The relation between patients' beliefs about the causes of their depression, treatment preferences, and demographic variables was studied in a sample of 156 patients in a randomized controlled trial for depression (supportive-expressive psychotherapy vs. medication vs. placebo). No gender differences were found in beliefs or preferences. Racial differences were found for causes endorsed, but not preferences. Treatment experience predicted endorsement of characterological and biological causes. Psychotherapy experience predicted preference for medication. Finally, patients preferring psychotherapy endorsed childhood and complex causes more than those preferring medication, but the groups did not differ in other reasons endorsed. Implications of findings are discussed. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–11, 2011.