The Role of Group Therapy in Intensive Outpatient Programs.

Key Takeaways

• Group therapy in an intensive outpatient program (IOP) is psychotherapy in a group setting instead of one-on-one, and it happens while you keep living at home.
• At Awkward Recovery, IOP groups draw on evidence-based approaches: DBT skills, CBT, motivational interviewing and process groups, plus experiential work like yoga and breathwork.
• How much you share, and how fast, is a clinical call you and your clinician work out together, based on readiness and skills.
• If you're here for mental health and don't have a substance use problem, you're in a group with other mental-health-primary clients.
• For social anxiety in particular, the National Institute of Mental Health notes that group CBT can offer unique benefits.

You're probably reading this because group therapy is the part of IOP that makes your stomach drop. You can already picture it: a circle of chairs, a room full of strangers, and the moment everyone turns to look at you. That picture leaves out most of what goes on in the room.

Group therapy in an intensive outpatient program (IOP) is therapy in a group setting instead of one-on-one, while everyone keeps living at home. Awkward Recovery is a Joint Commission-accredited outpatient mental health and substance use disorder treatment center in South Austin, and group therapy is part of how our intensive outpatient program works. Below, we cover what IOP groups are, the kinds of groups you'll find, what you will and won't be asked to do, and what NIMH and SAMHSA say about group therapy.

What Is Group Therapy in an IOP?.

Group therapy is psychotherapy with several people in the room instead of just you and a therapist. The National Institute of Mental Health (NIMH) explains that most psychotherapy takes place one-on-one with a licensed mental health professional or in a group setting. In other words, group is one of the two settings where most therapy happens. It is not a side activity.

The "intensive" part means more than a weekly appointment. An IOP gives you several sessions a week — skills, exposure work, and group — while you keep living your life: the job, the kids, the morning you have to show up for. That rhythm matters for group work. What happened at work on Tuesday is still fresh when you're back in the room, so you're working on your life as it happens, not on a summary of it a week later.

If you want the bigger picture of how the whole program is built, our guide to what an intensive outpatient program is and how it works walks through it.

What Kinds of Groups Are There in an IOP?.

At Awkward Recovery, IOP groups draw on evidence-based approaches: DBT skills, CBT, motivational interviewing (MI) and process groups. Experiential work, including yoga, breathwork, sound healing and fitness, is also available. Our mental health track and our substance use track use the same modalities.

• DBT skills: Mindfulness, plus skills for intense emotions, self-destructive behaviors and relationships
• CBT: Noticing automatic ways of thinking that are inaccurate or harmful
• Motivational interviewing (MI): Motivation for change
• Process group: One of the evidence-based approaches used in both tracks
• Experiential (yoga, breathwork, sound healing, fitness): Working with your body, not only through talking

DBT skills groups

Evidence-based dialectical behavior therapy (DBT) teaches skills to help people control intense emotions, reduce self-destructive behaviors and improve relationships. It also uses mindfulness, which means paying attention to your present situation and what you're feeling, according to NIMH. For a closer look at one DBT skill set, read our article on DBT distress tolerance skills.

CBT groups

Evidence-based cognitive behavioral therapy (CBT) helps a person "become aware of automatic ways of thinking that are inaccurate or harmful," as NIMH describes it. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes that, in treatment for alcohol problems, CBT can take place one-on-one with a therapist or in small groups.

Motivational interviewing groups

SAMHSA publishes a full clinical guide, TIP 35, to help clinicians support the change process with motivational interventions in substance use disorder treatment.

Experiential work and Family Nights

Yoga, breathwork, sound healing and fitness are available in both tracks, and so are Family Nights. If the people who love you want a place to start, point them to our family resources. You can also read more on our group therapy page.

Key Takeaway: Different groups do different jobs. DBT and CBT groups teach skills, MI works on motivation, and experiential work brings your body into it.

Do You Have to Share in Group Therapy?.

How much you share, and how fast, is something you and your clinician work out together. At Awkward Recovery, we work on the pace together based on clinical assessment of readiness and skills.

That is different from "share whenever you feel like it." Your clinician looks at how ready you are and which skills you already have, and the pace builds from there.

We also encourage facing fears. If anxiety has you avoiding certain conversations, places or feelings, your clinician helps you start moving toward them, with skills in hand.

Key Takeaway: Pacing isn't something you set alone. You and your clinician set it together, based on readiness and skills, and the direction is toward the things you've been avoiding.

Who Will Be in Your Group?.

If you come to Awkward Recovery for mental health, like anxiety, and you don't have a substance use problem, you'll be in groups with other mental-health-primary clients. You won't be folded into groups built around addiction. You don't need a drug or alcohol problem to come here.

That matters more than it sounds. Someone whose panic attacks are wrecking their commute needs a different conversation than someone working through early sobriety. Both tracks use the same evidence-based approaches and both have experiential components and Family Nights, but the people in your group are working on problems that look like yours.

If anxiety is what brought you here, our anxiety treatment page explains how we approach it. If you're dealing with substance use and a mental health condition at the same time, read how we treat dual diagnosis.

