One way to define moral injury fits neatly into existing clinical frameworks. A person experienced or perpetrated something that violated their moral code. They feel guilt, shame, and/or a corrosive sense of having become a different kind of person. Treatment involves processing the memory, challenging distorted cognitions, and working toward self-forgiveness. The internal wound, addressed internally, heals. This account is not wrong, but is incomplete -- and the part it miss

There is an assumption that runs through a lot of clinical work because it feels self-evidently true: if a client keeps coming back, something useful must be happening. It is not an unreasonable assumption. Therapy is effortful. Attending requires time, sometimes money, and a degree of willingness to engage with difficult material. Surely, the reasoning goes, people would not keep doing it if it were not doing something for them. That last part is correct. Therapy is almost a

Moral injury is defined, in the ACT framework Walser and colleagues have developed, not by what a person has but by what a person does in response to moral pain. In other words, moral injury is the way in which a person responds to their moral pain in such a way as to leave them disconnected from their own deeply held moral values. This functional orientation shifts the clinical question from symptom inventory to behavioural analysis: what is this person doing in response to

Process-Based Therapy (PBT) represents a significant shift in psychological treatment, moving away from rigid diagnostic categories and symptom-focused interventions toward a more individualized, dynamic, and flexible approach. At its core, PBT emphasizes understanding the underlying psychological processes that contribute to a person’s distress and well-being. A key aspect of PBT is its use in clinical case formulation, which allows therapists to develop tailored treatment p

Asking what your client wants from your work together might seem obvious but it isn't always as clear is it may first seem. In reality, it's common for clients in a mental health or psychological assessment to be focused on the things they don't want. For e.g., many will point to the symptoms they want to be rid of, such as anxiety, grief, sadness, low mood, intrusive thoughts or memories, or want to 'work through the trauma' (usually with the hope that doing so will make th

Experiential avoidance is an important concept within Acceptance and Commitment Therapy (ACT). It is the idea that, as humans, it is natural, and normal, for us to try and escape experiences which are uncomfortable or painful. That has survival value when it comes to many things in life; for example, it makes sense to avoid the physical pain of touching a hot surface because that will protect us from harm. But, equally, avoiding pain and discomfort in another context, such

Have you ever noticed yourself repeating the same unhelpful behaviours or patterns in your life, even when you know they do not work out well for you? Have you noticed your clients doing the same thing, even when they are aware of the problem? If you are anything like me, there's a good chance you have. Understanding why it happens for all of us is key to helping our clients, and ourselves, make changes to unworkable behaviours that last. The first thing to understand is

Principles and Processes: In this article, we look at the mechanisms that contribute to some trauma survivors going on to develop Post-Traumatic Stress Disorder (PTSD), and give an explanation, based on cognitive theory, for cognitive behavioural treatment interventions that target these mechanisms. Acute symptoms, such as intrusive memories, and intense feelings of fear, in days, weeks and months following a traumatic experience are common. Fortunately, most trauma survivo