This chapter discusses a suggested game of working with borderline personality disorders in the partial hospitalization program (PHP)/intensive outpatient program (IOP) setting. It reviews the challenges of working with the borderline personality patient and parent. The chapter discusses the individual, group, family, and milieu issues that exist when the borderline personality belongs to the patient, and family issues that arise when the borderline personality appears in the parent. In terms of the individual challenges, whether in treatment planning or individual therapy, many borderline patients is treatment savvy but claim that nothing yet has helped their problems. In group therapy sessions, individuals with borderline personality play a number of extreme and difficult roles that are challenging for the clinician. Clinicians and treatment teams often experience countertransference toward patients with borderline personality disorder. The clinician and clinical staff should practice mindfulness and objectivity about patient attacks and maintain a professional demeanor.