As someone with Dissociative Identity Disorder, I spent seven years in Dutch mental health care before receiving the correct diagnosis. After two years of treatment at an early childhood trauma center, I received an eight-year prognosis. I left the center and was able to largely treat my DID myself within two years. Over the years, I've gained extensive experience and knowledge about the pain points in various treatment relationships, explaining why I remained stuck in my traumas instead of addressing them. I've compiled all these insights with respect and love for all therapists who still encounter this group.

• Unkept promises 
  A promise about the duration of treatment or a lack of clarity about professional boundaries, which you take for granted, can become retraumatizing for a client if the process lacks congruence. For people with insecure attachment, this can be associated with, for example, an insecure parental figure.
   
• The therapist's avoidance of treating the trauma with Exposure based tools
  it's obvious, but it can be very damaging! It unconsciously sends a message to the client: "Oh no... your trauma is indeed very scary treating it would completely disregulate you! Even I am scared for you. You are doomed"
   
• Insufficient self-care by the therapist 
  When treating people with longterm trauma, it is especially important that you, as a professional, take good care of yourself and know your own boundaries. A sensitive client with a traumatic past is often "trained" to sense whether or not there is space for them, and as soon as boundaries are unclear, they can unconsciously push your own boundaries. Clients with a history of early childhood trauma, in particular, can evoke a sense of inadequacy in the therapist. This is because they project from a very old, unfulfilled desire for care, love, and attention that the therapist can never fulfill.
   
• Making the client afraid of the process 
  The more you emphasize that it's a long, years-long process and the very serious trauma that can't simply be treated, the more anxious the client can become about facing their traumas. And the more this can foster dependency. Acknowledgment is incredibly important, but it shouldn't be used as a reason to avoid or unnecessarily postpone the processing of traumatic memories.
   
• Separation between trauma processing and attachment-work 
  If the client was harmed as a child by their own parents/caregivers, trauma processing cannot be separated from the attachment process. The most important thing is that the client learns to attach to themselves; dependency can be detrimental to the healing process. However, aloofness and being overly distant can be just as detrimental to the process.
   
• Dismissing all client feedback as projection 
  You can be a brilliant therapist or practitioner, but you're not immune or an omnipitent being. Clients with complex trauma histories can be incredibly sensitive and therefore sometimes suddenly see and notice more than the therapist is always aware of. It's crucial to identify and verify whether the client is merely projecting, or whether there's a kernel of truth in the feedback. Don't let yourself be overtaken by doubts about your own competence. Because that's also something the hypersensitive complex trauma client senses, constantly scanning you for hidden agendas. This brings me to my next point.
   
• Lack of transparency 
  I'd like to shout this from the rooftops to any therapist who thinks a lack of transparency about their own processes is on par with professionalism. If there's one demographic of people highly developed in recognizing incongruity in contact, it's those who have experienced early childhood/complex trauma. If not in language, then because we can sense that "something's not right." And people with complex trauma are very quick to relate this incongruity to themselves, which contributes to a weakened self-image. For a more self-aware client, it can lead to distrust of the therapist and a lack of confidence in the treatment.
   
• Assuming the client can always form their own opinion and act accordingly 
  When someone has never learned that they are allowed to have their own opinion, a seemingly simple choice can feel incredibly frightening. And impossible, which can create disruption in the therapy relationship. Because the client can't express what they need or want, even if they already know it.
   
• Insufficient customization or coordination with the client 
  Every client is different, and what works fantastically for one person can lead to an increase in complaints for another. The most important thing is that the client supports the vision and treatment and isn't just "undergoing" it, but is an integral part of it.
   
• Positioning yourself above the client 
  Clients with a history of, for example, organized abuse and human trafficking, are particularly trained to believe that the person above them in the hierarchy has the final say. The more you adopt a distant, superior position, the more traumarelated projection and resistance you can expect from the client with this past.
   
• Inadequately maintaining boundaries 
  Chances are, the client you're dealing with has never learned about boundaries in the broadest sense of the word. If you leave room for ambiguity regarding professionalism and boundaries, the client won't know how to navigate them, potentially putting you in a position where you feel the urge to override them to restore balance. This can create a crack in the trust of an already distrustful client who doesn't understand what's happening.
   
• Protecting your (indirect) colleagues no matter the case. 
  Many survivors have a history of retraumatization in mental healthcare because there is far too little knowledge about their issues. This is also because, unfortunately, there are also healthcare providers who abuse vulnerable clients. It's understandable that wanting to protect colleagues can be a reflex, as they face the same challenges as you. However, when a colleague has harmed a client and you don't acknowledge this experience, you align yourself with the client's group of people who harmed them, and you are then seen as unsafe. This isn't always a case of splitting behavior; you don't have to reject the colleague, because retraumatization is often the result of incompetence, not harm. But acknowledging the experience so you aren't immediately labeled "unsafe" can be very important for the client's trust in the therapeutic alliance.