Four randomized controlled trials have shown out-patient cognitive behaviour therapy reduces fatigue and disability in people suffering from chronic fatigue syndrome (CFS). However, some patients referred to Kings College Hospital, London are unable to attend regular appointments. We therefore developed a self-help treatment manual using cognitive-behavioural principles for patients to use at home with telephone contact with a therapist. Nine consecutive patients with a diagnosis of CFS who were unable to attend regular out-patient appointments used this self-help treatment approach at home. The therapist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients had fortnightly telephone appointments to discuss their progress, plan and discuss their homework and any problems. Outcome was evaluated using measures of functional impairment, fatigue, mood and general health before and after treatment and at 3 and 6-month follow-up. Eight patients completed treatment. Functional impairment, fatigue and general health improved at discharge and gains were maintained at 6-month follow-up. Self-treatment at home guided by a manual with fortnightly telephone sessions was helpful in the treatment of patients with chronic fatigue syndrome. A randomized controlled trial is underway to compare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy. Patients with other conditions such as chronic pain who are unable to travel for regular appointments may benefit from a home-based treatment package involving therapist contact by phone.