Recovering from
moral injury

Concerns

Many people with moral injury - particularly when guilt and shame are involved - worry about being judged or rejected by a potential therapist. Some also worry about causing distress to the therapist and whether she or he can handle their story. There may also be concerns about the potential for legal ramifications of disclosure of transgressions.

 

With any therapy, it is important that you feel comfortable and able to establish a good working relationship with your therapist. Think of the first session as an interview of sorts; one in which you can sound he or she out and get a sense of their approach, their understanding of moral injury and how they might be able to help you.

 

Choosing a therapist

You should be able to have a frank conversation with a potential therapist about any concerns. A good therapist will be open about their stance and the professional ethics and guidelines that govern their practice. They can explain the principles of confidentiality and it's limits governed by the laws of your country and their professional body. Don't be put off if the therapist suggests that they would like to get back to you after seeking advice from a clinical supervisor or governing body. Every therapy situation is different and part of good therapeutic practice is seeking advice and a second opinion about certain matters.

 

You may not always feel the right connection with a therapist and may have to meet with several before you find the "right fit." You will know by a sense of ease, comfort and safety and a feeling that the therapist is in tune with you. They may be able to put words to things that you haven't been able to yourself and the things they say will demonstrate they are really listening and really "get you."

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Questions you can ask:

• What is their experience working with trauma?

• What is their understanding of moral injury?

• What is their treatment approach? What do sessions look like? Do they assign homework between sessions? How frequent are the sessions? (Trauma therapy should be at least weekly and can often be twice weekly.)

• What is their treatment "philosophy" - are they flexible and collaborative and able to tailor the treatment to the personal nature of your wounds?

• How are they supported and from whom do they receive clinical supervision?

• What do they think recovery will look like?

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Group therapy

Group based therapy interventions are often helpful in addition to individual counselling or as standalone support. The great benefit of group therapy is in the opportunity to meet and share with others who are experiencing similar struggles, which can be powerfully healing in ways that individual therapy can't.

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Look for programs that have been running for a long time and have lots of experience working with veterans. In some countries, programs may have to be accredited in order to provide services to veterans. This provides another layer of confidence that programs align with evidence-based treatment principles.

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Social support

Social support is the strongest predictor of mental health after traumatic events. While it is difficult to socialise when one is struggling and many people with moral injury withdraw from their social networks, social support is such a powerful lever of recovery and wellbeing that it is worth pushing through the discomfort and making the effort.

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Seek out people or groups that feel safe, that won't ask awkward questions or with whom you don't have to explain your circumstances. Often this is other people who may have had experiences of trauma and moral injury and there maybe dedicated support groups in your area.

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Whatever your circumstances, just know that there are people who can understand just how difficult moral injury can be and are willing to walk with you out of the darkness. Please go with my sincere wishes for your recovery and wellness.

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