This case report describes the treatment of an older woman with a longstanding, severe specific phobia for whom evidence-based practice was implemented. Clinical practice guidelines, responsive to the scientific literature, indicate that in vivo exposure is the treatment of choice for a specific phobia. However, treatment tailoring may be necessary for older patients not willing to endure the acute anxiety sometimes associated with in vivo exposure. The present case is one such individual who refused in vivo exposure, but benefited from relaxation therapy and systematic desensitization. Treatment outcome studies are needed to develop an evidence base for specific phobia treatment among older persons.