You did your job. Maybe you did it well. And something about it still doesn't sit right, and hasn't for a long time.
Moral injury gets mistaken for PTSD, depression, or plain burnout all the time, and the treatments for those don't quite reach it. If you've been to therapy before and left feeling like the therapist understood the fear part but not the shame part, this page is for you.
What moral injury is
Moral injury is the damage done when you do, witness, or fail to prevent something that goes against what you believe is right. It also happens when the people or institutions you trusted let you down in a way that mattered. The wound isn't fear. It's guilt, shame, disgust, or a sense of betrayal, and it changes how you see yourself and the world.
PTSD is a nervous system stuck on threat. Moral injury is a conscience stuck on a verdict. They often happen together, but they need different work.
Moral injury isn't a diagnosis. It's a description of a real injury. Naming it accurately is usually the first relief people feel.
Who gets it
- First responders: the call that went wrong, the one you couldn't get to in time, the use of force you replay, the decision made in two seconds that you've had years to second-guess
- Military and veterans: what happened on deployment, and what you were asked to do or not do
- Healthcare and dispatch: the patient you couldn't save, the triage decision, the caller you couldn't help
- Anyone who had to choose between two bad options and lives with the one they picked
- Anyone betrayed by leadership, an agency, or a system they believed in
How it shows up
Withdrawal. Drinking more. Punishing yourself in ways that don't look like punishment from the outside. No longer trusting your own judgment. Contempt for leadership or institutions. Loss of faith, religious or otherwise. Feeling like you don't deserve good things. Avoiding the people and places that remind you. And a flatness that doesn't respond to the usual fixes.
I'm not going to tell you it wasn't your fault if you don't believe that. We'll look at it honestly together.
How I work with it
Naming it accurately comes first. Then we separate what you're actually responsible for from what you've been carrying that was never yours, without letting you off the hook for what is. That distinction matters. People can tell when a therapist just wants to reassure them, and it doesn't help.
When a specific event is the anchor, EMDR can take the charge out of it so you can think about it without being back in it. The work after that is rebuilding a workable relationship with your own conscience: making amends where they're possible, accepting what can't be undone, and deciding what kind of person you're going to be from here. That part is slower than symptom work. It's also the part that holds.
I've spent years alongside law enforcement and other public safety agencies. I know the difference between a bad outcome and a bad decision, and I know that the people carrying this the hardest are usually the ones who cared the most.
Confidentiality
Sessions are confidential. I do not report to your agency, your supervisor, or your union, and nothing we discuss goes into any personnel file. Standard legal limits apply, and I can walk you through exactly what those are so there are no surprises.
I do not conduct any pre-employment evaluation services for current or former therapy clients. If a conflict comes up, I'll tell you and help you find someone else.
Questions people ask
Is moral injury the same as PTSD?
No. PTSD is driven by fear and threat. Moral injury is driven by guilt, shame, or betrayal. They can occur together, and treating one doesn't automatically treat the other.
Do I have to tell you what happened?
Not on day one, and not in detail unless you want to. Some people take a long time to say it out loud. We can still do real work in the meantime.
What if I'm not religious?
You don't need any belief system to have a conscience that got hurt. Faith communities named moral injury first, but the injury itself isn't religious. If your faith matters to you, it can be part of the work. If it doesn't, it won't be.
Practical details
Telehealth only, by secure video, for clients located in Oregon, Washington, or California at the time of the session. $225 per session. I accept PacificSource (commercial and OHP) and Blue Cross. If your insurance isn't listed, contact me anyway. There are often other ways to get sessions covered, and I can help you sort that out. See Fees & Insurance.
If after a phone call it turns out I'm not the right fit, I'll point you to someone who is.
