Certainly underlying issues are always relevant, but for me therapy itself was traumatic and devastating. And not just in a relative way, as a repetition of past injuries, but in an absolute way. This could take a very long time to process and might be the most pressing issue. If a therapist tries to move the client off of this in the first few sessions, or anytime before the client is done talking about it, jeez that is absurd. To paraphrase Stopdog, they need to say the hell back.