Dear Therapist:

As a teacher, I've noticed that some of my high school students seem to be experiencing the weight of their friends' struggles.

There is a student in my tenth-grade class who is going through a very hard time. Her family situation at home isn't easy and she is showing signs of unhealthy eating habits. We are aware that this student is struggling, and we are working on finding ways to help her. Recently, I noticed that her best friend has been more withdrawn and quieter than usual. She has trouble concentrating in class and seems to be on edge. I overheard her talking to a friend and telling her that she “is so stressed out these days and has trouble falling asleep at night.” I am nervous about this girl as well. I know that she has good intentions and is trying to help her friend, but I think it may be too emotionally draining for her to be in a supportive position to her friend with a seriously troubling situation. 
How prevalent is secondary trauma among high school students who are trying to support their friends dealing with emotional challenges?
Additionally, what strategies and support mechanisms can be implemented to help these students who are genuinely trying to assist their friends but are facing negative repercussions on their own mental well-being?



There can be many reasons that one person feels strong emotions almost vicariously through someone else. The simple explanation might be something like, “She’s just sensitive to others’ feelings.” The question is, however, what it is that makes her so sensitive, and whether this is a general sensitivity or specific to the relationship with her friend.

Some people are sensitive because they are empathetic; others are sympathetic. Practically speaking, the difference between the two can be viewed as feeling for others versus feeling for oneself using others as a medium. An empathetic person is typically grounded in terms of self-image, self-confidence, and self-esteem. Therefore, their concern for others is centered around that other person. A sympathetic person, however, is often attempting to build their self-image, self-confidence, and self-esteem through their relationships.

Of course, people do not operate on an all-or-nothing basis. We all exist somewhere on the empathy-sympathy spectrum. We are also able to be more empathetic in some relationships and circumstances than in others.

Throughout the generations, one of humanity’s ongoing struggles has been the building of self-esteem. Although people go about it in different ways, much of what we do—and much of our thought processes—center around this sometimes-all-consuming motivation. We define ourselves by how we look, what we have, what others think of us, our professions, and other factors (none of which actually has anything to do with who we are).

In 1943, psychologist Abraham Maslow proposed a five-tier hierarchy of needs, explaining that we need to meet more basic needs before we are psychologically prepared to grapple with higher order needs. Maslow’s five needs (in order of complexity) are: physiological, safety, love and belonging, esteem, and self-actualization. “Esteem” can be viewed as self-confidence (not intrinsically based). Although this may not have been Maslow’s intention, I would view self-actualization as intrinsically-based self-esteem.

In recent generations, we appear to be ever more focused—both consciously and unconsciously—on these externally-based ways of defining ourselves. This may be due, in part, to the fact that, more than in past generations, our basic needs are all being met, leaving us to ponder our own existence and importance without first building a basic personal foundation.

In a situation where it is clear that a person is allowing someone else’s issues to deeply affect them, it is likely that they haven’t yet successful processed earlier stages. For adolescents, the stage of “love and belonging” is prominent. Although this is a stage that we all go through, for some it can be excruciating. We also cannot separate stages and view them as standalone processes. While dealing with a need for love and belonging, your student may be conflating this need with self-image and self-confidence.

You refer to your student’s secondary trauma. While this may technically be an apt description, she is actually dealing with her own trauma—not with that of her friend. It may be traumatic for her that her friend is dealing with her trauma, but she is not dealing with her friend’s trauma, but her own. The student dealing with “secondary trauma” may have her own issues with body image and eating. Or it may be a different issue that is related in some way. Or it can be more of a general identity crisis, as described above.

Regardless of the problem, I think that it’s important to view each student’s issues as their own. We all react to others’ problems in one way or another, and this should be addressed as necessary. However, each person’s needs should be viewed with an eye to their needs, rather than as secondary to someone else’s. It sounds like your student is dealing with her own issues. Even if she believes that all her issues are related to her friend’s problems, a good therapist could help her to focus on her own feelings and needs.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200


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