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

One of the things I find most interesting about supervising ACT therapists is that the model itself tells you something about what the supervision should be like. ACT is not a set of techniques sitting on top of a generic therapeutic relationship. It is a coherent framework with a particular account of what keeps people stuck and what helps them move. That framework applies to the supervisory relationship just as much as it applies to the clinical one. What this means practic

Most therapists choose a supervisor the way they might choose a plumber. You check they're qualified, you check they work with your client group, and if they seem reasonable in the initial conversation you say yes. The decision is often not more deliberate than that. This matters, because the quality of supervision has significant consequences for your development as a clinician, and not all supervision is equal. The evidence is clear that the right supervisor can deepen your

Most therapists I speak to describe their supervision in one of two ways. Either they're getting something genuinely useful: sessions that leave them thinking differently about their clients, more confident in their formulations, clearer about their clinical direction. Or they're getting something that functions more like a caseload review: a structured run-through of who they're seeing, what's happening, and whether anything needs escalating. The second type isn't bad superv