One Wednesday afternoon, a client I worked with—Alexandra (name and identifying details changed for privacy, but the core of her story preserved)—appeared on my screen for our telehealth session. Her laptop balanced on her kitchen counter, with a meticulously organized row of spice containers visible behind her. She was still in her work clothes despite working from home that day.

“I had to reschedule three meetings to make this session work,” she said, not as a complaint but as a statement of fact. Her eyes were shadowed, jaw visibly tight. “Last night I was up until 11 PM answering emails. When I finally closed my laptop, I spent another hour reorganizing the spice rack instead of sleeping.”

She glanced behind her and laughed—a short, sharp sound. “Ending a 14 hour work day and doing more work instead of going to bed. Who does that?”

I didn’t answer right away. What I saw wasn’t random exhaustion. It was the culmination of patterns that had likely started decades ago—patterns now threatening the foundation of her adult life.

How the Pattern Forms

When Alexandra was eight, her mother’s depression manifested as unpredictable drinking. Some nights, dinner appeared at 6 PM sharp. Other nights, nothing appeared at all.

“I started making my brother’s lunches in third grade,” she told me during our fourth session, eyes fixed somewhere beyond her screen. “My father worked late. My mother was usually… unavailable. So I took over.”

Small hands making sandwiches before she could tell time. Learning to gauge her mother’s mood by counting empty glasses. Making excuses when permission slips weren’t signed.

This pattern—stepping into adult roles as a child—didn’t just shape what Alexandra did. It hardened into who she became.

Maya, another former client I worked with (name and identifying details changed), experienced this from a different angle. As the oldest daughter of immigrants working multiple jobs, she became the family’s translator and default caregiver at age seven.

“In my community, I was celebrated for being so responsible,” Maya told me, twisting her wedding ring around her finger like a fidget toy. “What nobody understood is that I never had a choice.”

These aren’t isolated stories. Research on children from households with family dysfunction shows they develop distinctive adaptations in their nervous systems. Famed trauma researcher Bessel Van der Kolk, PhD’s extensive work on developmental trauma demonstrates how these children’s bodies become hypervigilant—constantly scanning for needs to meet and problems to solve—creating patterns that persist into adulthood long after the original circumstances have changed.

For women especially, these patterns get reinforced by culture.

We praise young women for self-sacrifice and anticipating others’ needs. Research by Bréne Brown, PhD shows how girls are socialized to value relationship maintenance above self-care, creating a perfect storm where both early experiences and social expectations push toward the same outcome. Being the strong one, and taking care of everyone but yourself.

True strength includes vulnerability and receiving—a radical redefinition for many “strong ones.”

Our culture equates strength with self-sufficiency and stoicism, but research on resilience reveals a more nuanced truth.

We praise young women for self-sacrifice and anticipating others’ needs. Research by Bréne Brown, PhD shows how girls are socialized to value relationship maintenance above self-care, creating a perfect storm where both early experiences and social expectations push toward the same outcome: taking care of everyone but yourself.

From Survival Strategy to Identity Trap

“If I’m not holding everything together, who am I?” Alexandra asked bluntly in one session. “I built my career, my marriage, my friendships on being the reliable one. What’s left if I put that down?”

This isn’t abstract anxiety. When your entire sense of self is built around caretaking, the prospect of stopping registers in your body as an existential threat. Your nervous system responds as though your survival depends on maintaining the pattern.

The transformation from adaptive childhood behavior to rigid adult identity happens through thousands of small reinforcements.

Every time Alexandra anticipated her boss’s needs before they were stated, she received praise.

Every time she managed her father’s medical appointments without complaint, she got recognition.

The pattern that once helped her navigate a chaotic childhood became the walls of a prison she built around herself, action by action, lock by lock.

Dan, a former client I worked with (name and identifying details changed), a surgeon in his mid-thirties, put it bluntly: “The traits that made medical school possible are the same ones destroying my marriage. I can’t turn off the hyper-responsibility, the constant vigilance. I’m exhausted, my wife is angry every time I suggest improvements, but I literally don’t know how to function differently.”

Bosses value employees who anticipate problems before they arise.

Partners appreciate someone who handles logistics without being asked.

Research on perfectionism shows societal pressure toward hyper-competence has increased dramatically in recent decades, creating environments where over-functioning isn’t just normalized but celebrated—masking the internal damage until the foundation begins to crack.

What Breakdown Actually Looks Like

The longer the patterns persist, though, the more they demand we pay attention.

For example, Alexandra’s body started speaking a language she hadn’t learned to interpret. Migraines that no medication touched. Jaw tension that never fully released. Digestive issues that baffled specialists. Chronic fatigue that sleep couldn’t fix.

“Last week I had a panic attack in the grocery store,” she told me. “Standing in the cereal aisle, I suddenly couldn’t breathe. My heart was racing so fast I thought I was having a heart attack.”

This physical breakdown isn’t random malfunction.

Research in psychoneuroimmunology shows how chronic stress—particularly the vigilant, persistent kind that comes with over-functioning—dysregulates immune function and creates predictable patterns of physical symptoms.

It’s your body communicating what your conscious mind hasn’t acknowledged: this pattern is unsustainable.

But the costs also extend beyond physical symptoms.

“I’m surrounded by people who need me, but I’ve never felt more alone,” Alexandra admitted. “My husband tries to connect, but I’m always too busy or too tired. My closest friend called me out last week—said she feels like she only gets my leftovers.”

