What is the Difference Between Setting Healthy Boundaries and Putting Up Walls?

I have written about setting healthy boundaries and putting up defensive walls in prior articles (see links for these articles at the end of this article).

What is the Difference Between Setting Healthy Boundaries and Putting Up Walls?

People often confuse healthy boundaries and putting up walls, so let's explore the difference between the two.

Setting Healthy Boundaries vs Putting Up Walls

The primary difference is that healthy boundaries are meant to protect connection between two or more people and putting up walls prevents connection.

The description below is a comparison between the two:

Core Motivation

• Healthy Boundaries: Self respect and love
• Putting Up Walls: Fear and self preservation

Communication

• Healthy Boundaries: Boundaries are explicit and clear
• Putting Up Walls: Walls are silent withdrawal or shutting down emotionally

Flexibility

• Healthy Boundaries: Permeable, situational and adaptive
• Putting Up Walls: Rigid, static and absolute

Relational Goal

• Healthy Boundaries: Show others where the "door" is
• Putting Up Walls: Lock others out indiscriminately

Personal Outcome

• Healthy Boundaries: Closeness, peace and security
• Putting Up Walls: isolation, loneliness and hypervigilance

Let's take a look at each one individually:

Healthy Boundaries

• Driven By Self Respect: Boundaries define what is okay and what is not based on your values, comfort level and energy.

• The "Doorway" Concept: A boundary acts as a "door' with instructions. It lets people know exactly how they can interact and achieve emotional intimacy with you. 

• Highly Communicative: Boundaries are explicitly defined. An example would be, "I want to talk about this, but I need us to speak calmly. If either of us raises our voices, I'm going to step away for 20 minutes to cool down before I come back and we resume our discussion."

• Context-Dependent: Boundaries can shift depending on trust, safety and the specific person involved.

Putting Up Walls

• Driven By Fear: Walls are defensive barriers which are often related to unresolved psychological wounds or, possibly, exhaustion.

Setting Healthy Boundaries vs Putting Up Walls

• Total Blockage: Instead of regulating the flow of the relationship, walls shut the external world out. Putting up walls assumes that vulnerability equals danger.

• Shutdown: Walls rarely come with clear, healthy communication. They can manifest as the "silent treatment", emotional coldness, ghosting or stonewalling

• Rigid and Indiscriminate: A wall implies a blanket rule for everyone. For example, "Everyone always let me down, so I'm never opening up to anyone."

Clinical Vignette

The following clinical vignette, which is a composite of many different cases, illustrates how someone can learn to take down their wall and learn to set healthy boundaries:

Eric

After a woman he was dating, Paula, told Eric that she found him hard to get to know because of the rigid walls he maintained, Eric decided to seek help in therapy to work on this issue. 

Other women had told him the same thing in the past and, since he really liked Paula, he knew his relationship with her wouldn't work out if he continued to be defensive.

Initially, Eric sought help in cognitive behavioral therapy (CBT) because he wanted quick tools for overcoming his problem. 

But, even after Eric developed insight in CBT into his problems and learned tools and strategies to open up, he didn't feel any more comfortable opening up (see my article: Healing From the Inside Out: Why Insight Isn't Enough).

Realizing that insight wasn't enough, Eric asked his friends to find about other types of therapy options he try and his closest friend suggested that he try one of the Experiential Therapies (see my article: What is the Difference Between "Top Down" and "Bottom Up" Approaches to Therapy?).

After Eric looked around, he began working with an Experiential Therapist who did IFS (Internal Family Systems) Therapy which is also known as Parts Work Therapy or Ego States Therapy.

Eric immediately noticed the difference. He and his IFS therapist worked on a much deeper level to help him understand why he kept walls up in his relationships with women and, more importantly, how he could learn to take down the walls and develop healthy boundaries.

IFS therapy didn't turn out to be the "quick fix" Eric hoped for, but he was gradually making progress which Paula noticed. He was able to communicate with her in a more open and flexible way. As a result, their relationship deepened and grew.

He also worked through the unresolved complex trauma that caused him to build walls with women in the first place.

Eric also learned to distinguish when he was safe with others and when he needed to set firmer boundaries. For instance, he learned to set firmer boundaries with certain family members who tended to say hurtful things to him and he felt proud of himself for that.

