Significant advances have been made in the last 20 years in the assessment and treatment of posttraumatic stress disorder (PTSD). Trauma outcome studies have consistently found the most effective PTSD treatments to be cognitive and exposure-based therapies that focus on emotional processing of the trauma material. Yet, in spite of this broad empirical support, CBT failures and high dropout rates continue to exist with this population. Recent estimates indicate that drop-out rates in CBT randomized clinical trials are as high as 43%, that up to 58% of trauma patients who complete CBT are still diagnosed with PTSD at post-treatment (Tarrier, 1999), and that only 28% of patients in “real world” CBT clinical practices are successful completers of exposure therapy (Zayfert, et. al., 2005). A deficiency in the trauma literature has been a failure to: (1) systematically examine, understand, and explain CBT failures with PTSD, and (2) offer guidelines on how to proceed when the empirically-supported CBT interventions being applied are ineffective. As such, practicing CBT clinicians have been little in the way of constructive guidelines on how to address PTSD treatment roadblocks and failures when they arise.