The delivery of intensive therapy requires capable, trained therapists who can frequently meet with their patients in a compressed time frame, or at regular time intervals but over a long duration of time. This type of delivery of therapy can be applied to many different models of psychotherapy. Intensive therapy models have been popular since the 1980s, and several of these models are effective in treating persistent mood disorders as well as with substance use disorders.
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What Is Intensive Therapy?
The delivery of intensive therapy can be a major benefit to those who need to dedicate concentrated resources at the treatment of addiction and mental health conditions. However, there are many iterations of this type of treatment. So, what is intensive therapy?
One intensive therapy definition shows it to be any treatment that is greater in quantity, duration, frequency or scope than conventional therapy. A person is most likely to see intensive therapy in three different treatment settings:
Intensive therapy refers to a specific delivery method for mental health treatment rather than a specific type of treatment. There are no commonly accepted criteria for what constitutes an intensive therapy session, as it does not refer to a specific concentration of treatment sessions nor to a particular frequency and duration of treatment. Intensive therapy is understood primarily by its augmented relationship with conventional therapy.
Benefits of Intensive Therapy
One of the many advantages of intensive therapy is the ability to undergo a deep exploration of the underlying psychological factors that contribute to a substance use disorder or a chronic mental health condition. During intensive therapy, patients have more ability to discuss and address their internal vulnerabilities to unhealthy thoughts and behaviors.
With the increased time, frequency, duration and scope of treatment, patients get the chance to build strong bonds of trust and open communication with therapists. Common topics for ongoing dialogue between patients and providers in intensive therapy include:
- Fear of abandonment
- Fear of engulfment
- Trauma history
- Unrecognized anger
- Patterns of resistance to change
- Increasing mindfulness
- Assertiveness training
Intensive vs. Traditional Therapy
Conventional outpatient therapy models often feature one-on-one meetings with a therapist for one hour per week. Such therapy models offer convenience and flexibility for patients. Standard therapy can be highly effective for addressing distressing symptoms of mild to moderate severity, especially for conditions like anxiety and depression.
Intensive therapy sometimes features more frequent interactions with the therapist, often over a relatively short time. This high concentration of interactions allows for a significant amount of work to be done by the patient and the therapist. Intensive therapy models often see large-scale progress in a relatively short amount of time.
At other times, intensive therapy can maintain the conventional frame of treatment (one hour per week), but for a sustained duration of time, such as months or years. Intensive therapy can be particularly well suited to treating challenging scenarios, such as coexisting mental health conditions and substance use disorders, or substance use disorders with complex presentations.
How Intensive Therapy Works
So, how does intensive therapy work? The phrase intensive therapy usually refers to the level of psychotherapy and related services administered, rather than to the intensity of medical treatment. There is no standard definition in medical literature for what constitutes intensive therapy.
The intensity of treatment can be determined in one of four ways:
- Frequency of treatment: The more often a therapist and patient meet, the more chances they get to discuss meaningful data, patterns, thoughts and behaviors. One of the most popular forms of high-frequency, short-term treatment is called intensive short-term dynamic psychotherapy. This form of psychotherapy was developed from video sessions by psychiatrist Habib Davanloo in the 1980s and 1990s. Intensive short-term dynamic psychotherapy has been effective in treating mood and anxiety disorders, and is currently being evaluated for its effectiveness in treating substance use disorders.
- The duration of treatment: Some forms of psychotherapy are meant to be time-limited. Cognitive behavioral therapy (CBT), for example, is usually designed to last between three and six months. However, the extension of cognitive behavioral therapy to nine months has been shown to increase long-term abstinence in the treatment of some substance use disorders.
- The setting of treatment: Intensive therapy most often takes place in settings that are conducive to high concentrations of therapist-patient interaction. These include inpatient hospitalization, partial hospitalization programs and intensive outpatient programs.
- The scope of treatment: While some forms of psychotherapy like CBT are typically problem-focused, therapies like psychodynamic therapy focus on gaining insight into patterns of unconscious behaviors to make a more fundamental personal change.
How Long Does Intensive Therapy Last?
The duration of intensive therapy depends on the specific nature and setting of treatment. The most acute types of traditional treatment are inpatient hospitalizations, which typically lasts from several weeks to three months.
Partial hospitalization programs, which are one level down in acuity from inpatient hospitalization, can also last weeks to months. Intensive outpatient programs, which offer a balance between high-level treatment and autonomy, are usually designed to last at least one month. Some intensive outpatient programs last for one year or longer and are being studied for their effectiveness in treating mental health conditions and substance use disorders.
Goals of Intensive Therapy
In intensive therapy, the ultimate goal of treatment is to increase self-efficacy, which is a patient’s belief that most routine stresses can be handled and most problems can be managed. To accomplish this larger goal, intensive therapy uses several other goals:
- Learn early sobriety relapse prevention techniques
- Develop effective coping strategies for common stressful scenarios
- Increase or maintain social and psychological support
- Directly address barriers to physical, emotional or spiritual health
When patients who face addiction develop self-efficacy, they are less likely to return to drug use once they have achieved abstinence.
Effectiveness of Intensive Therapy
Like all medical treatment, treatment of substance use disorders follows a general rule that the more severe the disorder, the more intensive and acute the setting must be to manage it.