Conclusion

Many people confuse setting healthy boundaries with putting up walls.

Putting up walls is often the result of unresolved trauma.

Change happens on an emotional level which is why traditional talk therapy often doesn't resolve trauma (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy?).

Experiential therapy, which includes IFS, EMDR, AEDP, Somatic Experiencing as well as other similar therapies, can help you to go beyond just developing insight so that you can make significant emotional and psychological changes in your life.

Getting Help in Experiential Therapy

If you are struggling in your relationships because you tend to put up walls, you could benefit from working with an Experiential Therapist.

Getting Help in Experiential Therapy

Rather than struggling on your own, seek help from a licensed mental health professional who is an Experiential Therapist so you can have healthier relationships and have live a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS, Somatic Experiencing and Certified Sex Therapist

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

I provide a free 10-15 minute phone conversation before I set up a first appointment.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Setting Healthy Boundaries in Relationships 

Overcoming Share in an Enmeshed Family 

What Are the Unspoken Expectations Between Some Mothers and Adult Daughters? 

Setting Boundaries With Family Members Who Want to Interfere in Your Relationship 

Emotional Numbing: The Wall That Once Protected You Now Imprisons You

How Therapy Can Help You With the Walls You Have Built Around Yourself  

 

Can You Heal From Your Trauma Without Psychotherapy? Part 2

In my last article,  Can You Heal From Your Trauma Without Psychotherapy - Part 1, I began with a very qualified "yes" to this question.

Healing From Trauma

Part 1 of this topic focused on the barriers to finding a therapist which often forces people who want therapy to deal with their trauma on their own. 

In the current article, I'll discuss the types of self-help interventions you can use on your own to heal from trauma and some of the challenges involved in trying to heal certain types of trauma on your own.

Generally speaking, you can try to heal on your own with one-time traumatic events that are mildly disturbing--although what is mildly disturbing to one person is severely disturbing to someone else. As a result, you have to know yourself well without being in denial about how you're affected by your unresolved trauma.

Healing From Trauma on Your Own Without Psychotherapy

Under certain circumstances, which I'll discuss in this article, individuals do heal from trauma on their own without psychotherapy.

Healing From Trauma

Many individuals who have a natural resilience, a strong support network and self-directed coping strategies have healed on their own from mildly disturbing traumatic events.

I'll discuss the limitations and risks in the next section of this article.

With the exception of complex trauma, chronic trauma, depression, panic attacks, severe flashbacks, substance abuse or debilitating anxiety and other related conditions, many individuals can heal from trauma without therapy.

Another exception is if a one-time traumatic event occurs and you have a history of complex trauma. Under these circumstances, the one-time event can exacerbate long-standing complex trauma, so it's not advisable to try heal on your own. You need professional help.

Whether or not you can heal from trauma on your own depends on certain personal factors including (but not limited to):

• The severity of your trauma
• The duration of your trauma
• The frequency of your trauma
• Your internal resources and coping skills
• Your personal access to a safe environment

It's not unusual for individuals who experience trauma to underestimate the severity, duration and frequency of their trauma, so you have to be objectively honest with yourself.

In addition, if someone is accustomed to living in an unsafe environment, they might have a blind spot about their current circumstances because it's familiar and seems "normal" to them. So, once again, you need to be objectively honest with yourself, which can be challenging.

When Is It Possible to Heal Independently?

Since trauma affects the brain's survival wiring and nervous system, the possibility of healing independently requires a combination of emotional, mental and physical strategies:

• Somatic and Nervous System Regulation: Trauma traps the body in a continuous state of fight, flight or freeze. Individuals who have unresolved trauma often benefit from physical practices like trauma-informed yoga, breathwork and rhythmic movement to signal to their nervous system that they are safe now. 

Healing From Trauma

• Structured Self Reflection: Tools such as expressive writing or structured journaling allow individuals with trauma to safely externalize their overwhelming feelings, identify trauma triggers and track behavior problems without immediate judgment. 

• Relational Safety: Healing from trauma rarely, if ever, occurs in isolation. Building trusted relationships with safe friends, family members or peer support groups help build a sense of shared belonging and mutual trust.

