcare, and housing.1
IOT may help in the following circumstances:1
- After a mental inpatient hospitalization/detoxification to transition back into the community
- Having mental/behavioral health issues requiring a psychological level of care that is more intensive than routine outpatient but less intensive than inpatient care
- To maintain healthy levels of functioning and prevent a mental health decline or substance abuse relapse
- Legal issues due to mental health/substance misuse, a court order, or after incarceration to reintegrate back into society
- Employee assistance program (EAP) referral due to behavioral/mental/substance issues affecting work performance
- Veterans reintegrating back into civilian life or military personnel returning from a deployment to prevent psychological/behavioral implications
- People with anger management problems/domestic violence perpetrators (may be court ordered or voluntary)
How Long Does Intensive Outpatient Therapy Typically Last?
The estimated length of stay or extent of treatment for intensive outpatient therapy fluctuates widely, but the recommended duration is typically 90 days. Factors like individual needs, mental health status, level of functioning, and health insurance/payer source may influence the duration of therapy.
In general, the course of treatment is designed to facilitate 9 to 20 hours of therapy spread out over the week. Each active treatment day is allotted a certain amount of time for group therapy sessions, psychoeducational groups, individual counseling, and skills-building groups.1,2
A patient’s stay in an IOT may be longer if there are setbacks like a psychological decline, symptoms not improving during the prescribed course of treatment, non-compliance, and relapse. Similarly, a person’s stay may be shortened if they progress at a faster pace, no longer benefit from therapy, or have limitations with insurance coverage/payer source. Lastly, an individual may opt to leave due to dissatisfaction.1,2
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Intensive Therapy Examples
IOT can be used to treat a wide range of psychological/behavioral conditions in a variety of settings. It can also be employed when traditional methods have not been effective or as a transitional treatment following inpatient care and more.
Here are three examples of IOT:
1. Evening Intensive Outpatient Program For Personality Disorders
Mary, a middle-aged working woman, has a personality disorder. She is referred to an evening IOT program by the employee assistance program (EAP) due to ongoing issues with her co-workers. The IOT hours are convenient and suitable to Mary’s lifestyle demands. She attends the program three times a week and during group therapy, her interpersonal and emotional difficulties are addressed.
The intensity and intimacy with other group members, along with the support of the program clinicians allows Mary to process her emotions openly and gain insight into ways to communicate more effectively and foster healthy relationships. After Mary completes the IOT, she is able to regulate her emotions more efficiently and her social skills substantially improve.3
2. Treatment-Resistant Depression
Bob is a young man who is resistant to treatment due to poor medication and therapy compliance. He presents with severe depression that impairs his daily functioning. Bob agrees to take an antidepressant, but after several months the medication alone is not enough to decrease his symptoms. His psychiatrist then refers him to an IOT to stabilize his depressive symptoms and improve participation in his treatment.
Once in IOT, Bob becomes more aware of how being consistent with his medication can assist him in regulating his mood. He also becomes more involved in his treatment plan. Bob benefits from group sessions by processing and identifying areas in his life that need improvement and gaining healthy coping skills that decrease his depression and improve overall functioning.4
3. Dually Diagnosed Population/Step-Down From Detoxification
After being discharged from an alcohol detoxification inpatient hospital stay, Sam is referred to an intensive outpatient program to address anxiety and alcohol misuse. As part of treatment, Sam attends IOT four times a week, is drug tested once a week, attends group therapy sessions for relapse prevention, and receives psychiatric care and medication management. He learns to identify stressors that trigger his alcohol misuse, as well as learning healthy behaviors and coping strategies to ease his anxiety and sustain long-term sobriety. After completing the IOT, Sam remains abstinent from alcohol and continues to attend a 12-step support group.1
How Much Does Intensive Therapy Cost
The cost of intensive outpatient therapy will depend on the facility, however the cost for one day can range approximately between $250 to $350.5 When examining your options and the cost, explore factors such as duration of treatment, intensity of services, and location of the treatment facility.
If you have health insurance with mental health coverage, fees or a portion of fees may be covered. For example, you could be eligible for a certain number of authorized IOT days through an employment-supported health insurance plan or an employee-assisted program (EAP). Those with governmental/public insurance obtained through healthcare.gov or an active military member/veteran/family dependent with Tricare may qualify to enter an intensive outpatient therapy program at little to no cost. Contact your health insurance carrier for more details.
