This paper examines two intertwining but different general categories of adversity: trauma and relational stress, including inadequate early attachment, and, later, the adversity that occurs in other important relationships and with society at large. Without conscious intent, children adapt automatically to traumatic events to assure survival, and to the inadequacies and misattunements of significant others, both individuals and groups, to maximize the resources available or at least minimize the stress. These adaptations leave scars in the form of symptoms and patterns of thinking, feeling and acting that correlate with each kind of injury. Understanding the differences in the etiology and effects of trauma and non-traumatic relational stress can help guide both general clinical approaches and specific technique (Ogden, 2009). The physical legacy of each category of adversity is different and can be seen in patterns of gesture, posture, and physiology that can obstruct the development of a rich and rewarding movement vocabulary. As well, irrational thought patterns, or cognitive distortions, arise that correspond to each category. Adaptive emotional responses in current time are superseded by both the dysregulated emotions associated with trauma and the unresolved emotions associated with misattunements of significant others that are ongoing or have not been sufficiently repaired. These physical, cognitive and emotional patterns tend to persist long after the events that elicited them are over. The repercussions of trauma combine with the stress that occurs in relationships between individuals and groups of people. Although these injuries cannot be fully separated, clinical intervention appropriate for addressing the effects of each as they emerge in the therapy hour are markedly different. Distinguishing between these categories of adversity helps clinicians prioritize appropriate clinical strategy and technique to maximize therapeutic efficacy. These clinical choices become imperative in a relationally focused, trauma informed, culturally sensitive integrative therapeutic approach.