When someone close to you struggles with their mental health…

By Annie Wright, LMFT · Licensed Marriage & Family Therapist (#95719)Clinically reviewed May 2026

RELATIONAL TRAUMA

LAST UPDATED: APRIL 2026

When someone close to you struggles with their mental health…

FAMILY DYNAMICS & BOUNDARIES • August 19, 2018

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.

TABLE OF CONTENTS

1. Did you know?
2. Some real talk.
3. I don’t think “shoulding” on ourselves is helpful.
4. The bottom line: there is no one-size-fits-all model.
5. References
6. Frequently Asked Questions

Did you know?

DEFINITION RELATIONAL TRAUMA

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.

DEFINITION COMPASSION FATIGUE

Compassion fatigue — also called vicarious trauma — is the psychological, physical, and emotional exhaustion that results from prolonged exposure to another person’s suffering, particularly in a caregiving role. Coined and researched by Charles Figley, PhD, traumatologist and professor, it involves symptoms similar to direct trauma exposure: emotional depletion, helplessness, a diminished sense of hope, and disruption of one’s own sense of safety and meaning.

In plain terms: You didn’t experience what your loved one is going through — but your nervous system has been absorbing it anyway. The exhaustion you feel isn’t weakness or selfishness. It’s what happens when you give more than your system can sustain without support.

Related reading: What does it mean to be an ambitious, upwardly mobile woman from a relational trauma background?, Attachment Trauma: How Early Relationships Shape Your Adult Connections, Trauma and Relationships: When Your Professional Strengths Become Your Relationship Blindspots

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.

*Statistics provided by The National Alliance on Mental Illness

Some real talk.

“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.

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.

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.

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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:

• 101 Self-Care Suggestions When It All Feels Like Too Much
• How boundaries impact every area of your life and what to do if yours need work
• Yes, sweetheart, you do get to grieve this…

Bessel van der Kolk, MD, psychiatrist and trauma researcher and author of The Body Keeps the Score, has written extensively about how relational trauma changes the way the brain processes threat, attention, and self-perception. The amygdala becomes hypervigilant. The medial prefrontal cortex — the part of the brain that helps you contextualize what you’re feeling — goes quiet. The default mode network, where the felt sense of self lives, becomes muted. None of this is metaphor. It’s measurable, and it’s reversible. The therapies that actually move the needle for driven women — somatic work, EMDR, IFS, attachment-based relational therapy — are all therapies that engage the body and the implicit memory systems where this material is stored.

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:

Here’s to healing relational trauma and creating thriving lives on solid foundations.

One thing I want to say before we close: if you’ve been carrying this — supporting a loved one while holding yourself together, navigating the guilt and the love and the exhaustion simultaneously — I see you. The weight of that is real. And you deserve as much care as you’re pouring outward. If you’re ready to explore what that support could look like, therapy and coaching are available to you. So is the free quiz, which can help you identify what kind of support might be most useful for where you are right now. You don’t have to carry this alone.

Warmly,

Annie

Frequently Asked Questions

You deserve a life that feels as good as it looks. Let’s work on that together.

References

• 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.

Nicole is a 38-year-old executive at a nonprofit social impact organization. From the outside, she’s known as the calm, stable friend everyone calls when something goes wrong. But her closest friend has been in a deepening depressive episode for eight months, and Nicole has become the primary support — at significant cost to her own nervous system. Last week, she caught herself resenting a friend she genuinely loves and then spent twenty minutes feeling guilty about the resentment. She told me, “I’m angry at her and I hate that I’m angry. She didn’t choose this. But I’m so tired. I feel like there’s nothing left of me.” Nicole’s resentment isn’t a character failing — it’s a signal from her own nervous system that her resources are depleted. The anger is information: she’s been giving from an empty account, and the account is sending alerts. Learning to support Nicole first is not abandonment. It’s the prerequisite for sustainable care.

Both/And: You Can Be Healing and Still Functioning at a High Level

There’s a particular form of isolation that driven women experience in recovery: the belief that needing help means they’ve failed. They’ve built entire identities around competence, self-sufficiency, and not being a burden. Asking for support — let alone admitting they’re struggling — feels like a betrayal of everything they’ve worked to become. In my practice, this is one of the first beliefs we examine, because it’s almost always a relic of childhood.

Talia is an entrepreneur who runs a multimillion-dollar company and texts her team at 5 a.m. She canceled her first three therapy appointments before she finally showed up. “I handle things,” she told me in our first session, as though that were a personality trait rather than a survival strategy. What Talia didn’t yet see is that her capacity to handle things and her need for support aren’t in competition. They coexist — and her refusal to let them has been costing her for decades.

Both/And means Talia can be the person her team relies on and the person who weeps in my office on Thursdays. She can run a company and still need someone to hold space for her. She can be the strongest person in most rooms and still benefit from being in a room where she doesn’t have to be strong. These aren’t contradictions. They’re completeness.

