Suffering In Silence: The Invisible Minority and How MFTs Can Help


As an MFT, you arrive in your office and begin an intake session with a new client. You see a woman in front of you. She tells you that she is in a relationship and feels that she doesn’t have much power in it. She tells you that she has made compromises in her relationship, such as giving up the freehold of her home, among other things, to still have access to disparaged resources and a place to live. At times, she fears that she could lose what she still has, so she doesn’t speak up like she used to many years ago. Her will and her identity have been assuaged through the years in this relationship. Despite learning helplessness, she still finds hope, and she comes to you for additional support.

You decide to create a genogram and learn that she has a family history full of loss. A family “friend” murdered a set of her grandparents, and sickness killed the other. Her only child was taken away from her and placed into a residential school, and their remains were recently found in a mass grave. She continues to tell you that her brother committed suicide, and her sister has been missing for many years and is feared to have been murdered. Her mother has a history of medical trauma after being forcibly sterilized, and her father has a history of substance abuse. She is close with her remaining sibling, who identifies as two-spirit (2S), an umbrella term used to describe a person who encompasses the sacred spirits of both masculinity and femininity, similar to the Western term LGBTQIA. After working on a genogram together, you see that her story is the story of American Indians and Native Americans (AI/NA) in Colonized America. You determine a diagnosis and start to write your treatment plan.

AI/NA family dynamics are often impacted by or directly related to generational trauma and its unresolved grief; trauma resulting from physical, mental, and social abuses such as genocide, the taking of land and property of the past and the present, and children taken away from their families and forced to assimilate at Residential schools until the 1990s (National Museum of the American Indian, 2020). Some of these were physically and sexually abused, killed, and disposed of in mass graves. In the 1970s, more than a quarter of AI/NA women of child-bearing age, sometimes younger, were forcibly sterilized (Theobald, 2019). Poverty and disparaged resources, along with substance use, domestic violence, and other maladaptive coping skills, have intergenerational consequences, at times leading to premature death and suicide. Violence is also common as a result of resistance when the United States government violates treaties with First Nations (Siegel, 2021). For generations past and present, AI/NA communities experience grief and loss, losing land, losing family members, and losing their culture.

Despite this trauma living on through AI/NA families, it is often invisible, and so are we. At the same time, we see our cultural identity celebrated by many as mascots such as “The Redskins,” “The Indians,” The Chiefs,” and “The Braves.” Even in my hometown growing up, the mascot was “The Red Raiders.” Why is our race a mascot and not others, and why has it taken us this long to see this? The sentiment for many may be that “what happened is over,” but the sentiment for us is that “it is still happening.”

This is what I see and hear when I speak to and work with members of my community. I see the systemic unresolved grief of generational trauma and the hope that lives on despite it, in communities and my own family dynamics. Hope lives on through dancing and drumming at powwows, cultural art, and the telling of stories by elders. I am a product of systemic unresolved generational trauma, and also a product of assimilation in Colonized America today.

Native Americans have similar experiences to other minority groups in America, however, they also have unique experiences of their own. If you are reading this somewhere in the United States of America, you are on land that was once tended to by a Native Tribe. They cared for this land, and found sustenance in this land, and it’s important to remember the generational transactions in which this land got into the hands that it is in today. There is very little recognition of Tribes located off of Reservation Land, and the ghosts of those who tended it.

For the Wampanoag people, they are mostly known not by name, but through the story of Thanksgiving. A day celebrated by many Americans, and a day often spent in mourning by AI/AN tribes and communities. The Mashpee Wampanoag Tribe, also known as The People of The First Light, is the Tribe in that story. I am an enrolled member of The Mashpee Wampanoag Tribe. The Wampanoag are still here, and so am I, Eastern Bright Star, a name given to me by my Tribe’s Medicine Man, bringing visibility and voice to such people and their light.

As MFTs, we have an ethical duty to be culturally competent, and in serving members of AI/NA families, we need to first be aware of the systemic relationship that AI/NA peoples have with Colonized American culture and society, the symptomatic challenges that have risen from it and how they affect family dynamics today.

