Failing to act when we think they should, particularly when the inaction involves harm to another person, or directly taking action against another challenge our ideas of moral rightness, and are what Kent Drescher, a clinical psychologist whose work with military veterans spans more than 25 years, calls “moral injuries.”

Drescher first used the term moral injury to describe when an individual experiences internal conflict stemming from involvement in acts that violate deeply held moral and ethical standards (Drescher et al., 2015). Moral injury is most likely to occur following events that involve betrayal, inappropriate or disproportionate violence, incidents involving civilians, and within-ranks violence (Drescher et al., 2015). Signs and symptoms of moral injury often include social problems, loss of trust or a sense of betrayal, spiritual/existential issues, psychological symptoms, and self-deprecation (Drescher et al., 2015).

Moral injury is also a concept that extends beyond the criteria for PTSD, typically involves disproportionate violence, is felt as morally injurious, and may include changes in spiritual and ethical attitudes and behaviors (Drescher et al., 2016). Where an injury might be defined as “damage or harm done to or suffered by a person,” a moral injury can be construed as damage or harm received to one’s moral center as a result of things experienced, seen, and done. Essentially moral injuries are actions that violate our sense of what is right, just, and fair. Further, they also violate our beliefs and assumptions about the way the world “should operate.”

The types of experiences that may lead to moral injury, Drescher notes, are acts of betrayal (by leadership, peers, civilians, or self); acts of disproportionate violence inflicted on others; incidents involving death or harm to civilians; and within group (or rank) violence (Drescher et al., 2016).

This is precisely why mass shootings often lead to feelings of moral injury. Why moral injuries matter when we talk about mass shootings is because mass shootings violate our ideas about what should happen. We don’t see them as fair, just, or in any way moral.

And what this leads to is often serious spiritual questioning, sometimes even a loss of faith, or what Drescher would call a “disruption in an individual’s confidence and expectations about their own or others’ motivation or capacity to behave in a just and ethical manner brought about by bearing witness to perceived immoral acts, failure to stop such actions, or perpetration of immoral acts, in particular actions that are inhumane, cruel, depraved, or violent, bringing about pain and suffering of others or their death” (Drescher, 2016).

The problem with moral injuries is not just that they lead to feelings of inner turmoil, shame, changes to a person’s sense of self, negative changes in ethical attitudes and behavior, changes or loss of spirituality, or reduced trust in others, but that all of these things combined make asking for help incredibly difficult.

But this is also where clinicians can be indispensable. Through understanding the mechanisms of moral injury, clinicians can become a critical life line for victims of mass shootings – one that understands and accepts their experiences, allows for their feelings of loss of spirituality, faith and trust, and continues to support them through the process of restoring them.

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Counseling Victims of Mass Shootings is a 3-hour online continuing education (CE) course that gives clinicians the tools they need to help their clients process, heal, and grow following the trauma of a mass shooting.

Sadly, mass shootings are becoming more widespread and occurring with ever greater frequency, often leaving in their wake thousands of lives forever changed. As victims struggle to make sense of the horror they have witnessed, mental health providers struggle to know how best to help them. The question we all seem to ask is, “Why did this happen?”

This course will begin with a discussion about why clinicians need to know about mass shootings and how this information can help them in their work with clients. We will then look at the etiology of mass shootings, exploring topics such as effects of media exposure, our attitudes and biases regarding mass shooters, and recognizing the signs that we often fail to see.

We will answer the question of whether mental illness drives mass shootings. We will examine common first responses to mass shootings, including shock, disbelief, and moral injury, while also taking a look at the effects of media exposure of the victims of mass shootings.

Then, we will turn our attention to the more prolonged psychological effects of mass shootings, such as a critical questioning and reconsideration of lives, values, beliefs, and priorities, and the search for meaning in the upheaval left in the wake of horrific events. This course will introduce a topic called posttraumatic growth, and explore the ways in which events such as mass shootings, while causing tremendous amounts of psychological distress, can also lead to psychological growth. This discussion will include topics such a dialectical thinking, the shifting of fundamental life perspectives, the opening of new possibilities, and the importance of community. Lastly, we will look at the exercises that you, the clinician, can use in the field or office with clients to promote coping skills in dealing with such horrific events, and to inspire psychological growth, adaptation, and resilience in the wake of trauma. Course #31-09 | 2018 | 47 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document).

Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more. Have a question? Contact us. We’re here to help!

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Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: Psychologists, Counselors, Social Workers, Marriage & Family Therapist (MFTs), Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), Registered Dietitian Nutritionists (RDNs), School Psychologists, and Teachers

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