What NIMH and SAMHSA Say About Group Therapy.

For social anxiety disorder, group CBT can help in a specific way. NIMH notes that CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder, and that CBT can help a person learn and practice social skills. If talking in front of people is the thing you dread, a group gives you a place to practice it with support.

Group work is also serious clinical territory in substance use treatment. SAMHSA's TIP 41 guide exists to help counselors improve their skills in leading group therapy for substance use treatment.

Key Takeaway: For social anxiety in particular, NIMH notes that CBT delivered in a group format can offer unique benefits.

When Group IOP Isn't Enough on Its Own.

Group therapy in an IOP is not crisis care. If you have suicidal thoughts with a plan and/or intent to act, that calls for a hospital or emergency room, not a group session. Call or text 988 or go to the nearest emergency room.

Suicidal thoughts without a plan or intent are different. They can be worked with in IOP, so tell your clinician and make them part of your treatment instead of a secret you carry into group.

Medication is a separate piece. NIMH notes that psychotherapy can be used as an alternative to or alongside medication. Awkward Recovery doesn't prescribe medication; we coordinate with your prescriber so your therapy and your medication plan aren't running on separate tracks.

How Group IOP Fits Around an Austin Workday.

Awkward Recovery runs a night IOP, so groups can fit around your workday instead of replacing it.

If you're trying to picture the logistics, our article on evening IOP for working professionals covers what that tradeoff looks like. You can read what your first week of IOP is like and how IOP unfolds week by week.

If the Circle of Chairs Still Scares You.

If group therapy still sounds like your personal nightmare, that's okay. You don't have to walk in calm. You have to walk in.

Group is where you pick up evidence-based skills to do something different: DBT skills for the moments that feel too big and CBT for the thoughts that lie to you. The pace is set with your clinician, based on where you are, and the direction is forward.

If you're in the Austin area and want to talk through whether our IOP is a fit, call us at (512) 616-0809 or reach out through our contact page. We're in-network with major insurance plans and verify your benefits for free.

If you're in crisis right now: Call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7. For treatment referral and information, call SAMHSA's National Helpline at 1-800-662-4357. You can also text HOME to 741741. If you have thoughts of suicide with a plan or intent to act, go to the nearest emergency room.

Frequently Asked Questions.

What is group therapy in an intensive outpatient program?

Group therapy in an intensive outpatient program (IOP) is therapy in a group setting instead of one-on-one. An IOP gives you several sessions a week — skills, exposure work, and group — while you keep living your life. At Awkward Recovery in South Austin, IOP groups draw on evidence-based approaches including DBT skills, CBT, motivational interviewing and process groups.

What types of groups does Awkward Recovery's IOP use?

Awkward Recovery's IOP groups use evidence-based approaches: DBT skills groups, CBT groups, motivational interviewing (MI) and process groups. Experiential work, including yoga, breathwork, sound healing and fitness, is also available, and so are Family Nights. The mental health track and the substance use track use the same modalities, so the approach to care is consistent even though the groups themselves are separate.

Do I have to share personal things in group therapy?

How much you share, and how fast, is worked out with your clinician rather than decided on your own. At Awkward Recovery, we work on the pace together based on clinical assessment of readiness and skills. We also encourage facing fears instead of avoiding them.

If I don't have a substance use problem, will I be in group with people in addiction treatment?

No. At Awkward Recovery, clients whose main concern is mental health are in a group with other mental-health-primary clients, not folded in with clients in addiction treatment. You don't need a drug or alcohol problem to come here. Both tracks use the same evidence-based approaches, such as DBT, CBT and process groups, and both have access to experiential components and Family Nights.

Can group therapy help with social anxiety?

Group CBT can. The National Institute of Mental Health notes that CBT delivered in a group therapy format can offer unique benefits for social anxiety disorder, and that CBT can help a person learn and practice social skills. For someone who dreads speaking in front of others, a group is a place to practice with support instead of avoiding the situation. A clinician can help you decide whether group work fits your situation.

Can I do group therapy in an IOP if I take psychiatric medication?

Taking medication doesn't rule out therapy. The National Institute of Mental Health notes that psychotherapy can be used as an alternative to or alongside medication. Awkward Recovery does not prescribe medication. Instead, we coordinate with your prescriber, so your therapy and your medication plan don't run on separate tracks. If you have questions about how that coordination works, ask us when you reach out.

What happens if I have suicidal thoughts while I'm in IOP?

Tell your clinician. Suicidal thoughts without a plan or intent to act can be worked with in IOP, and talking about them is part of treatment. Suicidal thoughts with a plan and/or intent need a higher level of care, such as a hospital or emergency room. If you are in crisis right now, call or text 988 to reach the 988 Suicide & Crisis Lifeline, which is available 24/7, or go to the nearest emergency room.

Can I do group IOP while working full time?

Awkward Recovery runs a night IOP, so group sessions can fit around a typical workday instead of replacing it. An IOP gives you several sessions a week — skills, exposure work, and group — while you keep living your life, so treatment doesn't have to mean stepping away from your job. For current program details, call Awkward Recovery at (512) 616-0809.