Some therapeutic practices, and occupational therapy in particular, require heightened forms of engagement and involve jointly coordinated actions that are grounded in intersubjective processes. These interactional processes enable people to be together in particular ways, co-create and share experiences, and coordinate actions. Qualities of engagement in therapeutic practices are analyzed in terms of the interrelatedness of the social actors and the investment in the doing of the occupations. Interpretive examples are provided from an interdisciplinary, longitudinal, urban ethnographic study of a cohort of African-American children, their families, and the practitioners with whom they engage in healthcare encounters. Findings include the use of vehicles for engagement to enhance participation, transactional features of jointly constructed clinical activities, and experiential and developmental aspects of children's engagement in therapeutic practices. Engagement is discussed as a mediator of effectiveness and contributing factor to the “mattering” of therapy. Implications for clinical and research practices are provided.
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