By Week 4 of Intensive Outpatient (IOP), you're officially in the work—you’ve built some emotional stamina, you’re more connected to the group, and you’re starting to see patterns in yourself more clearly. This is a critical week where people either lean in deeper or start to mentally check out—so staying engaged is key. Here’s what Week 4 typically looks like:
• You’re likely noticing more about: ○ Your emotional triggers ○ How you cope under stress ○ The core beliefs driving your behaviors (e.g. “I’m not enough” or “I have to be perfect”) This week often involves seeing how past experiences (family dynamics, trauma, etc.) continue to shape present challenges.
Therapy groups may now focus on deeper or more advanced topics, such as: • Abandonment, trust, or attachment wounds • Relapse cycles or self-sabotage behaviors • Inner critic work or confronting shame • Emotional regulation in relationships (especially if you’ve been discussing family or romantic dynamics) You’ll be asked to reflect more on how your struggles developed—not just what they are.
By now, you’ve likely been taught several coping skills. Week 4 is about: • Practicing those tools more consistently • Talking about what’s working and what’s not • Learning when to use which skill, rather than just relying on one strategy There may also be advanced work in boundary-setting, distress tolerance, or self-soothing.
• You’re probably more comfortable sharing in group now—and more invested in others’ progress too. • People may start giving each other gentle accountability or calling out patterns they notice (“I hear you saying X, but doing Y”). Trust is deeper, so group feedback becomes more honest and helpful.
In your individual sessions: • You and your therapist may review your treatment plan goals and adjust if needed. • If you’ve made progress, you might start talking about what comes after IOP—whether that’s stepping down to less intensive care or building a stronger support network. If progress is slower, you may look at barriers like avoidance, fear, or lack of support outside the program.
Everyone hits one of two paths in Week 4: ✅ Momentum: • You're using the tools. • You feel more confident managing emotions or cravings. • You’re more open to vulnerability. ⚠️ Resistance: • You’re feeling tired, disconnected, or “over it.” • You might be tempted to go back to old habits or isolate. • You might think you’re “fine now” and don’t need to dig deeper. Important: Resistance doesn’t mean failure—it’s part of the process. The key is to talk about it, not hide from it.
You might be feeling: • Tired — because emotional work takes energy. • Proud — you’ve made it this far. • Scared — because real change means letting go of old patterns. More grounded — even if you’re still struggling, you’re building insight and support.