Severe substance use disorders are commonly treated with inpatient hospitalization, residential treatment, partial hospitalization or intensive outpatient programs, where access to care is rapid, comprehensive and integrated. Rigorous evaluations called meta-analyses, where the data from multiple studies are pooled together and reviewed, have shown the effectiveness of intensive therapy.
Recovery is far more likely to be lasting when the most effective steps are taken to reach sobriety. Treatment providers will thoroughly emphasize the importance of following up a detox experience with continued treatment, since completing detoxification alone does not result in high rates of long-term abstinence. However, patients with addictions who continue with treatment within a month of completing detox take 40 percent longer to return to drug or alcohol use, if they do at all.
Intensive Therapy in Addiction and Mental Health Treatment
Increased, frequent contact with a trained therapist is a staple of intensive therapy in both mental health and addiction treatment. Both types of conditions are chronic with cycles of relapse and remission, similar to other chronic medical conditions like diabetes, hypertension or rheumatoid arthritis.
Inpatient Addiction Treatment
During this time, intensive therapy is the mainstay of treatment. Participants in inpatient and residential programs participate in multiple sessions per day, learning about the biology of addiction, medications, relapse prevention strategies, pattern recognition, the interaction of medical and psychiatric conditions and many other topics.
Co-occurring disorders, also known as a dual diagnosis, refers to the co-existence of a substance use disorder with a mental health condition. The Substance Abuse and Mental Health Administration estimates that over 8% of the population in the United States have a co-occurring substance use disorder and mental health condition.
It is important for treatment centers to identify when a person has a co-occurring disorder since the co-existence of these conditions can have a negative effect on a patient’s outcome if both conditions are not adequately treated. Fortunately, intensive therapy is well-suited to the treatment of co-occurring disorders, and some studies show evidence that longer treatment courses can be helpful to prevent a return to drug use or return of mood symptoms.
Intensive therapy for anxiety and depression can take the form of short-term psychodynamic psychotherapy as described above.
Intensive therapy can also be administered to patients who are experiencing difficulty due to a crisis situation that is taking place in their personal lives, which may be an adjustment disorder. Substance abuse rehabilitation can be complicated by intimate issues like a pending divorce, unexpected death in the family, or the presence of other substance use disorders in the home. Many who live with addiction may return to substance abuse during stressful periods such as these.
For those enduring painful events in their life, crisis counseling can be quite helpful. A Journal of the American Medical Association publication reported an improvement in grief symptoms in 51% of patients who were taught specific techniques to cope with their feelings, along with an improvement among 28% who were counseled. A primary concern among this patient group is the risk of suicide and overdose.
In a review published in the Journal of Addictive Diseases, it is noted that more than half of all suicides are linked to drug and alcohol addiction. The National Survey on Drug Use and Health, a large-scale, government-sponsored addiction and mental health annual survey, reports a staggering 197 deaths per day from drug-related overdoses in the United States. Early interventions like intensive therapy can likely improve these numbers.
Intensive Outpatient Programs
For those who do not require inpatient hospitalization, but could benefit from sustained high-level treatment, intensive outpatient programs are an excellent choice. Known as IOPs, these programs are a step down from the closely related partial hospitalization programs, but a step up from conventional outpatient treatment.
Intensive outpatient programs usually offer at least three hours of therapy for a minimum of three days per week. During program time, participants can engage in one-on-one therapy, family therapy and group therapy. These programs usually also offer classes on medication education and about the health conditions that patients commonly experience. Treatment in an IOP is especially well-suited to the management of more complex situations, such as the co-occurrence of mental health conditions.
Intensive outpatient treatment is designed to last for weeks to months at a time. It is frequently offered in the evenings or on weekends to accommodate the schedules of those who would like to continue their commitment to work, school or family.
If you are seeking therapy for a drug or alcohol addiction, The Recovery Village may be an option for treatment. Our highly trained, experienced staff will guide you in making an appropriate decision on which level of care is right for you. Call The Recovery Village today to learn more.
Morandi, S.; Silva, B.; Golay, P.; Bonsack, C. “Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study.” Substance Abuse Treatment, Prevention, and Policy, 2017. Accessed June 25, 2019.
Punzi, Elisabeth, PhD; Lindgren, Karin, MSc. “Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment.” Alcoholism Treatment Quarterly, 2018. Accessed June 25. 2019.
Hall, S.M., et al. “Using extended cognitive behavioral treatment and medication to treat dependent smokers.” American Journal of Public Health, 2011. Accessed June 25, 2019.
Kadden, RM; Litt MD. “The role of self-efficacy in the treatment of substance use disorders.” Addictive Behavior, 2011. Accessed June 25, 2019.
McCarty D., et al. “Substance abuse intensive outpatient programs: assessing the evidence.” Psychiatric Services: a journal of the American Psychiatric Association, 2014. Accessed June 25, 2019.
Moos, RH; Moos, BS. “Rates and predictors of relapse after natural and treated remission from alcohol use disorders.” Addiction, 2006. Accessed June 26. 2019.
Substance Abuse and Mental Health Services Administration. “2017 National Survey on Drug Use and Health (NSDUH)” 2018. Accessed June 26, 2019
Rush, BR; Dennis, ML; Scott, CK; Castel, S; Funk, RR. “The interaction of co-occurring mental disorders and recovery management checkups on substance abuse treatment participation and recovery.” Evaluative Review, 2008. Accessed April 28, 2019.