and Alaska Natives make up approximately 1% of the total U.S. population. However, in Alaska, where the state population is only 626,000, Alaska Natives comprise approximately 19% (119,241) of the state's people (Alaska Division of Planning, Evaluation and Health Statistics, 2002). Thus, therapists living in Alaska are very likely to work with Alaska Native clients. Therapists living Outside (the Alaskan term for places beyond state borders) may also encounter Alaska Native clients, particularly in the area of the Pacific Northwest.Psychological research regarding the mental health needs and treatment of Alaska Native people is extremely limited. Existing research focuses primarily on American Indians in the Lower 48 (states) and generalizes this information to Alaska Natives. Although there are some similarities, there are also significant geographical, cultural, political, and historical differences between these populations.A search of the American Psychological Association (APA) journals and books database yielded no empirical studies of counseling or psycho-I would like to thank Karen Ferguson, Barbara Fleek, Randall Madigan, and Alan Boraas for their feedback regarding this chapter.