• Psychoeducation: Reading evidence-basesd literature on trauma recovery can empower individuals to understand their emotional flashbacks and dismantle self-blame objectively. Although developing insight into your trauma isn't the same as working through it, psychoeducation is a good first step.

What Are the Risks and Limitations to Healing Independently?

While self healing is possible, trying to navigate healing from trauma entirely on your own has distinct challenges that should be carefully considered:

• Risk of Retraumatization: This is a very important consideration. The unchecked excavation of deeply repressed, distressing traumatic memories without professional stabilization from a mental health professional can inadvertently reinforce neural pathways of fear, anxiety, panic and amplification of panic and anxiety. 

• Blind Spots: An individual's psychological defense mechanisms, including dissociation and emotional numbing, can hide underlying trauma responses. This makes identifying a trauma response very difficult to identify and resolve on your own.

• Symptom Severity: Self-directed methods to healing trauma are generally more effective for localized, single-event trauma (e.g., a one-time argument with a loved one when the relationship is normally healthy, a close call with a car accident where the accident never occurred and other similar one-time events). Complex trauma, chronic trauma, persistent panic attacks, severe flashbacks, substance abuse and depression are among the conditions that shouldn't be handled independently. Under those circumstances, a qualified mental health professional is required.

• Avoid Reliving Instead of Revisiting the Trauma: Retelling your trauma, whether you do it on your own or you talk with a therapist who isn't a qualified trauma therapist, will be retraumatizing instead of healing.

Healing From Complex Trauma

Complex trauma stems from chronic, repeated interpersonal violations such as childhood abuse and neglect and other similar conditions.

Complex trauma fundamentally alters your brain structure, your nervous system and relational trust.

Trauma therapy remains the gold standard for complex trauma.

Why is Self-Healing Not Advisable For Complex Trauma?

Here are some of the major reasons:

• The "Window of Tolerance" Danger: Healing complex trauma requires processing traumatic memories without tipping into panic or shutting down with dissociation. Without a trauma therapist to help you monitor your "window of tolerance", processing deep trauma on your own can lead to unintended retraumatization (see my article: Expanding Your Window of Tolerance to Overcome Emotional Problems).

• The Relational Wound: Complex trauma is usually caused by people. Since the hurt happened in a relationship, true rewiring of your attachment system and relational trust requires a safe, consistent relationship--the type of relationship you have with a skilled trauma therapist.

• Nervous System Hijacking: Trauma lives in the trauma-focused and emotional parts of the brain and body--not just in the logical part of your brain. It is extremely difficult (if not impossible) for you to talk yourself or think yourself out of an automatic biological panic without professional help.

When Self Help is Not Enough

Self-guided healing is more likely to work for mild symptoms and establishing baseline stability.

As previously mentioned, professional help is needed if you have complex trauma, panic attacks, depression, substance abuse problems, flashbacks, relationship problems, debilitating anxiety or other symptoms that affect your daily functioning.

Before You Try to Heal Your Trauma On Your Own, Consult a Professional: If you are considering whether or not to try to heal without therapy or you want to make sure you'll be safe on your own, have a consultation with a licensed mental health professional who is a trauma therapist. 

A skilled trauma therapist can assess whether you can safely try to heal on your own or if you need professional help.

Getting Help in Trauma Therapy

If you decide to pursue trauma therapy with a licensed mental health professional, you have various choices with regard to trauma therapy modalities:

The Top Down Approach to Trauma Therapy

The top down approach to trauma therapy includes cognitive behavioral therapy (CBT) which challenges your distorted thoughts and beliefs related to your trauma. The problem with CBT, in my professional opinion, is that it usually leaves out the mind-body connection and it often doesn't go deep enough.

Trauma Therapy: Top Down and Bottom Up Approaches

The Bottom Up Approach to Trauma Therapy

I recommend the Bottom Up approach to trauma therapy, which are also known as Experiential Therapies (see my article: What is the Difference Between Top Down and Bottom Up Therapies?

Experiential Therapy tends to be more effective for processing trauma than traditional talk therapy like CBT (see my article: Why is Experiential Therapy More Effective Than Traditional Talk Therapy to Overcome Trauma?).

