RELATIONAL TRAUMA • June 2026

LAST UPDATED: APRIL 2026

Last reviewed: June 2026 by Annie Wright, LMFT

In short: Systemic compassion is a clinical framework that extends self-compassion to include the structural and cultural forces shaping a woman’s suffering, offering relief from self-blame for conditions that are not only personal but also produced by unjust systems.

The Voice That Says You Should Be Able to Handle More

It’s Sunday morning, and Tasha is lying in bed at 9 AM, which should feel like a luxury. She booked this weekend deliberately. No meetings, no travel, no children. She told herself she’d rest. Genuinely rest, for the first time in months.

Instead, she’s cataloguing everything she hasn’t done. The inbox with 212 unread messages. The performance review she still needs to write for her deputy. The fact that her mother called twice this week and she answered neither time. The fact that she hasn’t exercised in eleven days. The fact that even now, lying still in expensive sheets, she cannot seem to turn off the part of her brain that is already composing tomorrow’s to-do list.

She is a managing director at a private equity firm. She is 39. She has built, from scratch, a career that her 22-year-old self would have found almost unimaginable. And she is lying in bed at 9 AM on the first free morning she’s had in four months, unable to let herself have it. Quietly certain that if she were stronger, more disciplined, more organized, she would not be this tired.

That last part. The certainty that her exhaustion is a personal failure. Is what I want to talk about today. Because in my work with clients, it’s one of the most damaging beliefs I encounter: the conviction that a woman’s suffering is entirely her own doing, evidence of her individual deficits, solved entirely through individual effort. It isn’t. And naming that clearly is what Systemic Compassion is designed to do.

This isn’t a framework designed to let anyone off the hook. The individual work is real and necessary. But it is a framework designed to ensure that when you look at your exhaustion, your anxiety, your difficulty resting, your relentless inner critic. You see all of what actually created it. Not just your nervous system. Your nervous system, in a body, in a culture, in a system that has very specific ideas about what driven women are supposed to be able to do.

What Is Systemic Compassion?

Systemic Compassion is a framework I developed to describe a specific, necessary expansion of self-compassion that I see as essential for the driven women I work with in trauma-informed therapy.

Most of us are familiar with self-compassion in its standard form: the practice of treating yourself with the same warmth and understanding you’d offer a good friend when you’re struggling or failing. The research base for self-compassion. Anchored especially in the work of Kristin Neff, PhD, professor of educational psychology at the University of Texas at Austin. Is robust. Self-compassion is associated with reduced anxiety, greater resilience, and improved emotional wellbeing.

But here’s what I notice in clinical practice: for many of the women I work with, standard self-compassion practice hits a wall. They can intellectually generate the compassionate voice. They can write themselves the kindly-worded letter. But something doesn’t shift. The shame persists. The inner critic reasserts itself. The exhaustion doesn’t lift. And part of the reason. Part of a significant reason. Is that individual self-compassion applied to a systemic problem is like putting a fresh coat of paint on a cracked wall without repairing the plaster underneath.

Systemic Compassion extends the self-compassion lens to include the structural and cultural forces that created the conditions for a woman’s struggle. It asks not just “how can I be kinder to myself?” but “what actually produced this suffering. And which part of that is mine, and which part belongs to the systems I’m navigating?”

I want to be clear about something: Systemic Compassion is not about bypassing personal accountability. The individual nervous system still needs healing regardless of the system it’s navigating. The relational trauma recovery work is still essential. But it does mean approaching your psychology with the full complexity it deserves. Understanding that your wounds were created in relationship, AND in culture, AND in systems. And that genuine healing requires holding all three.

Here’s the language I use in my clinical work: “Part of healing is developing what I call a systemic compassion. The capacity to look at your overwork and see not just your psychology, but your context.”

If you’re uncertain about the patterns shaping your psychology, taking the relational wound quiz can be a useful starting point for understanding what you’re actually working with.

The Research: Why Systems Matter in Mental Health

The clinical intuition behind Systemic Compassion isn’t new. It has deep roots in feminist psychology and trauma theory. What is relatively new is the accumulating empirical evidence that structural and systemic factors aren’t just context for a woman’s distress. They are causative.

