Posted by: counselorcarmella | July 28, 2011

The Benefits of Partial Hospitalization Or Day Treatment Programs

When I’m talking with a client and they seem to be having a hard time just getting themselves together to carry out daily tasks, I know that they probably need more than I can do in an hour, or even two hours, a week. This is especially true if they are not sleeping or eating, talking about death, or just too emotional to perform work or household responsibilities. If they seem hopeless or have recently experienced an important personal loss, I take this into consideration, as well.


Certainly, if death comes up, I want to know more about their thoughts, but I don’t automatically assume they need to be hospitalized. It does mean I need to pay attention and take some kind of action. The first action is to really listen and ask questions to get more of an idea of what their thoughts are (previous attempts, clear intent, plan, means, making preparations, justifying suicide, etc). I want to know if they really want to die or if they just want anything that will make them feel different. I want to know what or who matters to them or reasons they have for wanting to stay alive/keep trying.


I rarely have clients hospitalized. When I do, its generally voluntary and it is for clear overwhelming suicidal thinking. What I am more likely to do with a client who is having severe symptoms and significant problems functioning is suggest that they participate in the intensive day programs that take place at several local hospitals. Some call them intensive outpatient or partial hospitalization programs. They are outpatient and usually take place from 9:00 am to 3:00 pm. These programs involve individual and group counseling and support sessions, skills training in emotion regulation, consulting with psychiatrists, and family education/counseling. I would much rather someone do this than have to stay overnight in the hospital, particularly when they have a family at home.


This is much less frightening to clients than the idea of inpatient hospitalization. Plus, it is easier to get someone into one of these programs than it is to try getting them admitted into the psychiatric unit of a hospital.


Some participants are suicidal to an extent, but not so much that they are judged to be in need of hospitalization to protect themselves from immediate harm. They may have to safety contract, as in identify several people they would tell if they thought they would act on their thoughts, several distraction techniques they could engage in when having thoughts, and procedures for getting help such as counseling center’s crisis number or calling 911 or going to the ER if necessary. Plans may need to be made to make loved ones aware of the situation so they can be alert for any signs of worsening symptoms. If the treatment team at a partial program feels a person needs to be hospitalized for safety or stabilization reasons, they can get that done much easier because that person is already under their care. The psychiatrist supervising them would make this happen.


I tell clients this is a way to help them to stabilize more quickly and is a good way to provide them with a lot of support and skills to help them regain their balance more quickly. Honestly, it is also a quicker way to get them to see a psychiatrist for medication evaluation if they haven’t done that yet. Oftentimes, clients just don’t have time to wait weeks to see a doctor and then weeks for meds to start working. I would encourage anyone struggling a lot to consider a partial program. My clients report positive experiences with them.


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