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Many counselors feel pressure to use manualized treatment approaches because of pressure from 3rd-party payers. Unfortunately, this is not always the best practice, especially in cases of complex trauma, in which a very strong therapeutic relationship is a vital component of successful treatment. Relational-cultural theory provides an alternative conceptual lens for treating complex cases and is a natural fit for counselors' professional identity. This case illustrates how a counselor used a relational-cultural conceptualization as a guide in treating a client with complex presenting concerns.

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