John R. Paddock, Ph.D., ABPP, LLC

When patients believe they can profit from a more structured approach that combines interpersonal and cognitive-behavioral conceptualizations, I draw upon James P. McCullough’s Cognitive Behavioral Analysis Systems Psychotherapy (CBASP), (Book 1, Book 2, Book 3, Book 4, Book 5, Book 6) as a cognitive-behavioral approach that helps patients learn to more adaptively interpret problematic interpersonal events or situations.

Used predominantly for treating depression, this approach is a protocol-driven methodology that teaches patients to focus on that which they are able to control in their day-to-day interpersonal interactions. Specifically, CBASP helps patients learn to increase awareness of what they are attempting to accomplish in a given slice of time with others, and learn to craft goals in the moment that are both realistic and obtainable – behavioral and cognitive targets that are in their charge. In addition, patients learn to attend to how they interpret these moments accurately (without “mindreading”) and in a manner that is relevant to them hitting their target(s). On the face of it, the process seems simple. It is not an easy skill to learn, as these vulnerabilities in thinking often seem glued to each dysphoric, depressed, or highly anxious patient. It takes some time to unlearn these associations and develop new, disciplined patterns of thinking and behaving to alleviate or minimize negative or anxious mood.

In addition, the model focuses on interpersonal transactions between patient and therapist. Specifically, most patients with problems managing mood have well-learned negative expectancies about how significant others are likely to interact with them, and come to therapy unaware of how the predictions they make about people can lead to self-fulfilling prophesies (e.g., depressed persons may come to expect others to reject them, thereby confirming their low self-worth). The CBASP therapist understands that the problematic errors in thinking made by people with mood management issues (e.g., mis-reads of situations, interpretations irrelevant to achieving target objectives, crafting unrealistic and unobtainable desired outcomes) develop from problematic, stressful, or difficult learned interpersonal experiences in the past. Thus, it is important for both parties to understand how patients are likely to relate to the therapist, and how this emerges predictably from their relational past. This approach is another way of working with people to help them begin to answer.

The Prime Directive:

Why does it make sense that I am having these sets of problems with these people in these situations in my life, and what can I do to be more effective and satisfied in these relationships.


Driscoll, K. A., Cukrowicz, K. C., Reardon, M. L., Joiner, T. E., Jr. (2004). Simple treatments for complex problems: A flexible Cognitive Behavior Analysis. System approach to psychotherapy. New York: Erlbaum.

McCullough, J. P., Jr. (2000). Treatment for chronic depression: Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford.

McCullough, J. P., Jr. (2006). Treating chronic depression with disciplined personal involvement: Cognitive Behavioral Analysis System of Psychotherapy (CBASP).New York: Springer.

McCullough, J. P., Jr., Schramm, E., & Penberthy, J. K. (2015). CBASP as a treatment for persistent depressive disorder. New York: Routledge.

Penberthy, J. K. (2019). Persistent depressive disorders. Boston: Hogrefe.