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Understanding Moral Injury in the Helping Professions: Recognition, Treatment, and Resilience

Moral injury, a term originally associated with military contexts, has gained recognition across various helping professions, including healthcare, social work, and emergency response. It refers to the profound psychological distress that arises from actions, or the lack thereof, which violate an individual’s deeply held moral or ethical beliefs (Litz et al., 2009). This phenomenon is…

Moral injury, a term originally associated with military contexts, has gained recognition across various helping professions, including healthcare, social work, and emergency response. It refers to the profound psychological distress that arises from actions, or the lack thereof, which violate an individual’s deeply held moral or ethical beliefs (Litz et al., 2009). This phenomenon is particularly prevalent among professionals who regularly face ethically challenging situations, leading to significant emotional and psychological turmoil.

Manifestations of Moral Injury in Helping Professionals

In healthcare, for example, critical care nurses frequently encounter situations that challenge their moral frameworks. Research indicates that 71.5% of critical care nurses report significant moral injury symptoms, closely linked to burnout and traumatic stress (Rushton, Swoboda, Reller, & Skarupski, 2024). Institutional betrayal and moral distress further exacerbate this experience, underscoring the complex interplay between individual ethics and organizational policies. These findings emphasize the need for systemic changes to support healthcare professionals in navigating ethically distressing situations. The consequences of not addressing moral injury are far-reaching, including burnout, attrition and people leaving helping professions all together.

The Role of EMDR in Addressing Moral Injury

Eye Movement Desensitization and Reprocessing (EMDR) therapy has shown promise as an effective treatment for moral injury. Initially developed for post-traumatic stress disorder (PTSD), EMDR has been adapted to address the cognitive and emotional struggles associated with moral injury (Hurley, 2021). This approach integrates compassion-focused techniques to help individuals process morally distressing events, leading to emotional healing and cognitive restructuring. Studies suggest that EMDR can reduce symptoms of guilt, shame, and intrusive memories related to moral injury, thereby facilitating psychological recovery (Hurley, 2021).

Consequences of Untreated Moral Injury

When left unaddressed, moral injury can contribute to severe mental health conditions, including depression, anxiety, and PTSD (Litz et al., 2009). The internal conflict stemming from ethically distressing situations can result in pervasive guilt, self-condemnation, and emotional exhaustion (Mantri, Song, Lawson, Berger, & Koenig, 2021). Over time, unresolved moral injury may impair professional functioning, interpersonal relationships, and overall well-being. As a result, timely recognition and intervention are critical to preventing long-term psychological distress.

Identifying Signs of Moral Injury

Recognizing moral injury involves observing both emotional and behavioral indicators. Common signs include:

  • Emotional Distress: Persistent feelings of guilt, shame, or remorse related to specific professional actions (Mantri et al., 2021).
  • Cognitive Disruption: Intrusive thoughts or ruminations about morally challenging events (Litz et al., 2009).
  • Behavioral Changes: Withdrawal from professional duties, decreased job satisfaction, or increased absenteeism (Rushton, Batcheller, Schroeder, & Donohue, 2015).
  • Spiritual Struggle: Questioning previously held beliefs or experiencing a crisis of faith (Litz et al., 2009).

Awareness of these signs is the first step toward addressing moral injury effectively.

Building Resilience Against Moral Injury

Developing moral resilience is essential for professionals exposed to ethically distressing situations. Strategies to enhance resilience include:

  • Ethics Education: Continuous learning about ethical decision-making frameworks to navigate complex situations confidently (Rushton et al., 2024). Most licensing board of health require annual ethics Continuing Education Courses, which the perfect opportunity to reflect on personal morals and ethics.
  • Reflective Practice: Regularly reflecting on professional experiences to process emotions and reinforce personal values (Rushton et al., 2015).
  • Support Systems: Cultivating a network of colleagues, mentors, or mental health professionals to discuss and debrief morally distressing events (Mantri et al., 2021).
  • Organizational Advocacy: Promoting institutional policies that support ethical practices and provide resources for employees facing moral dilemmas (Rushton, Batcheller, Schroeder, & Donohue, 2015). This is particularly critical in the mental health field where many clinicians get their start by working in large, community mental health centers that are so overwhelmed with need that, sometimes, new clinicians (and more seasons ones too) come face-to-face with situations that, if not addressed, may lead to moral injury.

These strategies can help mitigate the psychological impact of moral injury and enable professionals to sustain their commitment to their work.

Our Commitment to Supporting Professionals Experiencing Moral Injury

At Nodelman Counseling & Psychotherapy, LLC, we understand the profound impact moral injury has on helping professionals. Jordan Nodelman, LCSW, BCD, provides specialized support through evidence-based interventions, including EMDR therapy, to assist individuals in processing morally distressing experiences. He offers a confidential, compassionate space where professionals can explore their emotions, reconcile their actions with their ethical beliefs, and develop strategies to enhance resilience. The goal is to empower you to continue your essential work with renewed confidence and well-being.

Please explore the website for more information.

References

Hurley, E. (2021). EMDR therapy and moral injury. EMDR International Association. Retrieved from https://www.emdria.org/blog/emdr-therapy-and-moral-injury/

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003

Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral injury and burnout in health care professionals during the COVID-19 pandemic. Journal of Nervous and Mental Disease, 209(10), 720–726. https://doi.org/10.1097/NMD.0000000000001367

Rushton, C. H., Swoboda, S. M., Reller, N., & Skarupski, K. (2024). Critical care nurses’ moral resilience, moral injury, institutional betrayal, and patient-related burnout. American Journal of Critical Care, 33(2), 105–114. https://doi.org/10.4037/ajcc2024481

Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412–420. https://doi.org/10.4037/ajcc2015291

Jordan Nodelman

Jordan Nodelman, MSW, LICSW, LCSW is a Licensed Independent Psychotherapist and Clinical Social Worker in Florida, Vermont (TELE), Virginia and Washington, DC. He is also a Board Certified Diplomate in Clinical Social Work, by the American Board of Clinical Social Workers. He is an EMDR Certified Psychotherapist and offers EMDRIA Consulting to EMDR clinicians. He provides both in-person & virtual therapy and EMDR in Fort Lauderdale, FL and Statewide in Florida, the Commonwealth of Virginia and Washington DC. He is a Tele-LICSW for the State of Vermont.

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