This study sought an understanding of clients' experiences with psychotherapy from clients' own points of view. Eleven 18-23-year-old clients or former clients participated in in-depth, semi-structured interviews about their experiences and opinions of therapy. The interviews were transcribed, and themes were extracted, drawing on techniques from Grounded Theory. From the themes that emerged in this analysis, we focus in this paper on the major theme of client agency, by which we mean clients actively making and enacting choices regarding their therapy. Agency was consistently salient and highly valued by the participants; it encompassed participant accounts of (a) doing the work of therapy, (b) informing themselves about therapy, (c) different manifestations of agency in different therapeutic approaches, (d) their valuing of accomplishment and empowerment, (e) how experiences in therapy differed from expectations, and (f) experiences of compromised agency. Klienten erfahren sich als selbstwirksam Handelnde in der TherapieDiese Studie zielte darauf ab, die Erfahrungen von Klienten mit Psychotherapie aus deren eigener Perspektive erfassen. Elf 18-23 Jahre alte Klienten oder fru¨here Klienten nahmen an halbstrukturierten Tiefeninterviews u¨ber ihre Erfahrungen und Meinung zu Therapie teil. Die Interviews wurden mit Hilfe von Techniken der Grounded Theory transkribiert sowie dann Themen extrahiert. Von den Themen, die in dieser Analyse auftauchten, konzentrieren wir uns in diesem Artikel auf das Hauptthema des Klienten als selbstwirksam Handelndem. Damit meinen wir Situationen, in denen Klienten bezu¨glich ihrer Therapie aktiv eine Wahl treffen und dementsprechend handeln. Selbstwirksames Handeln beurteilten Teilnehmende als etwas Besonderes und es wurde sehr gescha¨tzt; es umfasste Berichte der Teilnehmenden zu (a) die Therapiearbeit tun, (b) sich u¨ber Therapie zu informieren, (c) verschiedene Manifestationen des selbstwirksamen Handelns in den verschiedenen therapeutischen Ansa¨tzen, (d) dass sie es scha¨tzten, etwas zu erreichen und bewirken zu ko¨nnen, (e) wie Erfahrungen mit Therapie sich von den Erwartungen zuvor unterschieden und (f) Erfahrungen, wo das selbstwirksame Handeln gesto¨rt wurde.Experiencias de los consultantes de ser su propio ''agente'' en terapia Este estudio busco´comprender las experiencias de psicoterapia de los consultantes desde sus propios puntos de vista. Once consultantes o ex consultantes de 18 a 23 an˜os de edad participaron en entrevistas en profundidad y semi estructuradas acerca de sus experiencias y opiniones de la terapia. Las entrevistas fueron transcritas y se *Corresponding author.

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A sample of volunteers from a group of randomly selected psychologists in New York State (N ϭ 119) provided a primary diagnosis and rule-out diagnoses for a case vignette that included balanced criteria for borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in a mail survey. Vignettes portrayed a male or a female client, and history of childhood sexual abuse was presented either first or last. Results indicated that cognitive-behavioral therapy (CBT) clinicians were more likely to diagnose PTSD than BPD or other disorders, and psychodynamic clinicians were more likely to diagnose BPD or other disorders than PTSD. An anchoring effect (i.e., evidence that one regards initial information as an anchor that may or may not be adjusted upon exposure to subsequent information) of abuse history presentation was found. Findings did not support a patient or clinician gender bias.

This chapter examines the recent rise in the use of antidepressant medications as well as the growing emphasis on biomedical explanations for depression. The chapter presents the history of antidepressant medications and changes in the Diagnostic and Statistical Manual as well as an analysis of the shift in the treatment of depression from psychotherapy to drugs. The author provides an overview of evidence for social factors in the origin of depression and argues that social models of depression have been marginalized by the dominance of biomedical discourse and practices. The chapter looks at the gaps in current scientific understanding of what constitutes effective treatment for depression. The chapter also discusses implications for depression treatment that considers the broader social environment and that acknowledges the effects of life stress and trauma.

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