🩺 Secondary PTSD: The Quiet Echo of Trauma in Helping Professions

Secondary PTSD, also known as vicarious trauma, is the emotional residue that accumulates when we bear witness to the suffering of others. For those in healing and protective roles—psychiatric nurse practitioners, therapists, doctors, nurses, EMTs, firefighters, police officers—it’s not just the stories we hear. It’s the weight of holding space for pain that doesn’t belong to us, yet somehow lives in us.

💔 What It Feels Like

• Emotional Overload: You might feel drained after sessions, not just tired but soul-weary. The stories linger. The images replay. You carry the ache of others in your chest.

• Hypervigilance: Even off-duty, your nervous system stays on alert. You scan for danger, anticipate crisis, feel the pulse of trauma in everyday moments.

• Numbing or Detachment: To survive the emotional toll, you may unconsciously shut down. Empathy becomes effortful. Joy feels distant. You start to feel like a shell of yourself.

• Intrusive Thoughts or Dreams: You might dream about your patients’ experiences, or find their trauma bleeding into your own memories.

• Guilt and Helplessness: You question whether you did enough. You feel responsible for outcomes beyond your control. You mourn the limits of your reach.

• Empathic Identification: You wonder, What would I do in their shoes? Would I survive that? Would I make the same choices? You mentally rehearse safety plans, escape routes, emotional responses—trying to find control in the uncontrollable.

That last point is especially resonant for PMHNPs and frontline helpers. It’s the quiet rehearsal of trauma, the mental simulation of survival, the aching empathy that makes us both effective and vulnerable.

🧠 Why It Happens

We’re trained to listen deeply, to validate, to stay present. But holding space isn’t passive—it’s an act of emotional labor. We absorb tone, tension, silence, and suffering. Our mirror neurons fire. Our bodies respond. Over time, without adequate support or release, this exposure can lead to symptoms that mirror PTSD—even if we were never in the traumatic event ourselves.

🕯️ The Sacred Burden

Helpers often carry trauma like sacred cargo. We don’t just hear stories—we feel them. We translate chaos into care, fear into safety, despair into hope. But in doing so, we risk losing pieces of ourselves. Secondary PTSD is not weakness—it’s a sign of deep empathy, of proximity to pain, of being human in the face of human suffering.

As a psychiatric nurse and then a psychiatric nurse practitioner, I’ve spent nearly 18 years walking alongside people in their darkest and most courageous moments. I’ve worked in emergency psychiatric departments with patients as young as 4 and as old as 88. I’ve served on inpatient adult units across three major hospitals, and in outpatient care with veterans—including my oldest patient at age 92.

I’ve provided medication-assisted treatment for addiction, praying my patients stay on the path of recovery, knowing relapse is part of the reality—and being there to help them back up when they fall.

I’ve held space for trauma, grief, rage, and resilience. And I’ve felt the quiet echo of it in my own body.

If you’re curious about what those “day in the life” moments were really like, let me know in the comments. I’d love to share more.

And if you work in a helping field—PMHNP, therapist, doctor, nurse, EMT, firefighter, police officer, etc...—have you ever felt the weight of secondary trauma? The kind that settles in after holding space for someone else’s pain?

You’re not alone. Let’s talk about it.

🌿 How I Care for Myself—One Breath, One Paw, One Cup at a Time

Throughout the day, I find little ways to reset and reconnect. I pet my dogs. I step outside for fresh air. I make coffee and savor the ritual. I pause for deep breaths when the weight of the world—or the work—starts to settle in.

I don’t exercise regularly (yet), though I know how much it helps. Honestly, I’m like many of the patients I care for—searching for motivation, trying to carve out time, reminding myself that even small steps count.

Weekends are my sanctuary. I hike, kayak, and spend time in nature with my family, friends, and of course, my dogs. And soon, with van life on the horizon, those weekend escapes will become daily rhythms. I can’t wait to make movement, nature, and freedom part of my everyday healing.

🧠 The Hardest Part of My Job Isn’t the secondary Trauma—It’s the Sitting

One of the toughest parts of my job as a PMHNP isn’t the emotional weight—it’s the physical toll of sitting at my desk from 7am to 6pm. The neck tension, the eye fatigue, the screen glare. And the charting. Oh, the charting.

Most providers I know feel the same—we joke about it, but it’s real. I’ve had to learn to check in with myself and say, “It’s okay to leave the afternoon notes for tomorrow.” That used to keep me up at night, chasing perfection and productivity.

But sometimes, I still get caught in the loop—telling myself I have to finish everything before I step away. That “just one more note” mindset can stretch into an extra hour or two. The dogs don’t love it. And honestly, neither do I—because dinner by at least 6pm is one part of my schedule I don’t want to miss.

I’m learning to honor my limits, not just my patients’. And that’s a practice, too.