Purpose: To examine perceptions of depressed African-American adolescent males towards mental health services and providers. Factors that facilitate or hinder engagement and the establishment of a therapeutic alliance with this population are delineated to understand the most successful ways to treat this population. The interview questions were part of a larger study “Social Network Influences on African-American Adolescents' Mental Health Service Use (NIMH: R03 MH63593 – 01).”

Background: Annual estimates in the general population indicate that 8.3 percent of adolescents suffer from depression (Birmaher, Ryan, Williamson, et al., 1996). Although research indicates that depression is highly amenable to treatment (Petersen, Compas, Brooks-Gunn, et al., 1993), the Surgeon General's Report on Mental Health (DHHS, 2001) indicates that few children and adolescents with a depressive disorder receive care. African-American adolescents who reside in urban, high-risk communities are more vulnerable to experiencing depression and may be among the most underserved in terms of treatment.

Methods: Qualitative interviews were conducted with 18 depressed African-American males, ages 14-18, who were recruited from community-based mental health centers and afterschool programs for youth. Interviews covered: sociodemographic information, questions regarding depressive symptomotology, and open-ended questions derived from the Network-Episode Model – including knowledge, attitudes and behaviors related to problem recognition, help-seeking, and perceptions of mental health services. Analyses were conducted by three reviewers for corroboration of themes and by using the NVivo software package.

Results: Emergent themes centered on aspects of the engagement process that have the potential of influencing successful therapeutic alliance for this group. In particular, client's perception of their mental health problem severity, therapist's lack of understanding of the client's cultural context, and failure of therapists to be “active” or “real” (i.e., self-disclosure, emotional closeness as opposed to emotional distance) in their treatment approach all influenced engagement and therapeutic alliance.

Implications for Social Work Practice: This study presents a viewpoint from the perspective of depressed, African American adolescents about the challenges of delivering effective mental health services to this population. In particular, social workers who work in mental health settings need to be aware of the barriers related to service engagement and therapeutic alliance when treating depressed African American adolescents. Engagement strategies that include collaborative work with network members are discussed as a means for eliminating these barriers.