A 44-year-old man with persistent depressive disorder (dysthymia) lasting over six years has failed to respond meaningfully to two adequate antidepressant trials. He describes a pervasive sense of hopelessness and a pattern of withdrawing from others when he perceives even minor criticism. His therapist begins a structured exercise in which the patient identifies a specific interpersonal situation, articulates what he wanted from the interaction, examines his actual behaviors and interpretations, and then compares the desired outcome with the actual outcome to reveal the disconnection between them.