Search

Clients can develop feelings of romantic or sexual attraction to their therapists. From a cognitive-behavioral perspective, how should therapists handle these situations? Although the topic of client attraction is comprehensively covered in the psychoanalytic and psychodynamic literature, it is woefully neglected in our cognitive-behavioral therapy (CBT) focused training programs and literature. This paper aims to address this gap by using CBT principles to provide explanations for why clients develop feelings of attraction to their therapists. In addition, this paper offers general guidelines for how to manage client attraction from a CBT perspective. Three case vignettes are used to illustrate those concepts. Recommendations for future research and training in this area are also provided.

Pain tolerance and dissociation have individually been shown to be risk factors for suicidal behaviors. The aim of the current study was to investigate how dissociation and physiological pain tolerance influence the relation between suicidal thoughts and behaviors. The sample consisted of 70 undergraduate college students who completed self-report measures of suicidality and dissociation and an electrical stimulation task to measure physiological pain tolerance. Results showed that dissociation and suicidal ideation, but not pain tolerance, were independently associated with increased suicide attempts. A three-way interaction of suicidal ideation, physiological pain tolerance, and dissociation statistically predicted number of suicide attempts, with an increased number of suicide attempts associated with high suicidal ideation and dissociation, regardless of pain tolerance. These results suggest that dissociation plays a significant role in predicting suicide attempts, perhaps by engendering a state of disconnect from one's body.

The Research Domain Criteria (RDoC) emphasizes the discovery of mechanisms of psychopathology and treatment outcome. In the case of Obsessive-Related Disorders (OCRDs), the available research shows that research exists that describes negative valence variables, specifically neural circuitry, that may be mediators of cognitive-behavioral treatment (CBT) outcome for obsessive-compulsive disorder (OCD). There is limited research on neural circuitry associated with CBT outcome in the other OCRDs. A small body of work exists on cognitive processes, as defined by the RDoC, in the context of mechanisms of OCD treatment outcome. The other major domains of the RDoC have not been addressed for any OCRD in association with CBT outcome. The review concludes with a broad research agenda that emphasizes: clarification of taxonomic features of obsessive-compulsive psychopathology; explicate this taxonomy of obsessive-compulsive psychopathology in relation to neural circuitry; and identify limits of these findings based on culture and environment. It is expected that this research agenda would lead to a clinical heuristic to aid cognitive behavior therapy providers in developing targeted interventions for the full range of OCRDs.