Psychologists must understand their clients' cultural values and backgrounds before they can offer appropriate mental health services. This article addresses issues that arise when non-Indian psychologists become involved in the delivery of psychological services to American Indian children and families. It reviews cultural differences in attitudes of and expectations for services, communication styles, and cultural values that may be relevant to service delivery. The focus is on helping the non-Indian psychologist understand and relate to his or her Indian clientele. Some children in any culture exhibit psychological or psychiatric disturbances that interfere with their normal growth and development. American Indian children may present a myriad of psychological disturbances that merit mental health attention and care (Green, Sack, & Pambrum, 1981). However, numerous barriers to effective service delivery to American Indian populations have been identified, arid Indian children and families remain an underserved population (Center for Social Research and Development, 1976; President's Commission on Mental Health, 1978;Slaughter, 1976).Although the American Indian population is increasing, there is a continuing shortage of Indian mental health professionals. The 1980 census (Bureau of the Census, 1981) reported that 1,418,195 American Indian and Alaska natives were living in the United States. The American Psychological Association (APA) estimates, however, that only 76 of its members (.2%) are American Indians and that only 27 of these members have subspecialties in the clinical and counseling areas (Russo, Olmedo, Stapp, & Fulcher, 1981). Such trends are also not changing or, at best, are changing very slowly. Of'the 3,098 doctoral degrees conferred in psychology in 1980, only 9 were to American Indians and only 4 of these were in clinical and counseling psychology (Russo et al., 1981). Thus, many of those providing mental health services to American Indians will continue to be non-Indians.Although non-Indian psychologists are becoming increasingly involved in mental health service delivery to American Indians, they are, unfortunately, typically not prepared to work effectively with Indian clientele. The non-Indian psychologist may not be aware of the cultural values, life-styles, family practices, developmental progressions, and needs of their American Indian clients. This lack of cultural awareness typically results in conflicts and frustrations for both the psychologist and his or her Indian clients; ultimately, American Indian children and families may not receive appropriate mental health services.Psychologists who work with Indian children and families must become sensitized to the issues inherent in service delivery to this population. The National Institute of Mental Health (NIMH; Fields, 1979), the APA (Korman, 1974), the President's Commission on Mental Health (1978), and others have acknowledged the need and ethical responsibility for psychologists to understand their clients' cultural values before

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The purpose of this study was to assess the effects of client preparation and problem severity on children's and parents' understanding, attitudes, and expectations of child psychotherapy. Thirty-eight children with one of their parents served as subjects. Half of the children and parents received preparation information, and the other half were not prepared. Following preparation versus no-preparation procedures, children and parents completed questionnaires assessing problem severity, knowledge of and attraction to therapy, and prognostic expectations. Therapists rated problem severity and expectations for treatment outcome. Preparation increased children's and parents' knowledge of therapy, attraction-receptivity to therapists and treatment, and expectations for therapy outcome. Children and parents were found to be quite attracted and receptive to psychotherapy and to have very positive expectations for treatment outcome. The study's findings further indicated that therapists saw the children's problems as more severe and had lower prognostic expectations than did children and parents. No relation was found between problem severity and attraction-receptivity to treatment or expectations for treatment outcome.Current research in psychotherapy outcome is revealing psychotherapy to be a multidimensional process with a multidetermined outcome. The major determinants of successful psychotherapy are presently thought to lie in the characteristics of the client, the therapist, and the client-BARBARA L. BONNER received her doctorate in clinical psychology from Oklahoma State University in 1984. She is presently serving a 2-year postdoctoral fellowship in pediatric psychology and adolescent medicine at the University of Oklahoma Health Sciences Center. Dr. Bonner's current research interests are child psychotherapy outcome and the treatment and prevention of child sexual abuse.

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