Extreme and complex traumatization represents a severe problem in today's world. Many traumatized individuals and their families live in difficult conditions in refugee camps, in shelters, and in exile. Treatment and rehabilitation approaches thus need to take social and cultural conditions into consideration. This paper will discuss how psychoanalytic therapy may be helpful for severely traumatized patients, as well as the mechanisms of change in the therapeutic process. It focuses on how traumatic experiences are actualized in the transference and bring the analyst into a situation where enactments inevitably occur. It will be shown how these processes may lead to a symbolization of nonsymbolized reminiscences of traumatic experiences. Psychoanalytic therapy with patient with complicated loss experiences will be analyzed, and some conclusions based on this and others researched therapies will be discussed. The advantages of working with trauma-related material in the transference will be considered.