Addressing Moral Injury In Clinical Practice

This book helps clinicians conceptualize moral injury and select evidence-based approaches to incorporate in their therapeutic work with trauma survivors, particularly military service members and veterans.

"This edited volume summarizes promising, evidence-based strategies clinicians can implement in their work with morally injured persons. Many service members transitioning to civilian life struggle with mental health issues. For some, these mental health issues revolve around moral injury-acts or experiences that contradict the individual's fundamental beliefs about the world, or how it ought to be. The book's expert contributors are researchers and clinicians who are leading efforts to define and assess moral injury, identify its potential mechanisms and outcomes, and develop and disseminate treatments to promote recovery and healing from morally injurious events. Through the use of case examples, authors discuss promising theoretical models for conceptualizing moral injury, prominent conceptual and clinical concerns for addressing such injuries in clinical practice, and existing and novel intervention approaches"--

Suffering is an unavoidable reality in health care. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, in part a reflection of the increasing complexity of health care, their roles within it, and the expanding range of available interventions. Moral suffering is the anguish that occurs when the burdens of treatment appear to outweigh the benefits; scarce human and material resources must be allocated; informed consent is incomplete or inadequate; or there are disagreements about goals of treatment among patients, families or clinicians. Each is a source of moral adversity that challenges clinicians' integrity: the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. If moral suffering is unrelieved it can lead to disengagement, burnout, and undermine the quality of clinical care. The most studied response to moral adversity is moral distress. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. It is vital to shift the focus to solutions and to expanded individual and system strategies that mitigate the detrimental effects of moral suffering. Moral resilience, the capacity of an individual to restore or sustain integrity in response to moral adversity, offers a path forward. It encompasses capacities aimed at developing self-regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum approach, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and source the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all.

A complete guide to an innovative, research-based brief treatment specifically developed for service members and veterans, this book combines clinical wisdom and in-depth knowledge of military culture. Adaptive disclosure is designed to help those struggling in the aftermath of traumatic war-zone experiences, including life threat, traumatic loss, and moral injury, the violation of closely held beliefs or codes. Detailed guidelines are provided for assessing clients and delivering individualized interventions that integrate emotion-focused experiential strategies with elements of cognitive-behavioral therapy (CBT). Reproducible handouts can be downloaded and printed in a convenient 8 1/2" x 11" size.

Introducing the first self-help workbook for moral injury, featuring a powerful approach grounded in acceptance and commitment therapy (ACT) to help you heal in the midst of moral pain and connect with a deeper sense of meaning and purpose. If you’ve experienced, witnessed, or failed to prevent an act that violates your own deeply held values—such as harming someone in an automobile accident, or failing to save someone from a dangerous situation—you may suffer from moral injury, an enduring psychological and spiritual pain that is often accompanied by post-traumatic stress disorder (PTSD), depression, substance abuse, and other mental health conditions. In order to begin healing, you need to (re)connect with your values and what really matters to you as a human being. Written by a renowned team of PTSD and trauma professionals, this workbook can help. The Moral Injury Workbook is the first workbook of its kind to offer a powerful step-by-step program to help you move beyond moral pain. With this guide, you’ll learn to work through difficult thoughts, emotions, and spiritual troubles; (re)connect with your deeply held sense of self, values, or spiritual beliefs; and gain the psychological flexibility you need to begin healing and live a full and meaningful life. Links to downloadable worksheets for veterans and clinicians are also included. Whether you’ve experienced moral injury yourself, work in the field of mental health, or are a pastoral advisor seeking new ways to help facilitate moral healing, this workbook is an effective and much-needed resource.