Experiential Therapies are mind-body oriented therapy that get to the root of the problem by focusing on the mind-body connection (see my article: Experiential Therapy and the Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Bottom up Experiential therapies include:

• Somatic Experiencing Therapy (SE)

• AEDP (Accelerated Experiential Dynamic Psychotherapy)

• Somatic IFS Therapy (Somatic Internal Family Systems Therapy)

• EMDR (Eye Movement Desensitization and Reprocessing Therapy)

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS/Parts Work Therapy, Emotionally Focused Therapy for couples, Somatic Experiencing and Certified Sex Therapist.

As a trauma therapist, I have helped many individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

I offer a free 10-15 phone call before I sent up a first appointment.

You can call me at (917) 742-2624 during business hours or email me to make an appointment.

Also See My Articles:

How Does Somatic Experiencing Process Emotions? 

Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs

Combining EMDR and IFS Somatic Parts Work Therapy 

How Does AEDP Heal Trauma? 

What is Somatic Resonance and Why Is It Healing?

Can You Heal From Your Trauma Without Psychotherapy? Part 1

Can you heal from your trauma without therapy? 

Can You Heal From Trauma Without Psychotherapy?

The answer is a qualified yes under certain circumstances.

Since this is a big topic, I'll get discuss some self-help techniques in Part 2 of this topic and the exceptions to healing from trauma on your own.

Barriers to Psychotherapy

First, I want to acknowledge that there can be significant barriers to therapy for many people.

It's understandable that these barriers are some of the reasons why people with unresolved trauma often want to try to heal on their own. 

These barriers include:

Financial and Logistical Barriers

• Shortage of Therapists: Many regions in the US, especially in rural areas, have a shortage of mental health professionals. You can do online therapy with a licensed therapist within your state so you don't have to go to the therapist's office in person, but there still aren't enough therapists for all the people who need therapy. Even if New York City, the demand for therapists is higher than the available therapists. This often means there are long waiting lists or, worse still, people can't access therapy at all.

• Finding An In-Network Therapist on Your Insurance Plan: Even if you have health care insurance, finding an in-network therapist can be difficult--even in New York City where there are hundreds of therapists. If you're trying to use your in-network health insurance, you might discover that the list of therapists from the insurance company is out of date. When I worked as an EAP counselor in New York and I tried to find in-network therapists for clients, I kept coming up against this problem. There were times when I discovered that psychotherapists and psychiatrists listed on the panel were dead for 10 years or more. So, you can't always rely on that information. Then, even if you do find a therapist who is in your network, they are often completely booked up. Another barrier is that, even if you get an appointment with an in-network therapist, they usually see 30-40 clients per week, so you're often getting a therapist who is overworked and underpaid by the insurance company. There is a high percentage of therapist burnout among psychotherapists who take insurance due to the high volume of clients they need to see to make a living and the administrative burdens the insurance company places on them.

• Finding An Out of Network Therapist: You're more likely to find an out of network therapist because highly trained, experienced therapists don't want to deal with the challenges of being an in-network therapist (low insurance reimbursement rates, a lot of paperwork, lengthy waits to get paid by the insurance company and intrusive insurance audits where the insurance company asks for private information about clients' treatment). The problem with a lot of out of network therapy is that it can be expensive and, if you don't have an out of network benefit or a health savings plan, the cost adds up, especially if the therapist doesn't offer reduced fees to qualified clients.

• Time and Schedule Constraints: Balancing therapy, which is usually once a week, can be difficult with work demands, child care issues or other responsibilities.

• Transportation Issues: New York City has a good public transportation system, but in many other areas there isn't reliable transportation to get to a therapist's office.

Cultural and Social Barriers

• Social Stigma: Although going to therapy has less of a stigma than it used to in the past, many people still see going to therapy as a "weakness". So, this stigma can keep many people out of therapy (see my article: Common Myths About Therapy: Going to Therapy Means You're "Weak")

Barriers to Psychotherapy

• Lack of Cultural Competence and Humility: There is a shortage of therapists who understand specific cultural backgrounds, racial realities, LGBTQ+ issues and other related cultural issues. Outside of major cities, like New York City, this can leave people in certain cultural groups feeling underrepresented and misunderstood. 

