When someone close to you struggles with their mental health…
RELATIONAL TRAUMA
When someone close to you struggles with their mental health…
SUMMARY
1 in 5 adults in America will experience a mental illness. 1 in 5 children ages 13-18 has or will have a serious mental illness. Depression is the leading cause of disability worldwide. 42 million American adults have some sort of an anxiety disorder.
Relational trauma refers to psychological injury that occurs within the context of important relationships, particularly those with primary caregivers during childhood. Unlike single-incident trauma, relational trauma involves repeated experiences of emotional neglect, inconsistency, manipulation, or abuse within bonds where safety and trust should have been foundational.
1 in 5 adults in America will experience a mental illness.
1 in 5 children ages 13-18 has or will have a serious mental illness.
Depression is the leading cause of disability worldwide.
42 million American adults have some sort of an anxiety disorder.
90% of both adults and teens who die by suicide had an underlying mental illness.*
The bottom line: Mental health struggles are exceedingly common which means that the chance you have someone in your life who struggles with their mental health is high.
SUMMARY
When someone you love is struggling with their mental health, the experience can be confusing, frightening, and deeply depleting — especially if you don’t know how to help or what to say. This post offers grounded, compassionate guidance for those supporting a loved one through mental health challenges: what actually helps, what doesn’t, and how to take care of yourself in the process.
Vicarious Trauma / Compassion Fatigue
Vicarious trauma — also called compassion fatigue — is the psychological toll of caring for someone who is suffering. It is particularly common among those supporting loved ones with mental health struggles, and involves symptoms similar to direct trauma exposure: emotional exhaustion, helplessness, hopelessness, and disruption of one’s sense of safety and meaning. Supporting someone else’s healing requires actively tending to your own.
And if someone close to you struggles with their mental health – whether it’s episodic or ongoing anxiety, depression, addiction, a mood or personality disorder – you’ve probably often wondered,
“How do I show up for this person?”
Or
“Do I even want to show up for this person?”
Or
“How can I hold boundaries with this person?”
None of these are easy questions and it’s often hard to know what to do or what you’re available for when someone close to you struggles with their mental health.
In today’s post, I dive into this topic and provide a series of prompts and inquiries to help you think through these questions so you can clarify questions you may have if someone close to you struggles with their mental health.
“The wound is the place where the Light enters you.”
RUMI
When someone close to you struggles with their mental health, it can sometimes feel challenging.
It may also feel easy and seamless sometimes, or you may know nothing different and living with or being close to someone who struggles with their mental health could feel completely normative.
But if you do find it to be challenging – either all the time or some of the time – please remember: you’re allowed to have your feelings.
It doesn’t make you a “bad person” for feeling challenged by the person or their mental health struggles, any more so than it makes the person going through them a “bad person” for having mental health challenges.
You’re allowed to have your experience no matter what it looks like.
This may not be something you’ve heard too often, but it’s more than okay to feel sad, angry, frustrated, tired, hopeless, triggered, or any other feeling you have about being in connection with this person.
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I think many of us sometimes should all over ourselves, telling ourselves stories like we should feel one way or the other, we should show up for that person who’s mentally ill even if we don’t want to, we shouldn’t resent or begrudge that person, and so forth.
I don’t think “shoulding” on ourselves is helpful.
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When we do that, we’re effectively layering on judgment and shame on top of what already might be tough and painful feeling states, adding even more challenge to our emotional experience that otherwise doesn’t have to be there.
So remember: there is no should about how you might feel or choose to show up when someone close to you struggles with their mental health.
You get to have your experience no matter what this looks like.
Next, remember, you have to consider your own individual context when someone close to you struggles with their mental health.
You have to consider the context.
How we show up for a loved one struggling with their mental health can be very context dependent.
For instance, if it’s your child versus your brother-in-law, or if it’s a parent you don’t care to be close to versus your wife that you adore, a distant acquaintance versus a member of the team you manage at work, the level of investment, care, and availability you have to support this person will vary.
How you can show up for this person will also depend on how their mental health struggles manifest and what your personal capacities are, what resources are at your disposal, what level of personal work you have done to understand, recognize, and assert your own boundaries, how advanced the person’s mental health struggles are, how much space you have left to give them is, etc. etc..
The bottom line: there is no one-size-fits-all model.
There’s no rule here about how and if to show up for a person who struggles with their mental health.
Thinking about this or about how you have or have not shown up for them in the past, you may feel a sense of guilt or even compulsion, wanting to show up with them but just not being able to do so, or feeling like you “should” support them because of some internalized, pressured belief(s) you hold.
At the end of the day, there is no right or wrong way to respond when a person close to you struggles with their mental health.
You’re not supposed to fix them (indeed, you cannot “fix” them!).
What you can do is figure out how you need and want to show up for someone close to you by reflecting on the context of the relationship, on your own personal boundaries, how you need/want to take care of yourself, and action steps that feel reasonable and realistic to you.
To that end, I want to provide some inquiries for you to help answer and address these questions.
Inquiries to consider.
Open a Google doc or crack open your hard-copy notebook and write down your answers to the following:
What is your level of responsibility to this person (are you a parent/legal guardian? A sibling, manager, or more distant connection?)
What’s your level of investment in this relationship? In other words, do you care about this relationship and want to invest in it? Or is it a relationship you would be happy to see fade from your life?
What is the story you tell yourself about how you think you “have to” show up for this person?
Where did you learn this story?
Is this – the story you tell yourself – empirically true?
Answer honestly, what feels good for you in terms of showing up for this person?