Judith Herman, MD, psychiatrist and trauma researcher and author of Trauma and Recovery, established a foundational principle that shapes everything I do clinically: trauma doesn’t occur in a vacuum. It occurs in social and political contexts that determine whose trauma is visible and whose is invisible, whose suffering is treated as pathology and whose is rewarded as ambition. Herman’s own work. Naming sexual and domestic violence as political phenomena, not merely personal ones. Was itself a radical act of systemic compassion applied to an entire population of women whose suffering had been thoroughly individualized.

The contemporary research continues to build this case. A 2025 narrative review by Cunningham and Saleh, published in Alcohol Research, examined structural stigma, racism, and sexism studies across substance use and mental health outcomes. Their finding was direct: structural-level determinants. Not just individual psychological factors. Significantly predict mental health outcomes. Structural sexism, they note, remains an under-studied dimension in mental health research. Which is itself a systemic problem. (PMID: 39713741)

A 2025 meta-analysis by Cénat and colleagues, published in Lancet Regional Health. Americas, examined depression symptoms across 1.3 million people in 421 studies. Their conclusion was unambiguous: structural challenges. Socioeconomic conditions, historical trauma, racism, and systemic disadvantage. Are significant drivers of depression, not merely backdrop to it. (PMID: 40040819)

This research matters for the driven women I work with because it empirically validates what many of them sense but can’t name: their suffering has a context. It is partly produced by systems, not only by their individual psychology. The question is whether the therapeutic frameworks they encounter actually acknowledge this. Or whether they inadvertently reinforce the belief that all suffering is self-generated and self-solvable.

Jean Baker Miller, MD, psychiatrist and author of Toward a New Psychology of Women, made an argument in 1976 that I return to constantly in my clinical work: women’s psychological problems are often rational responses to irrational systems. The anxiety, the over-functioning, the inability to rest, the relentless self-criticism. These are not signs of individual inadequacy. They are the predictable adaptations of people navigating environments that were not designed with their full humanity in mind.

Gabor Maté, MD, physician and author of When the Body Says No, extends this systemic frame to the body itself: stress-related illness and psychological distress are maladaptations to social conditions, not simply individual failures of coping. His framing. That addiction and mental health conditions are “not a choice but an adaptation”. Closely parallels what I’m calling Systemic Compassion. The woman who can’t stop working, who can’t rest, who has elevated cortisol and a collapsed immune system, is not weak. She is adapted to a specific environment. The question is whether that environment was actually safe for her.

Research published in 2025 by Zaidan and colleagues in BMC Medicine found that race, ethnicity, trauma history, and social support all moderated therapeutic outcomes. Meaning that the same intervention worked differently depending on the structural context a woman was navigating. (PMID: 40835941) This is the empirical case for Systemic Compassion in clinical practice: you cannot treat every woman as if she were navigating the same structural environment, because she isn’t.

How Systemic Compassion Shows Up. And What Happens Without It

When I introduce the concept of Systemic Compassion in therapy, the most common response is something between relief and suspicion. Relief because someone is finally naming the context. Suspicion because it sounds like it might be letting them off the hook.

Let me tell you about Tasha.

Tasha is 39, the managing director I described at the beginning of this post. She comes to therapy after her third ER visit in 18 months. Each time presenting with what turned out to be a panic attack, each time discharged with the recommendation to “reduce stress.” She finds this recommendation almost funny. She has been trying to reduce stress since she was a junior analyst. The problem, as she experiences it, is that she doesn’t know how.

As we work together, a picture emerges. Tasha grew up the eldest of four children in a household where money was unreliable and her mother’s anxiety ran the temperature of the entire home. Tasha was the stabilizer. She managed her siblings, anticipated her mother’s moods, performed academically, and learned to take up as little emotional space as possible while quietly holding everything together. She was praised for being so capable, so mature, so easy. No one ever asked what it cost her.

