Introduction: The current study obtained perspectives on psychotherapy practices from adults with intellectual disability receiving psychotherapy and mental health clinicians serving adults with intellectual disability. The goal was to identify opportunities, successes, and challenges through the perspective of adults with intellectual disability who have received mental health treatment (i.e. clients) and clinicians providing psychotherapy. Method: A total of six virtual focus groups, three with clinicians and three with clients with intellectual disability who had experience with psychotherapy, were conducted. Transcripts were coded by two independent reviewers guided by grounded theory. Results: Broadly, analyses indicated overlapping themes with rich perspectives from both groups. Both clinicians and clients with intellectual disability identified a number of key aspects that were perceived as foundational to therapy and to improving the therapeutic relationship and comfort of the client with intellectual disability. Themes related to rapport building and self-determination emerged, despite not being directly asked of either group. Both clinicians and clients with intellectual disability discussed the therapeutic process at length, related to general types of treatment modality as well as the importance of individualizing treatment strategies. Clinicians spoke of regularly making accommodations to increase treatment accessibility. Conclusion: The focus group results align with and supplement treatment outcome research and have implications for training, practice, and future research.