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.

This chapter reviews the concerns of safety and risk management in the partial hospitalization program (PHP)/intensive outpatient program (IOP) and elaborates on ways of making the milieu safe. It explains how to gracefully play the game of having to make a protective services report and maintain relationships with the patients and/or their families. The chapter discusses suicidal and aggressive patients and analyzes safety issues pertaining to sex, trauma, religion, politics, and confidentiality. Challenges to safety in the PHP/IOP setting must be considered within the context of the clinician’s intense workpace and the multiple demands he/she faces. The aggressive patient may be verbally threatening or actually physically aggressive. The child and adolescent cohorts overall have a significant presence of aggressive patients. To foster peace of mind, a clinician experiencing angst over potential liability should consider purchasing a personal professional liability insurance policy as a supplement to whatever coverage the employer provides.

This chapter discusses how to play conceiving initial treatment planning as a game, which is a helpful framework for organizing and executing myriad task in the intense partial hospitalization program (PHP)/intensive outpatient program (IOP) setting. It reviews the limits the clinician faces in conducting treatment planning as a game. The chapter also discusses reasonable expectations in goal constructing, suggests a game consisting of scripts and methods for treatment planning, and presents depression and anxiety scales. The quality of initial treatment planning is based on how the clinician efficiently joins and attends with the patient and family, offers hope, and gives information as to how recovery theoretically progresses. The PHP/IOP clinician must do initial treatment planning in the midst of numerous other clinical tasks. Developing the script as the strategy for successful initial treatment planning is a learning process.

This chapter presents some closing thoughts on the key concepts covered in this book. The book offers the relevant, general guidance and direction on providing clinical services to multiple partial hospitalization program (PHP)/intensive outpatient program (IOP) cohorts that reflects the current state of affairs. An adaptation of Norton Long’s ecology of games theory was conceptualized for each aspect as a set of suggested practice strategies needed to address the challenges. Understanding and managing some clinical situations requires cross-sectional analysis of the current phenomena. The management of other clinical situations requires analyzing sequences of events. Some complex clinical situations will require both analyses in order to choose effective interventions or address problems. The book also illuminates daunting emotional intensity and suggest cues on how a clinician can respond with professional composure and perspective so as to manage the emotionally challenging PHP/IOP situations and crises.

This chapter discusses the differences among children, preteens, and adolescents and the implications for treatment planning and treatment goals for these groups. It also discusses the inclusion of family and individual therapy, the inclusion of the school as part of the milieu, and some unique problems that may need to be addressed. The patient in the child cohort is cognitively concrete, and the clinician interventions may be as much family based as they are individual. Although there may be some depression and suicidality present, impul-sivity and aggression tend to be more common problems. The successful group therapy approach is group play for socialization and art therapy for expression. Family therapy is important for addressing behavioral issues in the home and for monitoring progress. The child and adolescent cohort is the only partial hospitalization program (PHP)/intensive outpatient program (IOP) cohort for which both family and individual therapy are program expectations.

This chapter discusses the game of psychoeducation in the partial hospitalization program (PHP)/intensive outpatient program (IOP) setting. It discusses the challenges to imparting psychoeducation at this level of care. The chapter suggests a game for organizing, implementing, and evaluating a psychoeducational rotation that can be integrated into the existing workload of the clinician. The challenges of psychoeducation at the PHP/IOP level are both patient related and staff related. The challenge of redundancy refers to clinical-staff repeating the same educational material to the same group of patients. The challenge of discreteness refers to the separateness of each psycho-educational presentation. The development of the psychoeducational strategy requires staff cooperation in the evaluation, planning, and implementation phases. Although the psychoeducational topics should avoid overtly provocative subjects, the greater matter is that the staff is in agreement and works together to produce and implement the rotation.

This chapter helps the reader to understand the game of the therapeutic milieu in the partial hospitalization program (PHP)/intensive outpatient program (IOP) setting and identify ways to implement it. It discusses drama’s threat to the order of the milieu and how to minimize it. The chapter also discusses the paradigm of order over control and the games that develop and maintain a PHP/IOP therapeutic milieu across the different patient cohorts. A therapeutic milieu is a group treatment environment which is supervised and initially designed by appropriate professionals; it provides a model of the everyday world of reality and maximized opportunities for patients to benefit from their social and physical surroundings. The game makes the milieu therapeutic through commitment to the appropriate strategies; commitment to standards; commitment to routinizing the mundane, recurring tasks; and commitment to maintaining the necessary elements.

The partial hospitalization program (PHP) and intensive outpatient program (IOP) have evolved as significant services in the continuum of care for mental health treatment. This chapter offers an introductory overview of these programs. It reviews the theoretical nature of the PHP/IOP levels of care and the recurring theoretical themes and paradigms, which include the concepts of games, continuity, and reasonable expectations. The psychiatric services system can be described on a continuum of severity. At the severe end is inpatient care and least is the self-help group. The PHP patient is considered to need the services of a psychiatrist to evaluate appropriateness for medication. IOP and PHP settings with their different populations must operate differently in accordance with the treatment needs of the populations and rules of the payer sources. This chapter also discusses the overview of key concepts discussed in the subsequent chapters.

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.