By the time she reached private equity, she had decades of practice translating personal need into professional output. She was extraordinary at her job because being extraordinary had always been the price of feeling somewhat safe. What she hadn’t been taught, because no one around her knew how to teach it, was that her capacity had a limit. And that the systems she’d entered would push her to that limit reliably and then push further.

When I introduce the systemic lens, something shifts in Tasha. She has been treating her burnout as a personal failing. Evidence that she isn’t tough enough, resilient enough, organized enough. When she can begin to see it also as the predictable outcome of a system that rewarded her overwork financially while penalizing any visible vulnerability, she stops carrying it entirely alone. The shame decreases. Not because the work disappears, but because the weight is distributed more accurately.

“I didn’t cause all of this,” she says in one session. “But I’ve been treating it like I did.”

Exactly.

What I see consistently in clients without a systemic frame is this: they apply enormous amounts of individual effort to problems that are partially structural, feel like failures when individual effort isn’t sufficient, and add shame to an already overwhelming situation. The individual work matters. And it cannot carry the entire explanatory load.

The Internalized Oppressor: When the System Gets Inside Your Head

One of the most clinically significant dimensions of Systemic Compassion is what I call the internalized oppressor. The inner critic that speaks in the exact voice of the systems that shaped you.

Many of the driven women I work with have a highly specific inner critic. It doesn’t simply say “you’re not good enough.” It says: “You should be able to handle more. Everyone else is managing. You don’t have the luxury of rest. What’s wrong with you that you can’t keep up?” This voice is precise, demanding, and utterly convinced it is simply reporting objective facts about the woman’s inadequacy.

Part of Systemic Compassion work is tracking where this voice actually came from. Not from some neutral assessment of the woman’s capacity. From systems that benefit from her self-sacrifice and have installed their voice inside her head to do the ongoing management work for free.

Estés is describing something I see in clinical practice constantly: the way driven women are systematically disconnected from their own authentic rhythms. Their need for rest, for creative engagement, for genuine relationality. In the service of a productivity-oriented system that requires their full output and offers provisional belonging in return. When the belonging is conditional on what you produce, you will always produce more than is sustainable. That’s not a personal failing. That’s the system working exactly as designed.

Bell hooks, cultural critic and author of Feminist Theory: From Margin to Center, wrote extensively about how systems of oppression survive not just through external enforcement but through internalization. The way marginalized people come to police themselves according to the standards of the systems that marginalized them. For driven women, this internalization often sounds like the most demanding supervisor they’ve ever had, living full-time inside their own minds.

Laura Brown, PhD, feminist psychologist, argues that feminist therapy must include a political analysis of personal distress. That treating a woman’s anxiety without examining the gendered power structures that produced it is, at best, incomplete care. This is the clinical foundation of Systemic Compassion: not just asking “what happened to you?” but “what system were you navigating when it happened, and what did that system require of you?”

Working with the internalized oppressor in this framework involves two simultaneous moves: noticing when the inner critic is speaking in the system’s voice rather than the woman’s own truth, and gradually building the capacity to question its authority. This doesn’t happen through affirmations. It happens through the slow, careful relational work of trauma-informed therapy. And through the explicit naming of where that voice actually originated.

Both/And: It’s Your Trauma Response AND a System That Rewards It

The Both/And framing is foundational to everything I do clinically, and nowhere is it more essential than in Systemic Compassion work.

When a driven woman comes to me with burnout, anxiety, or an inability to rest, she is usually caught in an either/or frame. Either it’s her fault. Evidence of her individual weakness or inadequacy. Or it’s the system’s fault, in which case there’s nothing she can do about it. Neither of these is clinically useful. Both of them are partial truths.

The Both/And of Systemic Compassion sounds like this: This is your trauma response. Your specific nervous system, your specific family history, your specific pattern of using achievement as a survival strategy. AND it is a system that actively rewards that trauma response, making it harder to recognize as pathological and nearly impossible to dismantle without support.

Both of these things are true simultaneously. And holding both is what makes change possible.

