Adolescent substance use is a significant challenge for adolescents, their families, and the larger society. Clinicians and researchers continue to explore ways to effectively engage both families and substance using adolescents in an effort to improve treatment outcome. Therapeutic engagement can be especially difficult for immigrant families facing a variety of systemic and contextual factors that impact both treatment-seeking and engagement behaviors. This study explored the perceptions Mexican American families had about the processes that they feel hindered or contributed to their engagement in therapy. Major findings include identification of a multirelational engagement process linking specific relational dynamics to engagement outcomes including breaking cultural rules, sharing stories, managing fear of criticism, and building relational bridges.