Recent literature indicates that there are important clinical differences between chronic and non-chronic depression. This article considers the implications of these differences when conducting cognitive therapy (CT) with chronically depressed patients. CT with chronic patients requires a greater emphasis on combating hopelessness, helplessness, and perfectionism, addressing early life-adverse experiences, and modifying maladaptive schemas. In addition, the effectiveness of CT may be enhanced by focusing on patients' poor social skills, ineffective reasoning skills, and their depressive identity. The case example presented illustrates CT with a chronically depressed patient. © 2003 Wiley Periodicals, Inc. J Clin Psychol/In Session.