Anjali is a 44-year-old physician, a hospitalist at a regional medical center, and the first person in her family to complete graduate-level education. She comes to therapy presenting what she calls “functional depression”. She’s doing everything she’s supposed to do but feels nothing. She’s stopped being able to sleep, started having recurrent health anxiety, and describes most of her days as “going through the motions in a fog.”

When we begin working together, Anjali’s initial framing is entirely personal: she believes she’s “just not wired for work-life balance.” She has evidence. She’s always been like this. Her mother was like this. She chose a career that makes this worse. She should have known better.

We spend time examining the full picture. Yes. Her nervous system carries patterns from a childhood marked by economic instability and a mother who modeled relentless self-sacrifice as love. Those patterns are hers to heal. AND she’s navigating a healthcare system that is designed to extract maximum output from its physicians, that defines resilience as the ability to absorb institutional stress without complaint, and that was built. Structurally. Without accounting for the lives of women who are also primary caregivers, community anchors, and emotionally available partners.

Both of these things created her depression. Both of them require attention. When Anjali can hold Both/And rather than either/or, something softens. The self-blame decreases. The capacity to engage with healing increases. She’s not fixing a personal defect anymore. She’s doing the complex, courageous work of healing a nervous system while also learning to navigate. And sometimes resist. The systems around her.

This is what trauma-informed executive coaching with a systemic lens looks like in practice: not just helping a woman perform better within the existing system, but helping her understand what the system has cost her, and choose from that understanding how she wants to move forward.

The Systemic Lens: What Capitalism Does to the driven woman

I want to name something directly that often lives just beneath the surface of the work I do with driven women: capitalism is extraordinarily well-designed to convert the flight response into productivity. And to make that conversion feel like success.

The woman with a trauma history that taught her that momentum is safety and stillness is danger becomes, in a capitalist economic context, a remarkably efficient producer. She cannot stop. She does not rest. She delivers. She gets promoted. She is celebrated. Her inability to access genuine recovery gets rebranded as dedication. Her nervous system dysregulation gets repackaged as ambition. And the system benefits enormously from this, while she quietly accumulates a deficit in her body and her relationships that eventually becomes impossible to ignore.

Judith Herman made this point structurally: the systems that surround traumatized women often benefit from their over-functioning. The hospital that praises the physician who works 80 hours a week. The law firm that rewards the associate who never takes vacation. The family system that relies on the eldest daughter to manage everyone’s emotional needs. These systems are not neutral contexts. They are active participants in the maintenance of the woman’s dysregulation.

bell hooks argued that one of the most radical acts available to women within patriarchal capitalism is to rest. Because the entire system depends on their not doing so. This is not a comfortable political observation. But it’s a clinically useful one. When a woman understands that her inability to rest is simultaneously her nervous system’s survival strategy AND her culture’s preferred labor arrangement, she can stop experiencing that inability as purely personal failure. She can bring more curiosity and less shame to the work of changing it.

The research by Boga and colleagues (2025), published in the Journal of Behavioral Medicine, documented how self-silencing. The suppression of authentic voice and need in relationships and systems. Becomes encoded as individual psychological adaptation while actually being driven by structural gender oppression. (PMID: 39580576) The woman who can’t say what she needs, who swallows her own voice in the meeting to avoid being “difficult,” who edits herself down to the version of herself the system will accept. She is not demonstrating personal weakness. She is demonstrating a rational adaptation to an irrational system.

Systemic Compassion doesn’t offer resignation as an alternative to the system. It doesn’t suggest that because the system is partly culpable, the individual has no agency. What it offers instead is clarity. A more accurate account of what a woman is actually contending with, so that her efforts are directed toward the real problem rather than a self-defeating internal loop of shame and redoubled individual effort.

How to Practice Systemic Compassion Without Bypassing the Work

Systemic Compassion is not a philosophical position. It’s a clinical practice. Something you can actually do, moment by moment, in the way you hold your own suffering.

Here’s what it looks like in practice.

Name the system alongside the symptom. When the inner critic appears. When the voice says “you should be able to handle more”. Practice asking: whose voice is this, actually? Is this my assessment of my own capacity, or is this the voice of every system I’ve navigated that required more of me than I had? You don’t have to answer the question definitively. Just asking it creates space between you and the automatic belief.