• Language Barriers: Individuals who speak a language other than English can have a hard time finding therapists who are capable of conducting a therapy session in their language, especially in smaller cities.

• An Emphasis on Self Reliance: As I mentioned in a prior article, certain cultures and generations place a strong emphasis on handling problems on your own. These individuals often view therapy as an unnecessary reliance on strangers.

Emotional and Psychological Barriers

• Fear of Vulnerability: Many people find it difficult to open up to talk about personal problems, unresolved trauma or suppressed emotions with a stranger. For these individuals talking to a therapist brings up anxiety.

Barriers to Psychotherapy 

• Denial About Problems: Many individuals are in denial about their problems or unresolved trauma. Despite the problems they are having in their current life, they convince themselves that their problems aren't serious enough to get help. They might even point to others they think have far worse problems (see my article: The Problem With Comparative Suffering).

• Distrust Due to Bad Experiences From the Past: If a person has had bad experiences within the health care system in the past, they might have difficulty seeking help with emotional issues.

• Fear Problems Will Get Worse in Therapy: Some people avoid therapy because they fear their problems will get worse in therapy. They fear that their unresolved buried trauma will cause them to lose control before they can work through their issues.

Next Article: Can You Heal Your Trauma Without Psychotherapy - Part 2

About Me 

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS/Works Therapy, EFT for couples, Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

I offer a 10-15 minute free telephone call before setting up a first appointment. 

To set up an appointment, call me at (917) 742-2624 during business hours or email me.

Relationships: Asking Your Partner For Emotional Support

Many people in relationships have problems asking for their emotional needs to be met because it requires intense vulnerability and it also triggers deep fears of rejection, judgment or fear of abandonment.

Asking Your Partner For Emotional Support

In addition, our American culture treats emotional self reliance as a strength which causes many people to view their normal human needs as character flaws or signs of weakness.

Childhood Conditioning

Childhood conditioning can also play a role:

• Early Childhood Emotional Neglect: If someone's childhood emotional needs were minimized, ignored or punished, their nervous system learned that asking for their emotional needs to be met was emotionally and physically unsafe (see my article: What is Childhood Emotional Neglect?).

Childhood Emotional Neglect

• The "Easy" Child Trap: Many people learned as children that they had to earn love and approval by being low maintenance, quiet and overly accommodating and this belief often persists on an unconscious level in adulthood in their relationships.

• Hyper-Independence: Childhood emotional neglect often forces children to become overly self sufficient beyond their developmental capacity, but this is a pseudo-independence because it's a survival mechanism driven by fear and neglect rather than a natural, healthy stage of development. This builds thick emotional walls against relying on anyone else. This pattern continues into adulthood which makes it difficult to ask for emotional support in a relationship (see my article: Masking Vulnerability and Shame By Pretending You Don't Need Anyone).

Fears and Psychological Barriers

• Fear of Being a Burden: People frequently convince themselves that their feelings will overwhelm, stress out or inconvenience their partner. 

Fears and Psychological Barriers to Asking For Emotional Support

• Shame of Being "Needy": Internalized shame makes people worry they will be perceived by their partner as being too "needy", dramatic, high maintenance or emotionally unstable. They have learned from early childhood, often on an unconscious level, that their normal emotional needs were "too much". This often occurs because their parents were overburdened with just trying to survive. For example, the parents  might have been working two or more jobs just to be able to meet basic needs. In many cases, the parents also didn't have their own emotional needs met and this emotional neglect is part of a long line of intergenerational trauma (see my article: What is Intergenerational Trauma?.).

• The Mind Reading Myth: Many individuals have an unspoken belief that if their partner really loved them, they would automatically know what they need without being asked (see my article: Are You Expecting Your Partner to Be a Mind Reader?).

• Emotional Disconnection: Decades of suppressing feelings can leave someone fuzzy or completely unaware of their own emotional needs.

Relationship Dynamics

• Fear of Rocking the Boat: When a relationship is going relatively well, individuals might remain silent about their unmet emotional needs to protect the harmony in their relationship and avoid conflict.

• Past Experiences of a Partner Weaponing Vulnerability: Some people avoid asking for what they need emotionally because their emotional needs and vulnerabilities in prior relationships were used against them as leverage or ammunition during arguments.

