Abstract
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.