Moral Injury Reflection
A carefully paced worksheet for exploring moral injury: the event, violated values, related emotions, contextual factors and values-based steps toward repair.
2-page fillable PDF · US Letter (prints on A4) · Trauma · Moral injury
- Approach / concern
- Faith & Spiritual
- Technique
- Trauma · Moral injury
- Format
- Fillable PDF, 2 pages (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the Moral Injury Reflection?
Moral injury describes the lasting psychological, spiritual and social impact of perpetrating, failing to prevent, witnessing or being betrayed in events that transgress deeply held moral beliefs. First described in military contexts, it is increasingly recognized among healthcare workers, first responders and others.
Why it works
Moral injury is associated with guilt, shame, loss of trust and spiritual distress that may not respond fully to fear-focused PTSD treatments (Litz et al., 2009). Interventions emphasize contextualizing the event, self-compassion, and values-based repair actions.
When to use it
- Veterans and military members
- Healthcare workers after the pandemic or difficult cases
- First responders and public safety personnel
- Survivors of institutional betrayal
How to use it in session
- Build safety and rapport before using this sheet.
- Allow clients to describe the event at their own pace.
- Identify violated values and emotions.
- Explore context and compassionate perspectives.
- Plan values-consistent repair actions.
Clinician tips
- Avoid rushing to absolve; validate moral pain first.
- Consider spiritual or community resources if desired.
- Monitor for suicide risk, which can be elevated with shame.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Is moral injury the same as PTSD?
They can overlap, but moral injury centres on guilt, shame and betrayal rather than fear, and it is not a formal diagnosis.
Who is at risk of moral injury?
Anyone in situations involving high-stakes moral decisions, including military, healthcare, policing, child protection and emergency services.
References
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706.
Herman, J. L. (2015). Trauma and recovery: The aftermath of violence, from domestic abuse to political terror (Rev. ed.). Basic Books.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