What Are Practical Strategies For Asking For What You Need From Your Partner?

Focus on Your Internal State

• Identify Your Feelings: Pinpoint your emotional need (loneliness, feeling invisible, feeling overwhelmed) before speaking to your partner.

Locate Physical Sensations Related to Emotions

• Locate the Physical Sensation: Notice where the tension is located in your body to help you to connect with what you need. 

• Name the Core Deficit: Figure out if you need reassurance, physical touch, focused attention or validation (see my article: What is Emotional Validation and Why is It Such a Powerful Skill in Relationships?).

• Learn to Separate the Past From the Present: Acknowledge whether your current emotional reaction is being driven by old unresolved childhood wounds or prior relationship experiences (see my article: Learning to Separate Past Experiences From Your Current Experience).

Use Specific Communication Techniques

• Lead With Vulnerability: Use "I feel" statements rather than "You make me feel..." statements.

Asking Your Partner For Emotional Support

• Say the Hard Truth: If you feel afraid to express your needs, start with a phrase like, "It's really scary for me to admit this, but..."

• Describe Your Internal State: Feel into your internal state and become aware if you're telling yourself a story that might not be true. For instance, recognize if you're telling yourself something like "He's bored with me" or "He doesn't love me anymore" when this isn't true. Then, tell your partner, "I'm telling myself that you're bored with me" (or whatever you're feeling) and allow your partner to respond.

• Make Requests That Are Actionable: Ask for specific behaviors instead of vague concepts. For example, instead of saying "I need you show you care more", say "I need you to hold my hand while I'm talking to you about my feelings."

Asking Your Partner For Emotional Support

• Ask For a Specific Time: Ask your partner something like, "Can we find 20 minutes tonight to talk about something that has been weighing on me?" If it's not the right time, schedule another time that works for both of you. If you have children, choose a time when you won't be interrupted.

• Remove All Digital Distractions: Turn off and put away phones, turn off the TV, put away the computer and other distractions and sit face-to-face before diving into your discussion.

• Reassure Your Partner in Advance: If they haven't done anything that is making you unhappy, reassure them that they're not in trouble--you just need to share your feelings.

• Keep the Conversation to a Manageable Length: Focus on a specific emotional needs rather than listing months or years of unmet emotional needs (see my article: How to Stop "Kitchen Sinking" Your Partner).

Responding to Your Partner's Reaction

• Appreciate Your Partner's Willingness to Listen and Communicate: Thank your partner for listening--even if the conversation is awkward and uncomfortable. Recognize that your partner is experiencing their own emotional vulnerability by just listening.

Express Appreciation to Your Partner

• Validate Your Partner's Perspective: Acknowledge your partner's response. For instance, if your partner is opening up to hearing your unmet needs and you recognize that your partner is tired, acknowledge this to them by saying something like, "I realize you're tired and I appreciate that you're hearing me out."

• Allow Room For Pauses: Give your partner time to emotionally process what you are saying without rushing in to fill in the silence.

• Schedule a Future Check In: Propose circling back in a few days to see how the new approach to communicating your needs is working for you and for your partner.

Get Help in Couples Therapy

Communicating your emotional needs to your partner can be challenging especially if you never learned to do it before.

Get Help in Couples Therapy

A skilled couples therapist who is a licensed mental health professional can help you to learn to express your emotional needs and work out problems in your relationship.

Rather than struggling on your own, seek help from an experienced couples therapist so you can have a more fulfilling relationship.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS, Emotionally Focused Therapy for couples, Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

Before setting up an appointment, I provide a free 10-15 minute telephone call.

You can call me at (917) 742-2624 during business hours or email me.

Healing From Moral Injury

Moral injury is the profound psychological, social and spiritual distress that occurs when someone perpetrates, witnesses or fails to prevent acts that violate their deeply held moral beliefs and values.

Healing From Moral Injury

Moral injury was originally studied in military veterans returning from war. Now, it's seen as a widespread phenomenon affecting healthcare workers, first responders and everyday individuals.

The consequences of moral injury is that it has a negative impact on a person's conscience, shatters their sense of self worth and erodes their trust in institutions or leaders. 

What Are Core Causes of Moral Injury?