What would feel hard for you?
In what ways is this person asking/insisting (either implicitly or explicitly) that you show up for them?
In what ways do you struggle to show up for this person?
Is it an option for you NOT to show up for this person in this way and instead utilize different resources/options to get them support?
Who are the other people/resources that can support you? Who is your support team?
What resistance comes up for you (if any) when you think about changing the way you show up?
Do you struggle with setting boundaries in any other areas of your life? Does it feel hard to think about setting boundaries with this person?
If you could hold better boundaries with this person, what would they look like?
What’s the cost if you keep showing up for this person and keep feeling drained?
What do you stand to gain if you can change how you show up with this person?
What are one or two immediate action steps you want to take now that you’ve clarified more about what you are and are not available for?
If, after completing these inquiries you realize you do want to show up for this person but are struggling to imagine concrete steps you could take to do so that might be appropriate and effective, consider the following:
Educate yourself.
If you know what the person close to you is struggling with, consider educating yourself on their diagnosis/issues. Often when we learn more about the symptoms, side effects, and needs those who struggle with particular mental health challenges face, it can be helpful in terms of helping us understand what they might need, that their reactions to us may not be in their control, and education generally helps us feel more in control when we can sometimes feel out of control.
Practice empathy, lots and lots of empathy.
You may not have experienced what the person close to you is going through, but still you can attempt to understand the experience by recalling times you have struggled, by reading or listening to stories of others who deal with what the person close to you deals with, etc.. You can also ask them to share more of their experience with you, tell them you want to understand better.
Ask them what they would like from you.
Sometimes, with the best of intentions, we project our experience onto others and imagine they would like us to respond in a certain way because that’s how we would like to be responded to. But that may not be the case. If you’re wondering how to show up for the person close to you, ask them. You may be surprised at their answers. Of course, check in with yourself to see if you can meet their requests. But if you can, try those out.
Cultivate supports and remember your boundaries.
At the end of the day, when someone close to us is struggling with their mental health we are challenged to practice self-care and to recognize and assert our boundaries in myriad ways. Even as you support this person, don’t forget to pay attention to yourself. Give yourself what you need and want to make showing up for this person sustainable and reasonable for you. You absolutely do get to practice self-care. And you get to hold boundaries when someone close to you struggles with their mental health.
Also, you might want to consider reading this prior blogs of mine:
What moving forward actually looks like — and what it doesn’t.
I hope you found this post helpful and perhaps even a bit validating.
Now I would love to hear from you in the comments below:
Does someone close to you struggle with their mental health? What lessons have you learned about how and if to show up for this person? What has been a support to you as you have either showed up for them or stepped back?
Leave a message in the comments below so our community of blog readers can benefit from your wisdom.
Here’s to healing relational trauma and creating thriving lives on solid foundations.
Warmly,
Annie
Frequently Asked Questions
DISCLAIMER: The content of this post is for psychoeducational and informational purposes only and does not constitute therapy, clinical advice, or a therapist-client relationship. For full details, please read our Medical Disclaimer. If you are in crisis, please call or text 988 (Suicide & Crisis Lifeline) or text HOME to 741741 (Crisis Text Line).
National Institute of Mental Health (2023). Mental Illness. National Institute of Mental Health.
Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry.
World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization.
Anxiety and Depression Association of America (2023). Facts & Statistics. Anxiety and Depression Association of America.
National Alliance on Mental Illness (2023). Suicide Prevention. NAMI.
Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators.
Figley, C. R. (2002). Treating compassion fatigue. Brunner-Routledge.
What is ’emotional neglect’ and how is it different from physical neglect?
Emotional neglect is the failure to provide adequate emotional support, validation, and attunement to a child’s emotional needs. Unlike physical neglect, it’s often invisible—characterized by what didn’t happen rather than what did. It can include dismissing or ignoring emotions, failing to provide comfort, or simply being emotionally unavailable. Its effects can be profound and long-lasting.
How do I know if I experienced emotional neglect in childhood?
Signs that you may have experienced emotional neglect include difficulty identifying or expressing your emotions, a persistent sense of emptiness or numbness, feeling like your emotions are excessive or burdensome, difficulty asking for help, harsh self-criticism, and a tendency to minimize your own needs and experiences. These patterns often develop as adaptations to an environment that didn’t meet your emotional needs.
My parents provided for my physical needs. Can I still have experienced emotional neglect?
Absolutely. Emotional neglect is about the absence of emotional attunement and support, which is entirely separate from physical provision. Parents can be financially providing while being emotionally absent or unavailable. The impact of emotional neglect can be just as significant as other forms of childhood adversity.
How does childhood emotional neglect affect me as an adult?
The effects of childhood emotional neglect can include difficulty with emotional regulation, low self-worth, challenges with intimacy and vulnerability, a tendency toward depression or anxiety, difficulty identifying your own needs, and a pervasive sense of something being ‘missing.’ These are not character flaws; they are the natural consequences of having emotional needs consistently unmet.
How can I heal from childhood emotional neglect?
Healing from emotional neglect involves developing greater emotional awareness and self-compassion, learning to identify and honor your needs, and having corrective relational experiences—often in therapy. A therapist who is attuned and responsive can provide the emotional attunement that was missing in childhood, helping to heal the wounds of neglect.
Further Reading on Relational Trauma
Explore Annie’s clinical writing on relational trauma recovery.
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As a licensed psychotherapist (LMFT #95719), trauma-informed executive coach, and relational trauma specialist with over 15,000 clinical hours, she guides ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
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