Depression is a common psychiatric disorder of the aged. This article briefly reviews the literature on the use of cognitive behavioral therapy (CBT) with the elderly, and suggests some changes in using CBT with the elderly based on the authors' clinical experiences. Recommended changes in technique and common themes when dealing with the frail elderly are described, including the use of “supportive CBT” for patients with mild cognitive impairment. The authors' experiences suggest that CBT is an effective treatment for depression and other affective disorders of the frail elderly, and is especially useful when somatic treatments are contraindicated or produce intolerable side effects.