Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed specifically for the chronically depressed patient. CBASP has been shown to be as efficacious as medication singly, and in combination with antidepressant medication is associated with notably high response rates in chronic depression. CBASP's core procedure, "situational analysis," is highly structured, and designed to bring about changes in thinking and behavior by emphasizing the relationships between these factors and specific situational outcomes. CBASP conceptualizes the chronically depressed patient as having interpersonal difficulties that are likely to emerge in the therapeutic relationship. These difficulties are anticipated through "transference hypotheses" formulated early in treatment and instructions regarding the constructive resolution of therapeutic impasses are an integral part of treatment.