Procedures used for relaxation training can resolve or precipitate dysfunction in patients undergoing self-regulation treatments. The present article discusses the role of the clinician in administering relaxation training via thermal biofeedback and coping with unforeseen negative effects of treatment. A case illustration involving the biobehavioral treatment of chest pain is presented and discussed to remind the reader of the significance of the therapist's role in helping tailor treatment programs to unique responses of the individual patient. The case highlights the value of thorough case management and clinical formulation in the successful resolution of relaxation-induced leg pain.