How to Find an Intensive Outpatient Therapy Program
To find an IOT program, begin by talking to a primary care physician, psychiatrist, or psychotherapist who can refer you to a program. You can also check with your health insurance carrier to find out whether they cover intensive outpatient treatment. If you are employed, you could enter an IOT through an employee assistance program (EAP). You can also search online using a directory.
Who Is Able to Offer Intensive Outpatient Therapy?
Intensive outpatient therapy is usually directed by a team of credentialed practitioners including psychiatrists, licensed mental health professionals, and licensed social workers. Medically monitored services are provided by an interdisciplinary team of psychotherapists, nurses, counselors, social workers, addiction specialists, or other health and technical personnel under the direct supervision of a licensed physician.1,2
Key Questions to Ask Before Beginning Intensive Outpatient Therapy
Before entering an intensive outpatient therapeutic setting, ask questions regarding the type of treatment provided, group demographics, cost, and more.
Here are eleven questions to ask before beginning IOT:
- Does the facility of my choice hold proper state accreditation/licensure to address the level of care I need?
- Who will be involved in my treatment plan and what qualifications/professional experience do they have?
- What will my therapy consist of?
- Will my specific individual needs be addressed?
- What is the structure of this IOT?
- How long will I be in therapy? How many days do I need to attend? And how many hours a day?
- What should I expect from IOT and what would be expected of me?
- Will I be placed in a group with people who have similar struggles as me?
- How is confidentiality handled in this type of setting?
- Does my insurance cover my treatment, if not, how much is the cost and does your facility offer any payment arrangements?
- What happens after I complete IOT?
Is Intensive Outpatient Therapy Effective?
Evidence suggests that this type of holistic clinical approach has been successful in helping individuals maintain mental stability and overcome substance dependence.1,2
Studies have also shown IOT works with a variety of populations, conditions, and settings.
IOT For Veterans With PTSD
One study sought to evaluate changes in symptoms of PTSD and depression over the course of a 3-week IOT for a group of coed veterans with combat and military sexual trauma. The findings demonstrated a significant reduction in PTSD and depressive symptoms. Furthermore, not only did the IOT produce favorable results over a shorter period of time for these different types of veterans (men/women and different types of trauma), it also showed that participants remained more consistent with treatment in comparison to traditional therapy.6
Addressing Individualized Treatment Goals In an Evening IOT Program
Another research study analyzed 81 patients with personality disorders who attended an intensive integrative outpatient treatment program five days a week and four hours a day over an 18-week period. On completion, the study found that the group climate was conducive for participants to actively engage in group sessions by openly talking about their personal struggles. Moreover, the patients were able to make progress toward individualized therapy goals, thus contributing to an overall feeling of life satisfaction and well-being.7
In a third study, authors searched major databases and examined 12 studies between 1995 and 2012. They found strong evidence in favor of IOT for people who struggle with alcohol/substance misuse. Even though there were slight variations, all studies revealed major reduction in alcohol and drug consumption between baseline and follow-up visits.8
Limitations of IOT
There are limitations of IOT including high patient turn-over and limited time to receive individual attention.
Limitations of intensive therapy include:2
- High patient turn-over when it is an “open group” may impact other members in their progress
- Managed care or health insurance providers may not cover the entirety of the IOT necessary for patients to improve their level of functioning
- The social diversity, personalities, and acuteness of participants in IOT can challenge group therapy order and focus
- The composition IOT group sessions may not be compatible for the individual
- There may be unequal participation from group members in therapy sessions
- Group therapy is composed of several members, which limits time to share individual concerns and receive individual attention
Potential Risks of IOT
The main risks of intensive therapy involve the potential impact one group member may have on another.
Four potential risks of intensive therapy are:2
- Some more vulnerable or unstable individuals with more chronic personality/mental health issues may not benefit from this type of therapy
- The possibility of a patient having an angry outburst/personality issues that cause verbal/physical altercation imposes a safety issue to the clinical staff and other members in the program
- Group members can provide inaccurate, inappropriate, or unsupportive feedback to others
- Members who continue to engage in maladaptive behaviors negatively can influence other members
Final Thoughts on Intensive Outpatient Therapy
If traditional psychotherapy has failed to address your mental health and/or substance misuse issues, an intensive outpatient treatment may be suitable. Being in a supportive and guided environment can be conducive to achieving mental and emotional stability, and IOT can be the beginning of your journey to lasting wellness.