When you are in crisis, it can be hard to figure out what to do, and suggestions from your provider about going to a treatment program can be anxiety-provoking. Mary is someone who recently came through a very frightening crisis and found that the “partial hospital program” (PHP) that she was referred to was not only life saving, but also extremely valuable.
She was so enthusiastic about it that she spontaneously offered to talk to anyone I knew who could benefit from her experiences, and I thought that an interview in our series of “Conversations” might be the best way of doing that.
D.F.: Doctor Forster
D.F: What was the program like, and how was it structured?
MARY: I participated in a 30-day PHP. The first two weeks of the program are intensive, and patients are required to participate every day for 6 to 7 hours a day. Each day is highly structured, and I had constant contact with, and access to, highly specialized clinicians to help with coping through periods of severe distress. During the day, there are many different group sessions, as well as time for individual psychiatric care. Individuals have a primary psychiatrist, and meet with them every other day. For me, being able to receive such intensive care in terms of having regular sessions with a physician is a big sense of comfort and relief. Some themes covered in the group sessions are mindfulness, distress tolerance, emotion regulation, interpersonal skills, and covert topics like safety and activity planning. During sessions, there are exercises to help you comprehend and learn to apply the new skills to your own life.
The concepts are repeated, and you discuss the skills over and over so finally they start to click into place. The big value of the program is it brings you out of your head and back into the world. Most specific skills taught in the program were completely new to me, and the active practice has allowed me to recall these skills during periods of distress.
D.F: When I talk about the program to bright, high-achieving, distressed patients, I encounter the same systematic concerns. People have a hard time understanding the value of group work. It is often difficult to explain why that is useful, but the typical person I see would say, “Well, I could just come see you every other day, and I don’t know if that would fix stuff.” Many people have a previous cognitive understanding of mindfulness as well, and tend to not see the value of sitting in a group and going over it in detail. What are your thoughts on this issue?
MARY: I think there is great value of being in a very structured, full-day environment when you are in a period of extreme distress. It is very helpful to take a break from the normal daily stressors of work, running your home, or whatever you may typically do on a daily basis. Many of us are familiar with mindfulness, but I know from my own personal experience that once I leave the doctor’s office, I quickly go back to my other daily tasks and don’t spend dedicated time working on these skills. When you are depressed, you tend to feel really disconnected from other people, and you tend to avoid interpersonal interactions. One of the important values of this program is that you are forced to interact with others, and interact with people in similar situations.There is less pressure to be perfect and more of an opportunity to express your own feelings, challenges, or fears. I learned from others who had gone through really stressful experiences who have made it through to the other end.
D.F: What were your anxieties when thinking about the program?
MARY: It had been recommended to me a year and a half ago. Honestly, at that time, I had just started receiving care from a psychiatrist, and the thought of hospitalization really scared me. Fast forward a year later and many more months of depression, I was ready to enter the program. My initial hesitation was about taking time off work, and accepting the fact that it was something I needed to do. That challenges most people, but everyone I met who participated in the program realized that it was an important and helpful thing to do. It isn’t necessary to tell your employer the reason for your leave. Many did not share with their employer, but said they needed a month off for a medical condition. Once I made the decision to take time off, it gave me a sense of relief, and it also provided my husband some additional sense of safety and security in terms of my well being for the immediate and foreseeable future.
D.F: I have noticed that many people feel a certain reluctance towards the program because of an issue with the meaning of the word “hospitalization”. What was your experience with the hospitalization component of the program, and how was it different from what you thought the word suggested?
MARY: When I first heard the word hospitalization, I was scared. It suggested I was out of control and was like something I had seen in the movies. The word suggested something that was not my own choice. When I finally decided to join the program, I was in a place where I absolutely wanted help. It was the last hope for me. My decision to participate was based largely on the fact that I did not see myself getting better under my current treatment plan. Now, having gone through the program, I think it would have been great to go in earlier in the depression.
D.F: Was the PHP similar to what you imagined for hospitalization?
MARY: In some ways, it was. During the intake, they said what the program was going to be, and how the day was going to be structured. What was different is it was a lot more interactive than I thought. It wasn’t just being in a hospital being served medications all day long. My immediate thought earlier was bed clothes, medication, and people waiting for me to go crazy. This program was very different and was focused on group therapy. I saw a small classroom, learning environment and enjoyed learning. The program did save my life and taught me a lot of really necessary survival skills for someone who struggles with depression.
D.F: Any last thoughts?
MARY: PHP fosters an extremely structured, supportive environment, and I formed strong bonds with people in my group. There were 15-20 people from all different backgrounds– students, professionals, and different socioeconomic backgrounds. It’s interesting to see that people come with different challenges and different lengths of experiences with their own mental illnesses. You will find yourself connecting with people and spending time outside the group as well. The other thing I would add is where I initially felt some sense of stigma with participating in a mental health program. Since I have left, I find myself proactively talking about the program with friends, family, and others. More often then not, I get a lot of positive feedback about how smart I was for going to the program and what a great job I did getting additional help from the program.