A senior nurse with a 10-year history of hospitalization phobia was treated with a combined cognitive therapy, imaginal and in vivo exposure therapy package. All previous medical admissions for the subject had resulted in her being transferred to a psychiatric ward and being treated with neuroleptics. The cognitive therapy provided an explanation for the phobia and a rationale for the treatment, which secured compliance to the exposure therapy. Pre- and post-treatment fear ratings showed a large reduction. Follow-up data showed the subject to be free of all psychiatric symptoms in two subsequent medical admissions. It is suggested that an initial few sessions of cognitive therapy with intransigent phobics may be a pre-requisite for an exposure programme.