Your relationships lack the reciprocity that creates true intimacy. You become a function, not a person.

The Shift That Makes Change Possible

When I asked Alexandra what would happen if she stopped being everyone’s rock, what the worst case scenario was that she imagined, her instinctive answer was catastrophic: “Everything would fall apart. My team would fail. My brother wouldn’t get his medication. And my father’s care would suffer.”

But when I pressed her to give me specific examples of actual consequences, not just fears, she grew quiet.

“I honestly don’t know,” she finally said. “Maybe… nothing would happen? Maybe someone else would step up? Or maybe some things wouldn’t get done exactly as I’d do them, but the world wouldn’t end?”

This moment—when rigid certainty cracks open—is where real change becomes possible.

Thomas, a former client I worked with (name and identifying details changed), reached this point after his doctor told him plainly that his blood pressure would kill him before 50 if he didn’t change. He described his realization:

“I’d spent twenty years believing I was indispensable. Then I got sick and had to take three weeks off. Nothing collapsed. The firm kept functioning. My cases got covered. It was both humiliating and freeing to realize I wasn’t as essential as I thought.”

This often humbling recognition—that the world continues without our constant management—often precedes meaningful change.

Not because it diminishes our worth, but because it rightfully redistributes the weight we’ve been carrying.

What Actually Helps

Alexandra recently took a small but significant step: she declined to lead a new project at work.

“It felt terrifying,” she admitted. “I was convinced everyone would see me as selfish or lazy. Instead, my boss just nodded and asked who might be a good alternative. That was it.”

I could see her nervous system recalibrating—shoulders relaxing slightly, breathing deeper, a momentary stillness replacing her usual fidgeting.

The world hadn’t collapsed when she set a boundary.

The difference isn’t in what you do, but in why and how you do it.

Elena, another former client I worked with (name and identifying details changed), described what she discovered when she started saying no:

“People who only valued me for what I could do gradually drifted away. But my real friendships got stronger. The people who truly care about me wanted a relationship, not a support service.”

Building Something Different

Alexandra, in one of our last sessions together, shared with me a breakthrough moment with her daughter.

“I’d missed her science fair because of a work emergency—again,” she told me, her voice catching. “Instead of just apologizing and moving on, I sat down with her and told her how sad I was to miss it, how much I struggle with balancing work and being the mom I want to be. I actually cried in front of her, which I never do.

She just said, ‘It’s okay, Mom. I just want you to be real with me.’ It was the most connected I’d felt to her in years.”

It was a big movement in her attempts to raise a healthy family when she herself didn’t come from one…

True strength includes vulnerability and receiving—a radical redefinition for many “strong ones.”

Our culture equates strength with self-sufficiency and stoicism, but research on resilience reveals a more nuanced truth.

Being strong and stable means having a solid core sense of self that allows for both giving and receiving, both independence and interdependence.

It means having boundaries that protect your wellbeing while remaining open to authentic connection.

This balanced strength is sustainable in a way that the old “strong at all costs” model never could be.

Building a Foundation That Supports You: Your Next Steps

Here’s how I would refine the final section of your essay to maintain the strong rhythm established throughout the piece while creating a more focused conclusion:

Building a Foundation That Actually Holds

Just as a building needs a foundation that both bears weight and receives support from the surrounding structure, you can create a life where you both give and receive—where strength includes vulnerability, and where your worth isn’t measured by what you do for others.

The recognition you’re experiencing now—seeing these patterns that have shaped your life while remaining largely invisible—this is the essential first step. It’s where the repair work begins.

What I’ve learned across fifteen years of witnessing these patterns is that awareness alone rarely shifts the nervous system. The body keeps the score long after the mind has registered the insight. The patterns that have you constantly reaching to help, fix, and manage need more than understanding—they need a container that honors both your strength and your profound need for rest.

That’s the work we do together in Strong and Stable—finding what’s yours to carry and what isn’t, building a foundation that can support others without collapsing under their weight.

Next Sunday, paid subscribers will receive “Putting Down What Isn’t Yours to Carry”—not just information, but a guided journey of nervous system-informed practices designed specifically for those who’ve spent years being the strong one.

The following week, I’ll share a letter about how this pattern has moved through my own life—stories I haven’t shared elsewhere about one of my closest friendships, a moment of clarity that came while watching Encanto with my daughter, and what’s changed for me since my own foundation nearly gave way.

Throughout the month, paid subscribers can send me their questions for our end-of-month Q&A—the complex, nuanced questions that deserve more than quick fixes or generic advice.

Remember: this work isn’t another task for your already overloaded system. Your nervous system sets the pace. You get to come back to these tools whenever your capacity allows, patching the foundation cracks bit by bit in a way that creates lasting change rather than temporary relief.

I’m here with you in this work. Your story is held here.

Warmly,

Annie

References

Cheng, Y. Y. (2012). Re-conceptualizing parentified children from immigrant families [Doctoral dissertation, ProQuest Dissertations]. https://search.proquest.com/openview/c99343bdd065ed793dc8b6e9dfb513b1/1?pq-origsite=gscholar&cbl=18750

Rao, S. A. (2014). Parentification, emotional security and attachment in adolescents of parents with alcoholism [Master’s thesis, Christ University]. https://archives.christuniversity.in/disk0/00/00/63/46/01/binder.pdf