Guilt, Shame and Moral Injury

Moral injury is, mostly simply, when someone has to make a decision that violates their “deeply held values.” [1] The majority of research on moral injury is done with service members and veterans returning from areas of conflict but has implications for the everyday person as well. Guilt and shame are part of experiencing moral injury [2] which can be difficult feelings to change. Acting outside and counter to one’s values can lead to feeling that “healing is unattainable because they believe they deserve their suffering - a fitting punishment…” [3] The self-evaluation “I deserve to be punished” emerges from these situations from the difficulty of identifying the nuance and complexity of a situation for which one believes they are to be blamed. In order to capture this complexity of understanding, it is helpful to look at two things: (1) the social function of emotion and (2) evaluating our understanding of causation in morally injurious experiences. 

Dretcher and Farnsworth (2021) identify three social functions of emotions: they help keep us alive, keep us together (as social creatures), and “to help [us] navigate the various threats and opportunities of living together in social groups.”[4] Meaning, emotions have the potential to help us reflect on the impacts of our actions in order to keep us safe and within the bounds of the social contracts of the spaces we inhabit. Where this can go askew, is when our emotions take over and there is little space for self-compassion. 

Cognitive Processing Therapy (CPT) gives us language to think about this. CPT is a therapeutic modality to process traumatic events and experiences focusing less on the details of the experience itself and more on the interpretation and meaning-making happening in the wake of an event.[5] CPT asks us to look at beliefs about what caused the experience.[6] The human tendency is to focus on the parts we did have control over, or thought we had control over. Exploring the reality that there were actors and actions outside of our control contributing to the situation helps us create an updated and accurate understanding of the situation and our limitations therein.

All of this is to say that shame and guilt can be uncomfortable and undesirable to experience but are normal emotions to have - at times. They function only to teach us how to move forward and do better next time - but are not always as helpful to hold on to long term. When we have a sufficiently complex understanding of how the situation came to be we can foster self-compassion, begin identifying how we can adjust our behaviors in the future, and then move back into community. Vulnerability (with the right people) is important in reducing shame - vulnerability might be antithetical to what our internalized shame tells us but realizing that others likely do not evaluate us as harshly as we evaluate ourselves can be a gift. Blame (including self-blame) is a relatively unhelpful tendency. However, self-compassion and a willingness to learn can be transformative. 

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[1] Walser, R. D., and Wharton, E. (2021) “Acceptance and Commitment Therapy: Using Mindfulness and Values in the Treatment of Moral Injury,” in Currier, J.M., Drescher, K. D., and Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (p.163). APA PsycBooks.

[2] Drescher, K. D., and Farnsworth,J. K. (2021) “A Social-Functional Perspective on Morality and Moral Injury,” in Currier, J.M., Drescher, K. D., and Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (pp.39–42). APA PsycBooks.

[3] Walser, R. D., and Wharton, E. (2021) “Acceptance and Commitment Therapy: Using Mindfulness and Values in the Treatment of Moral Injury,” in Currier, J.M., Drescher, K. D., nd Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (p.163). APA PsycBooks.

[4] Drescher, K. D., and Farnsworth,J. K. (2021) “A Social-Functional Perspective on Morality and Moral Injury,” in Currier, J.M., Drescher, K. D., and Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (p.37). APA PsycBooks.

[5] Wachen, J. S., Evans, W. R., Jacoby, V. M., and Blankenship, A. E. (2021) “Cognitive Processing Therapy for Moral Injury,” in Currier, J.M., Drescher, K. D., and Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (pp.144–146). APA PsycBooks.

[6] Wachen, J. S., Evans, W. R., Jacoby, V. M., and Blankenship, A. E. (2021) “Cognitive Processing Therapy for Moral Injury,” in Currier, J.M., Drescher, K. D., and Nieuwsma, J. A. (Eds.), Addressing moral injury in clinical practice (p.149). APA PsycBooks.

This month Looking Glass Counseling is pleased to support CASCAP. Since 1973 Cascap, Inc. has been providing secure, affordable and dignified housing and services for members of the Greater Boston community who are disadvantaged due to income, disability or age. 

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Jon Wisdom, LCSW received his Master of Social Work degree, specializing in Trauma and Violence, from Boston University in a dual-degree program where he also received a Master of Divinity. Previously he worked as an interfaith hospital chaplain and holds a masters degree in Spiritual Care. Jon has pursued this integrated learning with the hope of working with queer individuals with religious trauma. As a queer man, he knows this is a complex issue that requires a lot of existential exploration which can be personally challenging.

In practice, Jon prioritizes affirming and patient-centered care. He uses modalities such as Phase Oriented Trauma Treatment, Motivational Interviewing (MI), Solution Focused Therapy, Cognitive Behavioral Therapy (CBT), narrative approaches, psychodynamics and operates with an anti-oppression framework. His goal as a therapist is to provide space for his clients to come as they are and for them to know that they have inherent worth and value.

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