Practice structural attribution alongside personal accountability. When you notice exhaustion, anxiety, or burnout, try holding both simultaneously: “This is partly my nervous system’s learned response to an early relational environment. AND it is partly the predictable consequence of navigating systems that were not designed with my full humanity in mind.” Neither statement excuses you from the work. Both statements make you a more accurate observer of your own experience.

Notice where the system gets rewarded at your expense. Who benefits from your inability to rest? Who benefits from your willingness to absorb institutional stress without complaint? These questions aren’t about blame. They’re about clarity. Seeing where the system’s incentive structures are misaligned with your actual wellbeing, so you can make conscious choices about how much of yourself you’re willing to put into those structures.

Find community with other women who are naming the same thing. Systemic Compassion is not a solitary practice. It deepens in the presence of other women who are simultaneously doing their individual work AND naming the collective conditions that make that work harder. Relational-Cultural Theory, developed at the Stone Center by Jean Baker Miller and Judith V. Jordan, PhD, psychologist, co-founder and scholar of the Stone Center at Wellesley, holds that healing for women happens most powerfully in connection. In the experience of being truly seen and understood within the full complexity of who you are and what you’re navigating. The Strong & Stable newsletter is one place where that conversation continues weekly.

Bring the systemic lens into therapy. If you’re working with a therapist who focuses exclusively on individual psychology without ever naming the structural context, you may be missing an important part of the picture. Trauma-informed therapy that integrates a feminist and systemic lens doesn’t let the individual off the hook. It gives the individual a more accurate map of what they’re actually healing from.

The goal of Systemic Compassion is not to replace the individual work. It’s to ensure that when you do that work, you’re not also carrying the weight of every system that shaped your suffering as if it were entirely your own. You didn’t build all of this alone. You don’t have to dismantle it alone either.

If you’re ready to explore what this work looks like in a clinical relationship, I’d invite you to learn more about working one-on-one with me, or to explore the Fixing the Foundations^™ course, which integrates both individual and systemic dimensions of relational trauma recovery.

You are not too much. You are a person who has been navigating a great deal, in systems that required it of you, with a nervous system that did its best with what it was given. That’s not a failing. That’s the truth. And truth. Clearly seen, held with compassion. Is where healing actually begins.

Related Reading

• Herman, Judith. Trauma and Recovery: The Aftermath of Violence. From Domestic Abuse to Political Terror. New York: Basic Books, 1992. https://www.basicbooks.com
• Miller, Jean Baker. Toward a New Psychology of Women. Boston: Beacon Press, 1976. https://www.beacon.org
• Maté, Gabor. When the Body Says No: Exploring the Stress-Disease Connection. Hoboken: Wiley, 2003. https://www.drgabormate.com
• Cunningham, J.K., & Saleh, A.A. (2025). Structural Stigma, Racism, and Sexism Studies on Substance Use and Mental Health: A Review of Measures and Designs. Alcohol Research, 44(1), 08. https://pubmed.ncbi.nlm.nih.gov/39713741/
• Boga, D.J., et al. (2025). Support systems, trauma, depressive symptoms, self-silencing, and risk of HIV viral non-suppression among Black women living with HIV. Journal of Behavioral Medicine, 48(2), 268, 279. https://pubmed.ncbi.nlm.nih.gov/39580576/

If any of this lands close to home and you’re ready for clinical support, you can reach out to Annie’s practice.

References

Peer-Reviewed Research (Vancouver)

1. Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, et al. A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress. 2009;22(5):399-408. doi:10.1002/jts.20444. PMID: 19795402.
2. Neff KD, Bluth K, Tóth-Király I, Davidson O, Knox MC, Williamson Z, et al. Development and Validation of the Self-Compassion Scale for Youth. J Pers Assess. 2021;103(1):92-105. doi:10.1080/00223891.2020.1729774. PMID: 32125190.

Books & Cultural Sources (Chicago Author-Date)

• Maté, Gabor. When the Body Says No. A.A. Knopf Canada, 2003.

Medical Disclaimer