A moral injury is triggered by a Potentially Morally Injurious Event (PMIE) which usually break down into the following categories:

• Acts of Commission: Doing something that actively violates your moral code (e.g., a soldier either accidentally or following orders to harm civilians in a combat zone).

• Acts of Omission: Failing to act or prevent harm when your ethical compass dictates that you should (e.g., as a bystander you fail to stop an assault).

Healing From Moral Injury

• Betrayal: Witnessing individuals in authority or institutions act against what is moral and just, especially in high stakes situations (e.g., an executive ordering employees to hide serious defects in a product that can do harm to consumers).

• Bearing Witness: Observing atrocities, extreme cruelty or systemic injustices without the power to change the outcome (e.g., care workers or visiting relatives witness bed-bound residents suffering from severe bedsores, malnutrition and prolonged isolation due to corporate understaffing and regulatory failures).

What Are the Symptoms and Manifestations of Moral Injury?

When an individual's ethical boundaries are crossed or when they are placed in a situation where they violate their own moral beliefs and values, it alters their worldview.

Common symptoms include:

• Sustained Guilt and Shame: Feeling a persistent sense of remorse or believing "I am a bad person."

• Social Isolation: Withdrawing from loved ones, peers or community activities due to feeling unworthy or that they will "contaminate" others.

Healing From Moral Injury

• Loss of Trust: An inability to trust authority figures, organizational leadership or systems.

• An Existential or Spiritual Crisis: Questioning long-held religious or spiritual beliefs, faith n a higher power or the fundamental goodness of society.

• Anger and Disillusionment: Directing profound bitterness toward a system or the people that forced an impossible choice.

What is the Difference Between Moral Injury and Posttraumatic Stress Disorder (PTSD)?

While moral injury and PTSD often co-occur, they are distinct psychological concepts:

Whereas moral injury is primarily a guilt, shame and values-based condition, PTSD is a mental health condition after experiencing of witnessing a deeply traumatic, terrifying or ife-threanting event or ongoing events. 

Primary Triggers

• Moral Injury: Ethical transgressions or a betrayal of core values

• PTSD: A life threatening, psychological event (or series of events) that overwhelms an individual emotionally and psychologically

Core Emotions

• Moral Injury: Guilt, shame and deep remorse

• PTSD: Fear, horror, helplessness or panic

Biological Impact

• Moral Injury: Identity disintegration (i.e., a shattering of a person's core sense of self, moral identity and personal narrative)

• PTSD: hypervigilance, visual replay (e.g., visual replay, present-moment distortion, flashbacks, body memories and so on) and a heightened startle response

Clinical Status

• Moral Injury: Recognized as a moral problem and clinical focus, but not a separate diagnosis

• PTSD: A formal psychiatric diagnosis

What Are Current Examples of Moral Injury in Everyday Life?

There are many current examples including but not limited to:

• Healthcare Resource Triage: A doctor or nurse is forced to triage care by rationing ventilators or critical ICU bed during a pandemic which, effectively, determines which patients will live and which will die.

• Family and Caregiver Burnout: A family member caring for a relative with severe dementia becomes completely exhausted and places the relative in an understaffed nursing home. This results in a deep sense of abandonment.

• Navigating Marital Separation and Divorce: A parent files for divorce to escape an unhappy marriage, but they experience profound guilt over the emotional distress and disruption caused to their children.

How to Heal From Moral Injury

Since moral injury is a wound of the conscience rather than a fear-based disorder (like PTSD), conventional trauma treatment focused only on anxiety reduction might not be enough.  Recovery requires specialized multi-dimensional support including:

• Meaning Making: Processing the event to contextualize actions within a chaotic or impossible situation.

• Self Forgiveness: Moving away from persistent self punishment and developing self compassion.

Healing From Moral Injury

• Communal Recognition: Speaking the truth to a supportive group of peers who understand the unique pressures of the situation.

• Moral Repair: Engaging in altruistic actions, volunteerism or advocacy work to reaffirm personal values.

• Psychotherapy: Therapy helps to heal moral injury by providing a structured, nonjudgmental place to process guilt and shame, deconstruct impossible standards or responsibility and rebuild a functional moral identity.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS, EFT (for couples), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.