Psychoanalysis began as a trauma theory, evolved into drive psychology, and can now be understood as relationship psychology, which views traumatic relationship experiences as the cause of severe mental disorders. In this context, the internalization of experiences of violence serves more to cope with long-lasting complex relational traumas, while acute extreme traumatizations lead to dissociations. While psychoanalytic therapy for complex trauma patients focuses on the therapeutic relationship and employs various metaphorical means, acute extreme traumatizations that can lead to post-traumatic stress disorders require a behavior-modifying, also suggestive approach. The concept of trauma and the handling of traumatization in therapy are presented.