<p>People with Complex PTSD present PTSD symptoms together with disorders of self-organisation (DSO), characterised by affective dysregulation, a negative self-image, and persistent relationship problems. In their relationship with the therapist, these patients often struggle to cooperate: their relational modes are driven by fear, perceived threat, or fear of humiliation. They enter the therapeutic relationship oscillating between trust and alarm, due to the reactivation of maladaptive patterns generated in the past. In this paper, we present key steps in the treatment of a patient with Complex PTSD, Borderline Personality Disorder, generalised anxiety, and obsessive-compulsive symptoms, treated with Metacognitive Interpersonal Therapy (MIT). Clinical attention focused on managing the therapeutic relationship to build safety, care, and trust. Managing and processing relational breakdowns from the beginning of therapy increased safety and strengthened the therapeutic bond, allowing the reconstruction of relational patterns active in therapy as an expression of patterns learned in the past, thus facilitating the reprocessing of traumatic memories.</p>