Moral Injury. It’s a term that not a lot of people know, but that many, many of my clients experience.

My story of finding and then coming to research and write about moral injury comes straight from my clients. Early on in my counseling career, I was working with women who were survivors of abuse, and who qualified for a diagnosis of PTSD, but traditional treatments like EMDR didn’t seem to touch their symptoms. It was confusing to me, because they absolutely were experiencing PTSD symptoms, but there was something deeper. Something more profound to their stories. I remember thinking that it almost felt like they were profoundly haunted by what they experienced, saw, witnessed, or even participated in during their abusive relationships. But I didn’t know what to call these experiences, how to define or understand it clinically, or how to treat it.

Serendipitously, I was invited to a lecture on the concept of moral injury. I wasn’t supposed to be in that lecture - I had planned on going to one on EMDR - but a colleague had mentioned “moral wounding” to me, and I decided to change my plans. What was shared with me that day was one of those lightbulb moments for me professionally. The descriptions were presented within military veteran populations, but what these individuals were going through was exactly what I was seeing in my clients, and that I hadn’t been able to wrap my mind around yet.

Moral injury is the deep, existential, soul wounding that happens when someone violates their deeply held morals or beliefs. It can happen through witnessing events (such as witnessing your child being harmed in some way), experiencing the event itself but not being able to act or escape from it, or even participating in it. And many times, these acts were the things they had to do to survive or to ensure their children’s survival. For women in domestic violence, you will often hear echoes of it in statements of “I should have known better”, “how could I have let this happen?”, or worst of all what society puts on women when they say “why didn’t you just leave sooner?”

A place where I most significantly hear moral injury from survivors is when they speak about how their children were involved. Some of them speak about how their children witnessed the abuse, and they feel intensely guilty for what was modeled to them. Others talk about how they didn’t know what to do, and allowed their children to be harmed as well. Post divorce, many women talk about the guilt and shame they feel about having to send their children visitation with their ex partner due to court orders, even when they know there could be abuse happening - they legally don’t have a choice but to expose their children to an abusive parent, but this violates their most fundamental belief of keeping their children safe. All of these things add up to having a felt sense of having not done enough, of doubting your own goodness, and feeling as though you are not living within your values.

And I can say that what is experienced in these thoughts and feelings of guilt and shame is profound.

And, it takes a different approach to healing than it does from the physical symptoms of PTSD.

At this time, there is very little research on domestic violence and moral injury. Moral injury is mostly researched within military populations, and has extended into healthcare populations since the Pandemic. Right now, there have been two small statistical studies on moral injury and domestic violence.

I am conducting the first qualitative study on moral injury and domestic violence where I am seeking to understand the lived experiences of women who are survivors. While this informs my work with clients, my biggest hope is that this study will inform the counseling field in general on how to best support you.

This is a topic I am highly passionate about, and one of my life’s callings. This is the topic of my dissertation, but I have also presented on this at international, national, and state-level mental health conferences.

I would love to talk to you more on this topic if you are interested - please reach out!