Purpose: Individuals with serious mental health conditions disengage from treatment at a higher rate than other populations. Factors associated with treatment engagement for this population in other contexts, or in outpatient therapy for other populations, include the therapeutic alliance, therapist empathy, and perceived coercion. This study tested the hypothesis that a stronger therapeutic alliance, a greater degree of therapist empathy, and a lower degree of coercion will be associated with a higher degree of engagement in outpatient therapy for individuals with SMHC when controlling for other factors found to be associated with engagement. Methods: 131 participants completed an anonymous web-based survey measuring the study’s constructs with established scales. The relationship between variables was tested using hierarchical multiple regression analysis. Results: After separating the therapeutic alliance and therapist empathy in the multivariate analysis due to multicollinearity, both the therapeutic alliance and therapist empathy were found to be significant predictors of change in client engagement. Perceived coercion was not found to be a significant predictor of change in client engagement. It was also found that participant treatment utilization at the time of survey completion was significantly less intensive than their historical treatment utilization, and that participants reflect a range of symptoms and levels of impairment. Conclusions and Implications: The therapeutic alliance and the quality of therapist-client interactions are the most important factors in maintaining engagement in outpatient therapy for individuals with SMHC. Individuals with SMHC are managing their conditions with less intensive and less restrictive treatments, despite a varying range of symptom severity and functional impairment. Additional research is needed to better understand engagement in therapy for individuals with SMHC and to develop more sensitive measures for evaluating these constructs.