Objective: This conceptual article addresses "best practices" for Indigenous Peoples in the United States and Canada. This topic is "thorny" both pragmatically (e.g., rare representation in clinical trials) and ethically (e.g., ongoing settler colonialism). Method: We outline four potential approaches, or "paths," in conceptualizing best practices for psychotherapy: (a) limiting psychotherapy to empirically supported treatments, (b) prioritizing the use of culturally adapted interventions, (c) focusing on common factors of psychotherapy, and (d) promoting grassroots Indigenous approaches and traditional healing. Results: Lessons from our four-path journey include (a) the limits of empirically supported treatments, which are inadequate in number and scope when it comes to Indigenous clients, (b) the value of prioritizing interventions that are culturally adapted and/or evaluated for use with Indigenous populations, (c) the importance of common factors of evidence-based practice, alongside the danger of psychotherapy as a covert assimilative enterprise, and (d) the need to support traditional and grassroots cultural interventions that promote "culture-as-treatment." Conclusions: A greater commitment to community-engaged research and cultural humility is necessary to promote Indigenous mental health, including greater attention to supporting traditional healing and Indigenous-led cultural interventions. What is the public health significance of this article?This article provides an overview to best practices for clinical psychologists working with Indigenous individuals and communities. Psychologists need to balance the delivery of evidence-based treatments with Indigenous Peoples, with the need to take caution to avoid harm and also support Indigenous-led cultural interventions.

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