Negative therapist beliefs about exposure therapy, along with systemic and institutional barriers, can unwittingly undermine patient treatment engagement and create a treatment gap between evidence-based practices and real-world application. Common therapist-level barriers to using exposure therapy include therapist anxiety, fear of client harm, lack of confidence, insufficient training, and misconceptions about the therapeutic process. Furthermore, institutional barriers including restrictive clinic policies, high caseloads, limited session time, and lack of resources further widen this gap. The chapter provides ideas for addressing these barriers, including increasing therapist access to specialized training, fostering ongoing opportunities for consultation and peer support, restructuring therapist work flows, and advocating for systemic policy changes. By addressing these barriers, therapists can more confidently apply exposure techniques, facilitate a patient’s treatment engagement process, and close the gap between real-world practice and evidence-based practice guidelines.