Relational Aspects of Therapy

Psychotherapy outcome research shows that the relationship between therapist and client is highly predictive of therapy outcome. This is especially so for chronically traumatized persons, who have been relationally violated so often. In the therapy of complex trauma patients, there are six choice points that present typical relational challenges. The beginning phase of treatment involves a relational “opening gambit,” an unconscious negotiation over how therapist and client will relate. The early relationship is then often tested through a “first emergency.” As the relationship becomes more solid, clients reveal a virtually universal “empty depression,” often then followed by “omnivorous rage.” There are countertransference challenges in dealing with these powerful emotions. As therapy nears termination, the client must first “rebuild the devastated life,” followed by “termination that does not destroy the work.” Each of these challenges will be described and useful approaches discussed, with case examples. Typical countertransference struggles at each phase will be presented.

Target Audience


Learning Objectives

At the conclusion of this session participants will be able to:

  • Understand the importance of relationship in complex trauma treatment
  • Identify six common relational challenges in complex trauma treatment.
  • Identify their common countertransference struggles at each relational crisis/choice circle
Course summary
Available credit: 
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.
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Presenter: Philip J. Kinsler, Ph.D., ABPP
Presenter Bio: Philip J. Kinsler, Ph.D., ABPP, is Clinical Associate Professor of Psychiatry at the Geisel School of Medicine at Dartmouth, and Instructor of Psychiatry at Dartmouth-Hitchcock Medical Center. He is a Past President of the International Society for the Study of Trauma and Dissociation. Dr. Kinsler has been writing, publishing, and training persons in the relational aspects of trauma treatment since the early 1990’s. His recent book, Complex Psychological Trauma: The Centrality of Relationship, was published by Routledge in 2018, and will serve as a guide to and a casebook for Dr. Kinsler’s presentation.

Available Credit

  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.


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