This chapter discusses clinical work with the geriatric/older adult partial hospitalization program (PHP)/intensive outpatient program (IOP) cohort, aged 65 and older and reviews the cohort’s age-related issues, which include an interplay of medical problems and dementia. It presents the younger clinician’s challenges in assuming the role of helper with this population and also reviews applications of the games of treatment planning and group therapy. Older adults decline in function and physical health and develop more and more medical conditions that are both stressors and causes of mental health symptoms. Many older adults have more and more sources of chronic pain, which diminish their quality of life throughout the day. Dementia is another medical condition connected with depression, anxiety, and psychosis that will be encountered in the older adult cohort. The clinician should respect boundaries in general by treating older adult patients as adults with self-determination.