Trauma and Faith serie: Working with Moral Injuries
When I was doing my research last year about the impact of Trauma on faith, I came across the term, Moral injuries.
Jeannette Harris define this term as ‘the psychological and behavioural sequellae of experiences that challenge deeply held moral, spiritual, or values related beliefs’. It is linked to the process of meaning making, a response to being forced to do something that in another context is viewed as immoral. Traumatic events and the harm witnessed can challenge some of our concepts of a Higher Power and the concept of good and bad (theodicity) which can then make us doubt previously held beliefs and disrupt previously supportive relationship with God and the community of faith.
Moral injuries can appear following an event when:
- We had to do something that violates our own moral codes
- We witnessed something that went against our moral codes, our values and/or our spiritual assumptions
- Feeling helpless to address a harmful situation
- We felt betrayed by authorities and peers that we felt shared values with us.
Signs that we are impacted by it can be:
- Loss of previously held spiritual beliefs
- Struggle and conflict in relationship with a Higher Power/ God
- Difficulty forgiving self, others, or a Higher Power/ God
- Feeling that there is no meaning or purpose in life
- Reduced trust in others
- Inappropriate guilt and shame.
Moral injuries affect our emotions and well-being and can make us feel angry, depressed, anxious, having nightmares, feeling ashamed and alienated from others.
How to help:
To offer support to someone suffering from moral injuries it is important to address the spiritual element of the trauma. One way to achieve this is to start by understanding the place of spirituality in the person’s life by asking question about their religious and spiritual life
We can start by asking questions about the client’s current religious affiliation, if it similar to their childhoods’ affiliation, if they perceive their beliefs as a strength and if they have any spiritual concerns that are contributing to their issues. In a second stage if the client describes themselves as religious, more specific question can be asked such as:
- How do you pray?
- What do you pray for?
- How do you envision God?
- What type of relationship do you have with God?
The response to those questions will be helpful to assess where the clients is in term of their spirituality using models of evaluation such as Fowler’s (Richards and Bergin, 2002:184) and Malony’s (:186) and will help decide which therapeutic intervention might be more appropriate.
Use of questionnaire to assess religious activities and religious and spiritual struggles could be useful tools for a more thorough exploration of what might be hindering recovery.
Jeanette Harris also developed an intervention called Building Spiritual Strength (BSS). It is an inter-faith group intervention of eight sessions that integrate spirituality (Harris et al. 2011). It is designed to ‘explore and reduce spiritual distress’ (:427) while helping participants to ‘make the best use of their pre-existing faith’ (:426). Most of the sessions, can be adapted for one to one work and used as a model for a specific intervention with the client. Some elements might be particularly useful to adapt such as the empty chair exercise and prayers logs that are used to encourage clients to talk or write about their issues and then think about what they think God might answer.
An example of the empty chair exercise can be seen here:
Harris, J. I., Erbes, C. R., Engdahl, B. E.,Thuras,P., Murray-Swank, N., Grace D., Ogden, H., Olson, R.H.A., Winskowski, A.M., Bacon, R., Malec, C., Campion, K., Lee, T. (2011) The Effectiveness of a Trauma-focused Spiritually Integrated Intervention for Veterans Exposed to Trauma. Journal of Clinical Psychology, 67:4, 425-438.
Harris, J.I., Usset T. (2018) Building Spiritual Strength [Power Point Presentation] Training for Chaplains and Therapists, 15 March 2018.
Richards, P.S., Bergin, A.E (2002) A Spiritual Strategy For Counselling And Psychotherapy. Washington: American Psychological Association.