Beyond the treatment manual: Examining factors influencing Black client engagement in psychotherapy

Despite the benefits of psychotherapy to improve mental health outcomes, therapy remains significantly underutilized among Black Americans. Yet, once therapy is initiated, Black clients experience mental health outcomes comparable to those in the general population, underscoring potential barriers to engagement. To address this gap, our qualitative study explored factors that contribute to client engagement throughout the therapeutic process, including core therapeutic skills related to therapist qualities, provider-client alliances, and nontherapeutic factors that shape the client experience. Using a qualitative hermeneutic phenomenological approach, semistructured qualitative interviews were conducted with past and current Black clients at a university-based training clinic about their experiences engaging in therapy. Data were analyzed through thematic analysis, and a codebook was developed to adequately capture patterns in perspectives across the interviews. Major themes, including therapist acknowledgment of cultural identity and perceived therapeutic collaboration, were emphasized as being integral in promoting engagement. Additionally, participants discussed factors that contributed to positive treatment experiences, including flexible procedures and accommodating clinic staff. These findings suggest that cultural acknowledgment, therapeutic collaboration, and a supportive clinic environment are essential to increasing Black clients' utilization of therapeutic services. Understanding the factors that increase accessibility and engagement for Black clients can lead to improved treatment outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).