This is a pilot study. The purpose of this study is to determine whether adding 4 months of behavioral therapy to primary care physician medication treatment(relative to medication treatment alone) improves outcomes for persistently depressed primary care patients.

Inclusion Criteria:

• Current MDD or MDD within the past year or current dysthymia
• PHQ-9 > 10
• have been prescribed an antidepressant medication (by their PCP) at least 8 weeks before pre-treatment timepoint
• are able to speak, read, and understand English sufficiently well to complete study procedures
• are between the ages of 18 and 70

Exclusion Criteria:

• presence of significant suicidal ideation or risk
• history of bipolar disorder, schizophrenia, psychotic symptoms, or severe alcohol or drug problems within the past year;
• history of antisocial personality disorder or borderline personality disorder;
• currently in psychotherapy or have received counseling more frequently than once per month in the past year.