As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.

Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science.

The training of American Indian counseling and community psychologists should move away from conventional counseling tenets toward the use of culturally sensitive mental health approaches that maintain American Indian values. In this article, unique American Indian social and psychological perspectives concerning the process and theory of counseling are contrasted with the individualistic focus, style, and outcomes of therapy as practiced in America today. Empirical studies are reviewed concerning the role of social influences in the counseling process as perceived by American Indians and the types of problems Indians present in counseling. The under use of mental health services by American Indian is is associated with the tension surrounding power differentials in counseling relationships and perceived conflicting goals for acculturation between counselors and Indian clients. In addition, three types of psychological intervention-social learning, behavioral, and network -are reviewed and summarized for their contributions and implications for training counselors in effective mental health service delivery with American Indians.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions.

Imagine the work of a mental health professional who accepts a new position in a close-knit community with cultural lifestyles very different from mainstream society. The therapist was born and raised far from that community but had been successful elsewhere. Although the therapist uses the same approach and techniques that had previously worked well, most clients fail to return after the first or second session. The few clients who remain in therapy seem to understand the therapist's intentions and respond to treatment, but reluctantly, the therapist begins to face the fact that the approaches taken in therapy do not align with the experiences and worldviews of most of the new clients. The clients perceive situations in ways unanticipated by the therapist. The clients' explanations about emotional events seem peculiar to the therapist, who realizes that trying to interpret the clients' behavior, feelings, and thoughts often results in misattributions. Desiring to better understand local lifeways and thoughtways and to acquire the skills necessary to implement that understanding, the therapist searches for evidenced-based guidelines Recognizing that all behavior is learned and displayed in a cultural context makes possible accurate assessment, meaningful understanding, and appropriate intervention relative to that cultural context. Interpreting behavior out of context is likely to result in misattribution.-Paul Pedersen (2008, p. 15)