This chapter discusses the game of process group therapy at the partial hospitalization program (PHP)/intensive outpatient program (IOP) settings level of care in general terms. It explores the general limits and challenges of process group therapy at this level of care. The chapter discusses a game of basic strategies for dealing with the challenges in starting and maintaining a process group. The PHP/IOP group will have a limited ethos. The patient turnover diminishes the likelihood of intimacy found in the typical closed outpatient group. The clinician therefore frequently has the challenge of creating an ethos of acceptance and connection in the midst of intense acuity, stigma, and diversity. Besides the issues of ethos, the social diversity within the patient cohorts and the acuity of the patients can challenge group order and focus. The daily self-assessment is a clinical instrument/worksheet that serves the clinician’s purpose in gathering the necessary clinical information.