As a therapist trained in family systems work, it is easiest for me to describe the relationship between AI/NA populations and Colonized America similarly to dynamics within a hierarchical conditional dyadic relationship. Within this analogy, it is important to observe the innate difference in power dynamics, which has over time, through compromise and an exchange of resources, reinforced the conditional nature of the relationship, and the invisibility of this minority. AI/NA communities and Colonized America have learned how to cohabitate through this compromise, and still do today, along with ongoing challenges.

Current challenges that affect AI/NA families often have intergenerational connections and should be treated from a systemic, trauma-focused lens; one that identifies the history of physical, mental, and social abuses and invisibility. Similar to the etiology of a mental health disorder, the etiology of issues affecting AI/NA families have an origin (onset), have changed and evolved through time (become chronic), and herein lies the issues we see in our clients when they come in for mental health services (presenting symptomatology).

Current issues experienced in AI/NA families are often related to or directly due to:

  • Historical trauma
  • Culture and identity crises
  • Health disparities
  • The state of education and opportunity
  • Tribal Land and property rights struggles
  • Murdered and Missing Indigenous Women (MMIW)
  • Using hope to overcome challenges

MFTs should help AI/NA families by fulfilling our ethical duty of cultural competence to educate ourselves about this population, and in session by bringing visibility to the historic relational patterns, and how they impact the client today. Rather than perpetuating the avoidance of the past, we can see how it continues to show up in the present. As MFTs, we can learn about the Tribal history in the communities we serve. We can reach out to the Indian Health Service (IHS) in our communities and learn what they offer for behavioral health services and resources. We can support local powwows, watch television and films that highlight Native voices and stories, and be witness to the hope that is on the other side of pain. And also, we can go back to common factors by showing up, showing empathy, and listening to our AI/NA clients.

As therapists, we are trained to validate, to believe the experiences of our clients as their own, and to help them look at options and differing perspectives. As MFTs, we have to look at AI/NA populations systemically. We have to identify how our clients have been affected by discursive dominance, interpersonal relationships, and their intrapersonal relationship with their culture and identity, all the while, seeing how we can support them in a way that honors their values and beliefs of balance, harmony, and hope.

Through awareness, we can bring about change. By listening to our clients, we can better understand them and better support them through their presenting problems, their trauma, and their pain. As MFTs working with AI/NA families, we can support them like we would any other client, by being compassionate, empathetic, and validating. Similar to how MFTs show up in session versus in their everyday life, we say “I hear you and I see you,” making it about the client, instead of saying, “I’m sorry you went through that” and making it about the MFT.

I currently have a Native client I see myself in. When I look at her, I see a younger version of myself. Her father is a veteran and recovering alcoholic like my father. Her mother is a hoarder like my mother. She has an older brother who has chosen not to identify as Native American like I did when I was younger, and her younger brother identifies as two-spirit, like one of my loved ones. This client and I created a genogram. I determined a diagnosis, and I wrote my treatment plan. I am a Native American woman and I am a family systems therapist.

I grew up on the land of Cape Cod that was once tended to by my ancestors. In 2007, my tribe was federally recognized, and after many generations of being invisible, we were finally seen.

I write this article in reflection of my own experiences and those within my community. I also write this in honor of the late Mashpee Wampanoag Tribal Chief, Vernon “Silent Drum” Lopez, my great-uncle. He passed away in April 2023 at the age of 100. Through stories, he and other Elders have told many of the changes experienced on the land of our people, and the land that we have called home for thousands of years. We are the result of the love of thousands, and we are still here.

Similar to how MFTs show up in session versus in their everyday life, we say “I hear you and I see you,” making it about the client, instead of saying, “I’m sorry you went through that” and making it about the MFT.

Jessica A. Lopez, MA, Eastern Bright Star, is an AAMFT Professional Member, an enrolled member of the Mashpee Wampanoag Tribe of Massachusetts, and an Associate Marriage and Family Therapist in California.

National Museum of the American Indian. (2020). Struggling with cultural repression: Boarding schools. Smithsonian. https://americanindian.si.edu/nk360/code-talkers/boarding-schools/

Siegel, E. (2021). Broken US-Indigenous treaties: A timeline. Stacker.com. https://stacker.com/history/broken-us-indigenous-treaties-timeline

Theobald, B. (2019). A 1970 law led to the mass sterilization of Native American women. That history still matters. Time. https://time.com/5737080/native-american-sterilization-history/

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