Obsessive-compulsive disorder (OCD) is a highly debilitating disorder with a global lifetime prevalence estimated at ~1–2%. Exposure and ritual prevention (ERP) is the cognitive-behavioral therapy of choice, but there are several challenges to treatment engagement with this form of therapy. Practical barriers to treatment engagement include access to providers with expertise in this approach, as well as issues with treatment duration and cost. Rates of treatment refusal and premature discontinuation (i.e., dropout) are also known challenges. Even among ERP treatment completers, many individuals will have residual symptoms. This chapter provides an overview of the literature on treatment engagement in ERP for OCD. Additionally, this chapter will discuss clinical considerations and strategies for addressing low treatment engagement using a clinical case example to demonstrate specific strategies to promote engagement with cognitive-behavioral treatment elements.