Moral Injury and Beyond: Understanding Human Anguish and Healing Traumatic Wounds uniquely brings together a prominent collection of international contributors from the fields of psychiatry, psychology, philosophy, theology, military chaplaincy and acute crisis care to address the phenomenon of moral injury. Introduced in the 1990s to refer to a type of psychological trauma, experienced especially by soldiers who felt that their actions transgressed the expected moral norms, this innovative volume provides a timely update that progresses and redefines the field of moral injury. The ten ground-breaking essays expand our understanding of moral injury beyond its original military context, arguing that it can fruitfully be applied to and address predicaments most persons face in their daily lives. Approaching moral injury from different perspectives, the contributors focus on the experiences of combat veterans and other survivors of violent forms of adversity. The chapters address thought-provoking questions and topics, such as how survivors can regain their hope and faith, and how they can, in time, explore ways that will lead them to grow through their suffering. Exploring moral injury with a particular emphasis on spirituality, the early Church Fathers form the framework within which several chapters examine moral injury, articulating a new perspective on this important subject. The insights advanced are not limited to theoretical innovations but also include practical methods of dealing with the effects of moral injury. This pioneering collection will be essential resource for mental health practitioners and trainees working with people suffering from severe trauma. Due to its interdisciplinary nature, it will be useful not only to those academics and professionals engaged with moral injury but will be a source of inspiration for any perceptive student of the complexities and dilemmas of modern life, especially as it interfaces with issues of mental health and spirituality. It will also be invaluable to academics and students of Jungian psychology, theology, philosophy and history interested in war, migration and the impact of extreme forms of adversity.

The first book to explore the idea and effect of moral injury on veterans, their families, and their communities Although veterans make up only 7 percent of the U.S. population, they account for an alarming 20 percent of all suicides. And though treatment of post-traumatic stress disorder has undoubtedly alleviated suffering and allowed many service members returning from combat to transition to civilian life, the suicide rate for veterans under thirty has been increasing. Research by Veterans Administration health professionals and veterans’ own experiences now suggest an ancient but unaddressed wound of war may be a factor: moral injury. This deep-seated sense of transgression includes feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs. Rita Nakashima Brock and Gabriella Lettini, who both grew up in families deeply affected by war, have been working closely with vets on what moral injury looks like, how vets cope with it, and what can be done to heal the damage inflicted on soldiers’ consciences. In Soul Repair, the authors tell the stories of four veterans of wars from Vietnam to our current conflicts in Iraq and Afghanistan—Camillo “Mac” Bica, Herman Keizer Jr., Pamela Lightsey, and Camilo Mejía—who reveal their experiences of moral injury from war and how they have learned to live with it. Brock and Lettini also explore its effect on families and communities, and the community processes that have gradually helped soldiers with their moral injuries. Soul Repair will help veterans, their families, members of their communities, and clergy understand the impact of war on the consciences of healthy people, support the recovery of moral conscience in society, and restore veterans to civilian life. When a society sends people off to war, it must accept responsibility for returning them home to peace.

Trauma Informed Guilt Reduction Therapy (TrIGR) provides mental health professionals with tools for assessing and treating guilt and shame resulting from trauma and moral injury. Guilt and shame are common features in many of the problems trauma survivors experience including posttraumatic stress disorder (PTSD), depression, substance use, and suicidality. This book presents Trauma Informed Guilt Reduction (TrIGR) Therapy, a brief, transdiagnostic psychotherapy designed to reduce guilt and shame. TrIGR offers flexibility in that it can be delivered as an individual or group treatment. Case examples demonstrate how TrIGR can be applied to a range of trauma types including physical assault, sexual abuse, childhood abuse, motor vehicle accidents, and to moral injury from combat and other military-related events. Conceptualization of trauma-related guilt and shame, assessment and treatment, and special applications are covered in-depth. Summarizes the empirical literature connecting guilt, shame, moral injury, and posttraumatic problems Guides therapists in assessing posttraumatic guilt, shame, moral injury, and related problems Provides a detailed look at a brief, transdiagnostic therapy shown to reduce guilt and shame related to trauma Describes how TrIGR can be delivered as an individual or group intervention Includes a comprehensive therapist manual and client workbook