CHANGING DIRECTION: My Experience in an Intensive Outpatient Program (IOP)

By Nancy Virden ©2011  Written at the request of my doctor

How did I end up in this place again? I do not want to be here or anywhere and cannot believe I am expected to continue to fight for the life I gave up on a few weeks ago. Nonetheless, I am sitting in this chair, filling out the daily IOP report, answering the questions honestly. A glance about the circle reveals other faces preoccupied with private thoughts, some more stoic, others laughing nervously. We greet each other warmly. No one feels superior here.

On the surface, it appears we gathered for one reason- to get our emotions under control and move on with successful, happy living. Nevertheless, I am not here to get well. I am here to be good, to obey doctors and therapists, and ultimately God, who I doubt is happy with me just now. Getting well means jumping back onto the spiral, riding out another round of trust only to have it hurt again. There is no reason to believe this perception of loved then unloved will ever end. I do not want to be in this cycle anymore.

Growing up in the country, my job was to keep the creek clean and flowing after thunderstorms. Fallen branches, stirred mud, and dead leaves would wind their way downstream only to become clogged inside a tunnel of unyielding cement walls. It was there, under the roadway bridge, where I spent many an hour in boots, raking and tugging away at the debris in hopes of freeing the water from its piled dam. It was hard work standing knee-high in the freezing wetness, straining muscles, and lifting heavy loads. If motivation ever waned, it was invigorated by the recollection of the stench of a stagnant creek.

Now, similarly to the motionless creek, a raging storm of disappointment and fear has left me at a standstill. I need the desire to face another day. IOP is offering the tools to find that hope, joy, and sense of purpose. I am resisting, certain none of those things are for me. Not this time around.

From what I am hearing, it appears there are only three choices for any of us in this program: to Live, to Die, or to Live Well. Which one do I really want? Suicide remains an inviting concept yet brings along with it punishing baggage to carry for those left behind. Right now, I am only living, stuck between desiring and escaping change. Misery is my companion, relationships at an uncomfortable standoff.

Ambivalence is the enemy. One day I decide to step forward, the next to pacify my hopelessness with sad thoughts. One of the first IOP lessons I took to heart is the concept of recognizing my needs and finding ways to meet them. Consequently, I signed up for an art class, launched a new career, and invited new friends into my world. Yet my feelings remain the same. Looking onward, then back, pivoting in my tracks, it is a decision by indecision. Refusing to make up my mind to pursue Living Well equals an automatic default to old patterns.

I am getting tired of feeling like only so much rubbish. A choice needs to be made. Sigh. Guess I might as well see about building a less dismal life.

Taking control of conflicting emotions and following through with processes I am learning in IOP include opening the blinds in my apartment each day. Positive, upbeat music plays in the background. To-do lists include art along with chores, and I try my best to complete each task. Violent television is avoided as it triggers high anxiety and self-destructive urges.

“Is the difference between me and people who don’t end up with depression that they get over their hurts and I don’t?” someone asks.

“Yes”, is the dismaying reply from the doctor. Ouch! I do not want to consider my role in this disaster.

“When you are holding onto something, it affects your day. Letting go gives you the freedom to think your positive thoughts about yourself and the situation,” he continues. “Distractions from depressive and anxious thoughts are good but temporary. It is the fear you are focused on, your negative beliefs that feed depression, and need to be let go.”

This is not pleasant to hear. Apparently, perceptions and assumptions that have influenced my emotions all my life are to be unveiled and changed. Just like tearing apart those clumps in the creek, this job begins with removing one obstacle at a time. I start by journaling those deep-rooted beliefs.

“Challenging negative beliefs means deliberately searching for evidence of the positive and not dismissing it”, the doctor adds.

It is not about eliminating negative thoughts; it is about choosing which thoughts to hang onto- evidence for the positive or evidence for the negative. This “letting it go” battle appears endless. Nevertheless, I am gambling that robbing negative thoughts of their power will make them diminish over time.

IOP is three months behind me now. A familiar question confronted me this morning – will I choose to Live Well? The cycle I feared is still a possibility, and today I wanted to worry and experience the comfort of isolation while dwelling in my own head. Yearning for relief by means of long-established, self-destructive measures was causing torment. Glancing at my list of newly defined values and goals laying open beside the couch, I knew it was my choice to either control the intensity of these feelings or give in to them. Knowing how to escape their pull offered some options to this tug-of-war.

For example, honoring my word to God who loves me and to significant persons in my life means I must do the exact opposite of what I feel like doing. I wanted to obsess, so I focused on accomplishing something positive by working on this article. Hiding was tempting, so I contacted a friend. Releasing long-held secrets from their deep reserve is terrifying, thus I made myself share openly with my new therapist. In answer to the draw of self-punishing habits, my hands and mind were kept busy with creating a collage.

These choices accomplished what the IOP promised they would- I feel better at the end of the day. Positive distractions not only gave my mind a rest from unsettling emotions, but they also came with a sense of success. I won this round. Victories like this one may become more and more frequent. Because despondency is most severe in the quiet of the night, staying busy throughout the day also helps me to fall asleep more quickly and spares me some difficulty.

No matter how many times I cleared the creek, storms would eventually create havoc and the process would have to repeat. Perhaps I could have stood in the downpour with my rake and tenaciously prevented the dense clog from forming; nevertheless, that kind of effort is not worth it when talking about a creek.

Regarding mental health and quality of life, the daily struggle against negative thoughts promises a pay-off.

After all, God alone knows what opportunities for hope, joy, and purpose lay ahead if only I will walk toward Living Well.

Today’s Helpful Word  

 Proverbs 3:13-18
Blessed are those who find wisdom, those who gain understanding, for she is more profitable than silver and yields better returns than gold. She is more precious than rubies; nothing you desire can compare with her. 

Long life is in her right hand; in her left hand are riches and honor. Her ways are pleasant ways, and all her paths are peace. She is a tree of life to those who take hold of her; those who hold her fast will be blessed.


Nancy Virden Seminar, May-2016
Photo Joe Boyle Photography

Always the Fight Ministries (ATFM) has been displaying compassion for those fighting mental illness, addiction, or abuse since 2012. Nancy is the founder and voice of ATFM and openly shares her emotional resurrection from despair. 


NOTE: I am not a doctor or a mental health professional, and speak only from personal experiences and observations. In no way is this website intended to substitute for professional mental or behavioral health care.

If you are feeling suicidal, or concerned about someone who is, in the U.S. call the National Suicide Prevention Lifeline 1-800-273-TALK (8255), or for a list of international suicide hotlines, go here.

If you are suicidal with a plan, immediately call 911 in the U.S. or go to your nearest emergency room. In the EU call 112. (For other international emergency numbers, go here ). Hope and help are yours!

*Unless otherwise indicated, Scripture quotations are taken from the Holy Bible, New Living Translation, copyright (c) 1996, 2004, 2015 by Tyndale House Foundation. Used by permission of Tyndale House Publishers, Inc.., Carlo Stream, Illinois 60188. All rights reserved


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