How an Intensive Outpatient Program (IOP) Works

An IOP (intensive outpatient program) is a type of mental healthcare that is considered one step up from traditional outpatient therapy where you see a therapist once or maybe twice a week in their office. An IOP is a program where you will likely be in therapy (both group and individual) somewhere between two to three hours a day, three to five days a week.

IOPs are considered a higher level of care on a spectrum that also includes:

• Outpatient therapy: This is the type of therapy most people are familiar with or attend. It is generally held in a therapist's office, and most people go once a week.
• Partial Hospitalization (PHP): A partial hospitalization program, often confused with an IOP, is typically about five hours of therapy a day (including both group therapies and individual therapy), for five days a week.
• Inpatient Acute Care: When someone is in a crisis or psychiatric emergency situation, they may be placed in inpatient acute care, which may either be at a psychiatric hospital or in the psych ward of a general hospital.
• Inpatient Residential: Someone who is placed in an inpatient residential treatment facility is typically there for a month or more. They receive the same therapies as those in an IOP program, except they also stay at the facility.

There are two ways that IOPs are used. One is when a person is potentially at risk for hospitalization and regular outpatient therapy doesn’t seem to be enough.

The other way is what’s known as a step-down from a higher level of care, such as inpatient acute care or inpatient residential. IOPs are used as a step-down to help someone transition from inpatient treatment back to their regular lives.

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History Of Intensive Outpatient Programs

IOPs rose to popularity in the 1980s, as many White, middle-class working professionals were dealing with cocaine addiction and did not want to have to take time off of work. IOPs, which sometimes take place in the mornings or the evenings, may allow individuals to still keep up with their professional responsibilities and maintain income.

In the 1990s, as managed care (healthcare designed to keep costs low) grew, so did IOPs. More than just White businesspeople, the populations served expanded to include everyone from those with moderate mental health or substance issues to unhoused individuals to adolescents and those with dual diagnoses.

Data from the latest National Survey of Substance Abuse Treatment services shows a dramatic increase in the number of IOPs from 2010 through 2020, with nearly 3,000 more facilities (16,000 in total) eligible for inclusion. The number of clients served also rose from 1.2 million per year in 2010 to 1.4 million per year in 2019.

Types of IOPs

Though IOPs originated as a treatment for substance use disorders, they are now used for several different kinds of conditions that may require more attention than is possible in once-weekly therapy. Some different kinds of IOPs may include:

• Depression/Mental health
• Dual diagnosis
• Substance use
• Eating disorder

How to Find an IOP

While you can search online for IOP centers in your area, it's best to get a personal recommendation if you can. You may also be able to get a recommendation from your therapist or psychiatrist if you see one or perhaps your primary care doctor or other healthcare provider.

The United States Substance Abuse and Mental Health Administration (SAMSHA) also hosts a behavioral health care service locator on their website. As these programs are a significant investment of time and money, you should take your time to do your research and talk to several different programs. Most programs will do an intake call with you for each of you to see if this is a good fit.

Here's some questions you might want to ask:

• How long are people usually in your program?
• Do you take my insurance?
• Have you worked with clients with issues/diagnoses like mine before?
• Have you worked with clients who identify like me? (This may include race or sexuality.)
• How will you prepare me for the transition back to my "regular" life?
• What age range are the people in your program, typically?
• What is the structure of the program?
• What is the treatment philosophy?
• What modalities do your therapists practice?

What to Expect in an IOP

Intensive outpatient programs are called that because they are, well, intensive. Treatment typically involves three to four hours of treatment per day for three to five days a week, for a duration of about four to six weeks.

Some IOPs may help you connect with adjunct or alternative therapies, such as Transcranial Magnetic Stimulation, ketamine infusions or EMDR. Other therapies that may be used include equine therapy or yoga therapy.

Modalities

Depending on what brings you to an IOP, or the individual IOP, the type or modality of treatment may vary, but what follows are some of the most common ones.

12-Step Facilitation

Though the 12-step model was originally developed for Alcoholics Anonymous, the approach is also used for people with drug misuse, eating disorders, and other compulsive disorders. When the 12-step model is used in an IOP or similar setting, people will begin working through the steps under therapeutic supervision.

A major advantage to these types of programs is the ease of ongoing support for individuals through their ability to attend AA meetings in the community afterward, continuing their work from the IOP.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is based on the idea of giving people skills to deal with when confronted with triggers, as well as helping reframe cognitive distortions that lead to those behaviors that are maladaptive. CBT is a particularly good match for intensive outpatient programs because people are still in their normal situations and so can test out the new skills right away.

Motivational Approaches

Approaches such as Motivational Interviewing or Motivational Enhancement Therapy are designed to discover someone's ambivalence towards treatment and changing their behaviors.

The therapy is kind—acknowledging that substances or behaviors had served some purpose for the client—but also directive by strong encouragement to confront one's behaviors that are not aligned with their desired outcomes or values.

Therapeutic Community

The idea of a therapeutic community is derived from residential substance use treatment. However, some programs also use them for IOPs, especially as a step down from residential. Their approach is "community as method," using any social interaction as a way to guide change and help people find better skills once they are back in their original community.

Matrix Model

The Matrix Model was founded in the 1980s to address the widespread cocaine and stimulant problems at the time. It integrates several different approaches, including CBT, 12-step and motivational enhancement to target change. The full program is 16 weeks and combines individual sessions with psychoeducational sessions, relapse prevention sessions and family and social support groups.

Community Reinforcement and Contingency Management Approaches

Those methodologies are based on the idea that future behavior is influenced by positive or negative consequences from past behaviors. The approaches, in an IOP setting, use a points/reward system to reinforce the desired behaviors. This could look like someone being able to "buy" (have a staff member buy them) a small reward once they have saved enough points.

A Word From Verywell

If you think you or a loved one could benefit from an IOP-style treatment program, talk to your healthcare provider about the available options and how to get started.