Developing the in vivo hierarchy with a client is an important step in implementing effective Prolonged Exposure (PE) treatment, but it is often given less attention by novice therapists because the more anxiety provoking and dramatic aspects of the upcoming imaginal exposure draw the focus of both the therapist and the client. However, the in vivo exposures address important avoidances in the client’s real life that may not be addressed in imaginal exposure, and are instrumental in making it possible for the client to participate fully in his or her own life.