This chapter discusses working with the chronically mentally ill cohort in the partial hospitalization program (PHP)/intensive outpatient program (IOP) setting. It discusses the treatment challenges and applications of the games used with older adult cohort. Group therapy can be difficult with older adult population, and it tends to be of limited value, given the nature of the chronic conditions. Like group therapy, treatment planning can be difficult depending on the poverty of thought, concrete thinking, or paranoia of a patient. Meaningful psychoeducation with this cohort can be a challenge because of redundancy. The discharge plan for the typical patient in this cohort is practically predetermined as follow-up at the local public mental health agency. The clinician can explore a patient’s resistance to follow up with the public mental health provider and determine whether the patient can be referred to a different therapist and/or psychiatrist within that agency.