A 34-year-old female with obsessive-compulsive disorder has been on fluvoxamine 300 mg daily for 16 weeks with a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction from 32 to 26, representing a 19% improvement. Due to the insufficient pharmacological response, exposure and response prevention (ERP) therapy was initiated 12 weeks ago as augmentation. She has completed 14 sessions of twice-weekly ERP with a therapist trained in the protocol. At today's evaluation, her Y-BOCS score is 20. She reports decreased time spent on contamination rituals from four hours daily to approximately 90 minutes and has been able to return to grocery shopping independently, though she still avoids public restrooms and hospital settings. Her therapist reports good session attendance but notes the patient frequently engages in subtle avoidance behaviors during exposures, including wearing long sleeves and using hand sanitizer immediately after in-session exercises. The PMHNP is evaluating the adequacy of the combined treatment response. Which of the following best represents the appropriate evaluation of this patient's treatment trajectory?