The Spectrum of Perinatal Care: When to Consider a Perinatal Intensive Outpatient Program

Criteria is generally based on severity of symptoms and level of functioning, so a pregnant or postpartum parent might benefit from the IOP when weekly therapy is not providing enough support to reduce the intensity and frequency of symptoms or improve level of functioning. For example, someone who is experiencing consistent, significant distress or impairment in their daily life (symptoms occur most days and last for several weeks or longer) or feeling isolated may benefit most from an IOP, as there is an emphasis on group therapy and support. Individuals experiencing significant birth trauma or perinatal anxiety and/or OCD generally benefit from an IOP setting, as highly intrusive thoughts may be present, as well as avoidance behaviors.

This sometimes depends on the specific program, but generally perinatal IOPs treat a spectrum of perinatal mood and anxiety disorders, including anxiety, depression, and OCD. Many participants have experienced birth trauma, so PTSD is also addressed. Those attending are encouraged and often required to have individual therapy in addition to IOP sessions, as more long-term processing is addressed. While perinatal/postpartum psychosis is a medical emergency, postpartum psychosis is a mental health concern that is also addressed when level of care needs decrease.

Typically, IOP sessions, whether virtual or in person, are three hours a day, three days a week. Morning sessions generally start around 9 or 9:30 and run until 12 or 12:30. Since we will be together for a while, snacks, blankets, coloring pages, and anything else that is comforting is encouraged. In the beginning, everyone is getting to know one another, so it is a lot of facilitator initiation, psychoeducation, and establishing group rules. By the end of the program (generally anywhere between six and twelve weeks), most participants are very comfortable and collaborative. Each day’s session is broken into 30-45 minute increments to allow for breaks and rest, as sessions can be information heavy. The first day of the week generally consists of symptom check-ins, some processing, psychoeducation and skills building. The next day continues with psychoeducation, often with a presenter, individual treatment planning, and/or an activity related to the day’s topic(s). The final day of the week consists of psychoeducation, reflection, and preparation for the weekend (triggers, coping skills). Some programs add a fourth or fifth day for special topics and interventions, including those experiencing perinatal OCD.

Someone considering enrolling in a perinatal IOP (as well as the person evaluating a potential client) should consider the severity of the symptoms, and how much the symptoms are affecting daily functioning. Consider how the symptoms are affecting their lives overall, asking, “do I feel safe? Can I stay at home during treatment?” Other symptoms to recognize that may indicate if a perinatal IOP is the best option are persistent intrusive thoughts, panic attacks, moderate to severe anxiety most days, feeling stuck in weekly therapy (if applicable), and experiencing distress that is impacting relationships and attachment. We generally want to look at quality of life, and of course, safety. If someone’s experience is managed well with weekly therapy, and there are no safety concerns, outpatient weekly therapy may be best. If someone is experiencing safety concerns (suicidal/homicidal ideation) and is experiencing significant impairment, a higher level of care than IOP may be needed. IOP can be a very effective middle ground.

I would of course validate their concerns and encourage them to recognize what they need. They aren’t failing, they are just really aware of what their needs are. Asking for help and recognizing the need for additional support is a strength. Perinatal mood and anxiety disorders are some of the most common complications of pregnancy and postpartum, so they are not alone. We consider therapy an investment, so a perinatal IOP is an investment of your time, with benefits typically outweighing the cost (time). So much mental and physical energy is spent experiencing perinatal mood and anxiety disorders, and this refocuses your time. What could functioning look like with more support? Therapy in general, especially more intensive therapy can help you feel more present and connected with your child(ren) and family, giving you back more quality time. Many perinatal IOPs provide virtual options, which is often helpful when childcare or being away from home is a concern. Additionally, some IOPs, including ours at Tulia Grove, allow participants to bring their baby to sessions if they choose.

Seeking treatment does not make you a bad parent or mean you have failed in any way. A lot of the time parents feel like they should be able to manage things on their own or wait until things get worse before asking for help. Pregnancy, postpartum, and parenting is hard and requires a lot of support.