Weeks one and two: assessment
Expect questions, measures, and no exposures. A clinician is working out what the fear predicts, what you avoid, and what you do to feel better afterwards. That last one matters most, and it is the one people forget to mention. Bring examples from the last week rather than the last decade; recent detail is more useful than history.
You will probably complete a standard measure. It exists so that week twelve can be compared to week one honestly, rather than by how you happen to feel that morning.
Week two or three: the ladder
You build the hierarchy together. This session often feels productive and slightly ominous, because seeing the top item written down makes it real. That is fine. Nobody starts there.
You will also agree what comes off: the safety behaviours, the reassurance rule, who in your household needs briefing.
Week three or four: the first exposure
It happens in session, with the therapist there, at around 30–40 SUDS. It is deliberately winnable. Then it becomes homework: the same item, repeated daily, until it is boring.
The most common surprise is how ordinary it is. The second most common is how much harder the homework feels than the session — which is exactly why the homework is the treatment.
Week five: the dip
This is the week people quit. The easy rungs are done, the hard ones are next, and the novelty has gone. Anxiety may not have dropped much yet, and it is tempting to read that as failure.
Look at behaviour instead. Are you doing things this month that you did not do last month? That is the outcome. The feeling usually follows the behaviour, sometimes weeks later.
Week six and onward
By now the pattern is set: plan, do, review, repeat, harder. Sessions get shorter on discussion and longer on doing. Most courses run three to five months, and the last stretch is about relapse prevention — practising badly-timed, real-world exposures so a bad week does not become a return to square one.