You’ve probably been there. That moment where you're staring at a grocery store shelf, unable to decide between two brands of pasta sauce, and you feel like you might actually start crying. It’s not about the sauce. It’s about the fact that your brain is absolutely fried from carrying everyone else's stress all day. Honestly, if you work in healthcare, social work, or even if you're just the "stable friend" everyone calls during a crisis, you’ve likely felt that weight.
Laura van Dernoot Lipsky has spent over thirty years looking at exactly why that happens. She isn’t just some academic theorizing from a distance; she’s someone who hit the wall herself. Hard.
About a decade into her career working with survivors of child abuse and domestic violence, Lipsky realized she was having what she describes as a near-psychotic break. She was jumpy. She was cynical. She was basically a shell of a person because she had been witnessing trauma without any clue how to process it. That realization birthed the concept of Trauma Stewardship, a framework that has since changed how thousands of frontline workers stay sane.
The Reality of Trauma Exposure
Most people think "trauma" only happens to the person directly involved in an accident or a crime. Lipsky argues that’s just not true. If you are a witness—if you are the one listening to the stories, cleaning up the aftermath, or even just watching the 24-hour news cycle—you are being exposed.
It’s like being a gardener. You can’t spend all day in the dirt and expect your fingernails to stay clean. The "dirt" of human suffering gets under your skin.
Lipsky’s work, particularly through The Trauma Stewardship Institute, focuses on what she calls the Trauma Exposure Response. This isn't a pathology or a mental illness; it’s a natural reaction to unnatural circumstances. Some people call it "compassion fatigue" or "vicarious trauma," but Lipsky’s term feels a bit more honest. It’s about how your world view shifts when you see too much pain.
Signs You’re Redlining
How do you know if you're actually suffering from trauma exposure? It’s rarely a single "boom" moment. It’s usually a slow erosion.
Lipsky identifies sixteen different responses, but they basically boil down to a few key vibes:
- The "I can't do enough" trap: You feel hopeless and helpless, like no matter how hard you work, the world is still on fire.
- Hyper-vigilance: You start doing background checks on everyone you meet, or you can’t enjoy a movie because you’re scanning the exits.
- Minimizing: Someone tells you about their bad day, and you think, "At least your house didn't burn down," effectively killing your ability to empathize with anything less than a catastrophe.
- Grandiosity: You start believing you’re the only one who can do the job right. This is a big one for "heroes" in the medical or nonprofit worlds.
Why Trauma Stewardship Matters in 2026
We live in a world that is objectively loud. Between climate anxiety, political instability, and the constant digital stream of "everything is terrible," Lipsky’s second major work, The Age of Overwhelm, has become a bit of a survival manual.
She talks a lot about Decision Fatigue. Ever wonder why you can’t decide what’s for dinner after a long day? It’s because you’ve used up your cognitive "budget" on high-stakes choices. Lipsky’s approach isn't about "self-care" in the sense of taking a bubble bath and calling it a day. It’s about systemic change and radical presence.
The Five Directions
In her book Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, Lipsky outlines a map for navigating this. She uses the metaphor of the "Five Directions" to help people find their way back to center:
- North (The Why): Why are you doing this work? If your "why" has become "because I have to" or "no one else will," you’re in trouble.
- East (The Choice): Recognizing that you have a choice in how you respond to what you see.
- South (The Presence): Learning to actually be in your body rather than just a floating head of anxiety.
- West (The Support): Finding a community that understands the "secondary" nature of your stress.
- The Center (The Clarity): Achieving a state where you can witness suffering without absorbing it as your own identity.
Common Misconceptions About Her Work
People often hear "Trauma Stewardship" and think it’s just another way of saying "don't get burned out." It's actually deeper than that.
One of the most nuanced points Lipsky makes—which often gets missed—is the connection between systemic oppression and trauma. You can’t "mindfulness" your way out of a toxic workplace or a society that devalues your labor. She’s very clear that individual self-care is a Band-Aid if the underlying systems are designed to grind people down.
She also catches flak from those who think her approach is too "soft." But if you’ve ever seen her speak—she has a famous TEDx talk called Beyond the Cliff—you know she’s anything but soft. She’s a "no-nonsense" communicator. She’s worked with everyone from U.S. Air Force pilots and firefighters to zookeepers and teachers. These aren't "soft" crowds. They’re people who deal with life and death every day.
Practical Steps for the Long Haul
If you're feeling like you're at the end of your rope, Lipsky’s research suggests a few immediate shifts that actually work. No, they won't fix the world, but they might keep you in the fight longer.
📖 Related: Eastern diamondback rattlesnake bite: What to do when the worst-case scenario happens
First, audit your "In-take." Are you scrolling through tragic news before you even get out of bed? Stop it. You are essentially poisoning your morning coffee with secondary trauma. Give your nervous system a chance to boot up before you invite the world's problems in.
Second, name the "Trauma Exposure Response." When you find yourself being a jerk to a coworker or feeling totally numb, stop and say, "This is my response to what I've been seeing." It shifts the perspective from "I'm a bad person" to "I am a person having a normal reaction to a lot of stress."
Third, find your "Micro-moments." Lipsky emphasizes that you don't need a three-week retreat to reset. It can be sixty seconds of intentional breathing between meetings. It’s about creating "buffers" so the trauma doesn't just hit you in one continuous wave.
Actionable Insights for Organizations
If you lead a team, stop telling them to "take a mental health day" while simultaneously piling on more work. Lipsky’s consulting work with groups like the Northwest Network of Bi, Trans, Lesbian and Gay Survivors of Abuse shows that sustainability has to be baked into the culture.
- Standardize debriefs: Make it normal to talk about the "weight" of a case or a project.
- Address decision fatigue: Reduce the number of trivial decisions employees have to make so they can save their energy for the stuff that matters.
- Normalize boundaries: If your staff feels guilty for turning off their phones at 6:00 PM, your organization is a factory for secondary trauma.
At the end of the day, Laura van Dernoot Lipsky isn't selling a cure. She's offering a way to live with the truth of the world without being destroyed by it. It’s about becoming a steward of the pain—holding it with respect, but never letting it become who you are.
Next Steps for Your Practice
To move from "overwhelmed" to "sustainable," start by identifying your primary Trauma Exposure Response. For the next week, notice when you lean into cynicism, hyper-vigilance, or numbing. Labeling these behaviors as they happen is the first step toward reclaiming your capacity to care without the cost of your own well-being.