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From a therapeutic perspective this can lead to difficulties in emotion regulation within\u2010session, challenges with patient\u2010therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom\u2010focused work. We describe a case study involving a 38\u2010year\u2010old woman presenting with C\u2010PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C\u2010PTSD (with or without comorbidity).<\/jats:p>","DOI":"10.1002\/jclp.23737","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T14:55:32Z","timestamp":1724338532000},"page":"19-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of the therapeutic relationship in a patient with Complex PTSD and Personality Disorder"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4903-8977","authenticated-orcid":false,"given":"Raffaele","family":"Popolo","sequence":"first","affiliation":[{"name":"Center for Metacognitive Interpersonal Therapy Rome Italy"},{"name":"DSM ASL Roma 1 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9289-8756","authenticated-orcid":false,"given":"Giancarlo","family":"Dimaggio","sequence":"additional","affiliation":[{"name":"Center for Metacognitive Interpersonal Therapy Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"MacBeth","sequence":"additional","affiliation":[{"name":"Department of Clinical and Health Psychology, School of Health in Social Science University of Edinburgh Edinburgh Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Ottavi","sequence":"additional","affiliation":[{"name":"Center for Metacognitive Interpersonal Therapy Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Centonze","sequence":"additional","affiliation":[{"name":"Center for Metacognitive Interpersonal Therapy Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2013.769400"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511777042.029"},{"key":"e_1_2_4_4_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association(2013).Diagnostic and statistical manual of mental disorders(5th ed.).https:\/\/doi.org\/10.1176\/appi.books.9780890425596.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2021.110574"},{"key":"e_1_2_4_6_1","volume-title":"Il trattamento basato sulla mentalizzazione. 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