Mental health treatment of the Old Order Amish is a relatively new phenomenon. Increasingly however, members of this sequestered Christian sect are either voluntarily seeking treatment or finding themselves ordered into treatment. Because they resist acculturation, many of the models of cross-cultural treatment are less than fully applicable; and because their pursuit of counseling is relatively recent, there is little information available to guide the therapist working with these clients. This article provides a practical approach to the more salient experiences and difficulties that arise in treatment of the Old Order Amish.