consider the client's cultural identity, level of acculturation, and worldview;
identify possible environmental contributors (e.g., discrimination, poverty, acculturation conflicts) to the client's presenting problems;
be aware that American Indians often adhere to a collateral social system that incorporates the family, community, and tribe;
recognize that cooperation, sharing, and generosity are important cultural values and that the interests of the family and tribe take priority over the interests of the individual;
be aware that American Indians are likely to regard wellness as depending on the harmony of mind, body, and spirit and illness as the result of disharmony;f)(keep in mind that American Indians tend to place more emphasis on nonverbal than verbal communication, consider listening to be more important than talking, and view direct eye contact as a sign of disrespect and a firm handshake as a sign of aggression; and (g) foster a collaborative therapeutic relationship and build trust by demonstrating familiarity with and respect for the client's culture and admitting any lack of knowledge. A collaborative, problem-solving, client-centered approach that avoids highly directive techniques and incorporates American Indian values and traditional healers is usually preferred. LaFromboise, Trimble, and Mohatt (1990) recommend using network therapy, which helps empower clients to cope with life stresses by mobilizing relatives, friends, and tribal members to provide support and encouragement.