Both/And also applies to the supported person. You can love someone deeply who is struggling with their mental health and still find some of their behavior harmful to you. You can want them to get better and need to protect yourself from the impact of their symptoms simultaneously. You can stay connected to the relationship and still set limits on what you’re available for. None of these positions is a betrayal of the other. They are the honest navigation of a genuinely difficult situation, and they deserve to be held with the same compassion you extend to your loved one.

The Systemic Lens: Why Trauma Recovery Shouldn’t Be a Privilege

When we tell driven women to “get help” for their trauma, we often fail to acknowledge what getting help actually requires: financial resources for quality therapy, schedule flexibility for consistent appointments, a workplace culture that doesn’t penalize prioritizing mental health, and a social environment where vulnerability is safe. These aren’t universally available. For many women, they aren’t available at all.

Even driven women with financial means face systemic obstacles. The pressure to be constantly productive means therapy often gets scheduled in margins that don’t allow for the emotional processing the work requires. The cultural expectation that women should “handle things” quietly means many driven women hide their therapeutic work from colleagues, friends, even partners — adding the burden of secrecy to the already demanding work of healing. The medicalization of trauma into neat diagnostic categories often fails to capture the complexity of what relational trauma actually looks like in an accomplished life.

In my work, I try to hold the systemic reality alongside the individual journey. You are doing courageous, difficult work. And the world around you was not built to support that work. Both things matter. Understanding the structural constraints isn’t an excuse to stop — it’s a reason to be more compassionate with yourself about the pace, and more outraged at a system that makes healing harder than it has to be.

For driven women specifically, there’s another systemic dimension worth naming: the way that mental health support for loved ones disproportionately lands on women. Research consistently shows that women provide more informal caregiving than men, across a wider range of relationships, with less recognition and less support. When a family member struggles with their mental health, the women in that family — mothers, daughters, sisters, partners — are typically the ones who coordinate care, hold the emotional weight, and absorb the impact of the struggle on family systems. This is not a personal choice. It is a cultural default. And it is worth naming clearly, because naming it changes what you ask of yourself and what you ask of the systems around you.

What I consistently see in women navigating caregiving for loved ones with mental health struggles is that their own needs — for therapy, for rest, for spaces where they are the ones being cared for — get systematically deferred. They’ll prioritize getting their loved one into treatment while putting their own support on a waiting list that never quite gets to the top. The message I want to send clearly: your wellbeing is not a bonus feature of this situation. It is the foundation everything else depends on. You cannot sustain meaningful support for someone else from a position of ongoing depletion. Getting your own support is not selfish. It is the prerequisite for everything you’re trying to do.

If what you’ve read here resonates, I want you to know that individual therapy and executive coaching are available for driven women ready to do this work. You can also explore my self-paced recovery courses or schedule a complimentary consultation to find the right fit.

One of the most important — and underrated — things you can do for someone you love who is struggling is to stay regulated yourself. Not detached. Not distant. Regulated. There’s a crucial difference. Detachment looks like: “I can’t let this affect me.” Regulation looks like: “I can stay present with your pain without becoming that pain.” The first is a wall. The second is a container.

Staying regulated while someone you love is struggling is genuinely difficult. It requires that your own nervous system has enough capacity — enough resources, enough support, enough processing space — to stay in the window of tolerance while being exposed to someone else’s distress. If your own nervous system is already depleted, that capacity isn’t there. And no amount of love will substitute for it.

This is why I always say to clients who are supporting a struggling loved one: your wellbeing is not a luxury. It’s a prerequisite. Individual therapy for you — not just couples or family therapy — is often where that capacity gets built. And the Strong & Stable newsletter is a weekly resource for maintaining your own nervous system health while you’re in a caregiving role. You can’t pour from an empty cup. But you also don’t have to wait until you’re empty to ask for a refill.

The cultural water that ambitious women swim in deserves naming explicitly. Joan C. Williams, JD, distinguished professor at UC Hastings College of Law, has documented extensively how women in high-status professions face what she calls the “double bind” — judged harshly when they’re warm (read as not competent enough) and judged harshly when they’re competent (read as not warm enough). Add a relational trauma history to that bind, and the inner monitoring becomes nearly continuous. Healing has to include a clear-eyed look at how much of the exhaustion isn’t yours alone — it’s a load you’ve been carrying for systems that were never designed to hold you.

Stephen Porges, PhD, the developmental psychophysiologist who developed Polyvagal Theory, describes neuroception as the way the autonomic nervous system continuously evaluates safety beneath conscious awareness. For driven, ambitious women raised in environments where attunement was inconsistent, that internal safety detector tends to run on a hair-trigger setting. The room may be objectively calm, but the nervous system isn’t. Healing isn’t about overriding that signal — it’s about slowly teaching the body that the rules of the present are different from the rules of the past.

References

Peer-Reviewed Research (Vancouver)

1. van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
2. Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. Clin Neuropsychiatry. 2025;22(3):169-184. doi:10.36131/cnfioritieditore20250301. PMID: 40735382.

About the Author

Annie Wright, LMFT

LMFT #95719  ·  Relational Trauma Specialist  ·  W.W. Norton Author

Helping ambitious women finally feel as good as their résumé looks.

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.

Work With Annie

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