This study suggests that systematic discussion of culturally salient content in therapy sessions can positively influence engagement (i.e., therapy participation and therapeutic alliance) with clinically referred African American adolescent males. In a sample of 18 African American adolescent males participating in 187 videotaped psychotherapy sessions, the in-session discussion of research derived, developmentally and culturally related content themes (anger/rage, alienation, respect, and journey from boyhood to manhood) were found to be positively associated with therapist-adolescent alliance and adolescent engagement. Discussions that focused on issues of trust and mistrust were found to negatively predict ratings of therapist-adolescent relationship, and discussions of racial identity/racial socialization were found to have no association with adolescent engagement. These findings provide clues about (a) how culturally responsive treatments can be developed, and (b) in this era of manualized therapies, the possibility of enhancing therapeutic outcomes by tailoring treatment protocols at specific levels of content focus and detail.
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