This article addresses the clinical issues of Asian Indians in the United States as they cope with transitions related to immigration. Many Indian families are multigenerational, uphold collectivist values, and might have hierarchical interactions based on age and gender. Immigration and cultural identity changes impacts these relationships between family members. Using clinical case examples, I illustrate and discuss how I conduct culturally sensitive therapy with Asian Indian clients in the U.S. The cases and the discussion highlight the importance of attending to gender, age, generational role, and cultural identity. I also offer recommendations to help clinicians in their work with their own clients of Asian Indian heritage, or those that come from a collectivistic background. These recommendations include weaving client worldviews in all interventions. Finally, I discuss the limitations of this paper and ideas for future studies, including considering all forms of diversity found in Asian Indian families, and collecting data from large samples. This article 1 will address how couple and family therapists can help Asian Indian families in the United States cope with cultural transitions. These transitions result from normative life cycle issues and immigration-related changes (McGoldrick, Giordano, & Garcia-Preto, 2005; Ramakrishna & Weiss, 1992). I discuss the intergenerational family structure, a collectivist value system, respect-based hierarchy, and the impact of modernization on Asian Indian families. South Asia consists of the countries of India, Pakistan, Afghanistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives. The people of this region are heterogeneous and culturally and ethnically diverse (Prathikanti, 1997). However, they