Challenges involving boundary management, the therapeutic frame, and interpersonal patterns repeatedly emerge in trauma treatment. These issues emerge out of the lessons that patients learned via abusive relationships about control and others’ unreliability and abusiveness. This chapter discusses methods for recognizing and resolving trauma-based interpersonal patterns such as boundary management, traumatic reenactments, mistrust of the therapist, and ruptures in the therapeutic relationships. The impact of insecure attachment on the therapeutic relationship is addressed, including patients’ difficulties tolerating therapists’ absences, overly frequent calls between sessions, and help rejection. Roleplays are presented with specific language and approaches that can guide clinicians in recognizing and discussing trauma-based relational difficulties. Although challenging, these “echoes of trauma” in the therapeutic relationship serve as powerful opportunities to resolve the interpersonal impact of victimization.