One step forward, two steps back.

Six days ago, on January 30th, I was admitted to a partial hospitalization program for depression. This is the second time I’m doing the same program, and I have mixed feelings about being back.

Battling a mental illness can feel a lot like getting thrown out of the saddle again, and again, and again.

For those unaware, a partial hospitalization program, sometimes referred to as a PHP or day treatment, is a program for mental health or substance use concerns where patients spend around 5-8 hours at a treatment facility during the day and return home in the evenings. Weekends and major holidays are typically also spent at home.

The PHP I’m currently admitted to for the second time consists of a curriculum designed to treat depression. It includes CBT (cognitive behavioral therapy), DBT (dialectical behavioral therapy), and behavioral activation (BA). If you haven’t already guessed, the mental health field uses a lot of acronyms.

A small group of patients and I have group therapy together, which includes not only CBT, DBT, and BA, but also experiential therapy (or ET; for this program, it’s like a combination of art therapy as well as playing meaningful games and doing activities that tie into what we’re learning in therapy). We also have one-on-one time with our therapists and psychiatrists or psychiatric nurse practitioners.

The last time I went through this PHP, I had just gone through 45 days of residential treatment, where I lived 24/7 at a separate facility and received intensive care. My depression has been severe and resistant to treatment for a little over ten years now, and much of the past few years—since around the time Covid-19 first hit us—has been spent troubleshooting and stumbling through efforts to make forward progress. For this reason, I haven’t been working since February 2022.

To say I’m frustrated would be a gross understatement. I’ve been dealing with a crushing amount of hopelessness, helplessness, and loneliness. As a result of my struggle to get on a path of meaningful recovery and stability, toxic shame has created an uncomfortable but protective blanket around my psyche: if I lack confidence and esteem in myself, I probably won’t keep trying, and I can’t fail or get hurt if I don’t try.

But the words that flow from this defensive mechanism, the words of my inner critic, are far from protective. They’re cruel, cold, and heartless. They only care about keeping me safe from potential future wounds while my current, core hurts continue to weep and refuse to heal.

That’s why I decided to return to this program. Things came to a head once I started experiencing mysterious medical problems last fall, which fed into my already-worsening depression symptoms.

I fell out of any sense of routine and lived day to day playing video games, scrolling through my phone, and surfing the web, just trying to avoid my painful emotions. Things like eating enough each day and brushing my teeth became incredibly challenging again.

I was seeing my outpatient therapist twice a week at this point, but I knew I needed more structure to my day-to-day and a more intensive form of treatment.

I’m trying to see the silver lining to being back in the program. I have more insight, wisdom, and new perspectives returning to PHP. The past year hasn’t been entirely unproductive, and my wonderful outpatient therapist has helped me realize a lot of the barriers that stand between me and my illnesses and a meaningful sense of stability, a path to recovery that is all my own. I’ve moved forward in many aspects of my illnesses and my life, not just backward.

Every time you fall off, you get back in the saddle again, and again, and again.

Perhaps some of the most important concepts I’ve learned about surround the fact that mental illness recovery is not a destination, but a journey, and a continually difficult one for many of us who suffer for years and decades. It’s a journey that is taken one step at a time, one day at a time. I’m learning to be less impatient about my own recovery, and I want to remember not to rush myself through this PHP or put pressure on myself to “do more”.

I’m trying to remember that even though recovery will be a lifelong and ongoing process, and there will likely always be times when I slip up, that doesn’t mean there isn’t hope. Life can still be worth living, even when it feels like hope can’t be found for miles around.

Recovery is a journey.

Being back in the same PHP with the same curriculum means I know what I’m getting myself into and I know where to focus most of my time and energy. This time, I know I need to put a heavy hand into behavioral activation or BA, which involves the gradual increase of routine and enjoyable activities.

Right off the bat, I’m attempting to fix my horrible sleep hygiene, participate in more activities I enjoy that don’t involve the use of video game consoles, computers, or my phone, and practice relaxation skills like respiratory control and mindfulness. I also know I need to start chipping away at my low self-esteem.

There’s something to be said about patients like me who return to these programs time and time again; I sometimes refer to us as “revolving door patients”. Perhaps only a few weeks ago I would complain about “the system” and the therapies being entirely to blame—and they’re certainly far from perfect, there are things that need to be changed.

I tend to find myself lamenting that if these programs don’t work the first time, they must not be effective for those revolving door patients who struggle with stubborn, treatment-resistant symptoms. Cynically, I sometimes feel that those like myself find ourselves in a cycle of inpatient stays and treatment regimens, only to be ignored or forgotten, and doomed to slip through the cracks of the mental health system.

I still believe this to some extent, and I plan on writing a piece about the topic in the future. However, I’m seeing now that it’s not so black-and-white. Maybe there’s a reason some patients complete programs like these, only to relapse or otherwise end up back in that dark place, needing to return to square one.

I believe that this isn’t a 100% negative thing. I think some people who struggle with mental illness need a second, third, fourth, fifth chance, and so on. Those repeated battles are part of the treatment regimen itself; it’s as though multiple rounds are prescribed, like chemotherapy or dialysis. It simply cannot be done in one go.

Trail rides are about the journey, not the destination, as is mental health recovery.

In my case, there’s clearly something I’m still missing, whether it’s insight or perspective or specific skills, or even an incorrect or missing diagnosis. There are pieces to the puzzle I still need to figure out, and the only way I can do so is by coming back to treatment. I know I’m not grasping parts of recovery and treatment that I watch some of my peers pick up with ease. I also know some of my peers are probably struggling with concepts that I find effortless.

Treatment can get complicated when programs like my PHP are structured in a way that makes them a bit cookie-cutter. People are individuals; each patient has their own needs, obstacles, histories, and traumas. To address every single issue in a program that only lasts 4-8 weeks is impossible. There’s still so much to gain from them, though.

I believe I can find help here, even if I come back a third, fourth, or fifth time. I believe this even through the hopelessness that hangs like a rain cloud over my head. These programs are imperfect and they have their limits, but that doesn’t keep me from coming back here when I need to. I still have things to gain here.

Author’s Note: I’m now publishing on Medium and The Mighty! Follow me wherever you like, but all posts I write be compiled here on my blog if you don’t want to miss a thing.

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