Little is known about black women’s perceptions of service barriers in mental health and substance treatment. This article reports the findings of a qualitative study that explored the perceptions of 29 black women who received treatment in a small urban Northeastern city. Findings of the focus group data revealed participants’ experiences of services as discussed through the themes of bias and stigma; incompatible perspectives of wellness versus illness between consumer and provider; consumer mistrust; and holistic wellness. Participants endorsed counseling as a treatment strategy but were adverse to the use of medication. Practice and research implications are discussed.