Healing Perfectionism With IFS Therapy

In my prior article, Journal Prompts to Cope With Perfectionism, I began a discussion about perfectionism.

In the current article, I'm discussing perfectionism from an IFS therapy perspective (see my article: IFS is a Gentle, Evidence Based Therapy).

Healing Perfectionism With IFS Therapy

In the next article, I'll discuss how IFS Therapy can help with overcoming perfectionism.

How Do Defensive Parts Develop?

From an IFS therapy perspective, defensive parts usually develop at an early age.

In IFS these parts are known as proactive and reactive parts.

When you're faced with trauma or adversity, some of the internal parts of yourself are forced to take on extreme, rigid roles to protect you from pain. This usually occurs when you have had experiences as a child of rejection, failure, loneliness, conditional love, abuse or childhood emotional neglect.

The Core Self: 

From an IFS perspective, the Core Self is not a part. 

Everyone is born with a Core Self and a natural ability to heal. However, when there is childhood trauma, the Core Self can get blended with your defensive parts (both proactive and reactive parts). That can make it difficult to access the Core Self. 

Your IFS therapist can help you to discover your Core Self which helps with the healing process (see below for explanations about the proactive and reactive/defensive parts).

The Core Self and the 8 Cs

The Core Self is composed of the 8 Cs:

• Curiosity: Wanting to learn about your thoughts and feelings without judgment
• Compassion: Feeling kind towards your inner struggles
• Calm: Feeling steady and peaceful inside--even during rough times
• Clarity: Seeing your situation clearly without emotional fog
• Courage: Feeling able to face hard truths and uncomfortable emotions
• Confidence: Trusting that you can handle what comes your way
• Creativity: Opening up to new ideas and flexible ways of thinking
• Connectedness: Feeling a deep sense of belonging within yourself and with others

The Wounded and Defensive Parts:

This is the usual sequence of how wounded and defensive parts develop and how IFS healing process:

• 1. The Wounded Child Develops First During Childhood Trauma: Before the proactive or reactive parts develop, a vulnerable child part is wounded. The vulnerable child part is not a proactive or reactive part. It's the part that holds the trauma. As an example, a child might be rejected, yelled at or abused by a parent when she gets a bad grade at school. The child internalizes the parent's attitude towards her and believes "I'm unlovable" or "I'm powerless". In order to survive, the child's system buries the memory and painful emotion deep inside, which creates the exiled wounded child part.

• 2. The Perfectionist Part Steps Up to Prevent Pain (Proactive Part): Once the wounded part is buried, the internal system realizes it can never allow the wounded part to be triggered or exposed again. The proactive part emerges to police your life and prevent future pain before it can happen again. This part's strategy is, "If I can be perfect and never make mistakes, no one can ever reject or hurt me again."  This part takes over your consciousness and establishes impossibly high standards. This might work reasonably well for you as a child and you get praise from relatives and teachers, which reinforces this survival strategy. 

• 3. The Inner Critic Develops a Preemptive Shield: As life becomes more complex, maintaining 100% perfection becomes impossible. To protect you from the crushing blow of external judgment, a harsher manager called the inner critic, develops after the perfectionist develops. The inner critic believes that beating you up first (before you get external criticism) provides a safe shield. The inner critic's logic is, "If I criticize you for being lazy or messy before anyone else notices, I'll force you to fix it before others are able to hurt you." The inner critic often adopts the same words, attitude and tone of the critical authority figures from your past (parents, teachers and critical others). The inner critic learned that those voices are what define "safety" and "correctness".

• 4. The Parts Freeze in Time: The primary reason why these parts continue to be problems is that they are frozen in the past. Your perfectionist and critical parts often don't know that you are no longer child. They still believe you are that fragile child that couldn't survive without them.  

• 5. The Parts Take on Healthy Roles: As part of IFS therapy, you learn to have a dialogue and a relationship with these parts of yourself to help them to understand that you now have adult resilience.  As you develop a trusting relationship with these parts, they usually realize for the first time that you are no longer a fragile child that needs protection and they can relax instead of staying in exhausting roles. This allows them to take on healthy functions. For instance, instead of obsessively criticizing and striving for perfection, they might encourage you with a sense of healthy motivation.

Conclusion

For the sake of simplicity, I have described an inner world that has one wounded part, one proactive defensive part and one reactive defensive part. 

In reality, there are usually many wounded, proactive and reactive parts to heal.

Although I have focused on perfectionism, the IFS step-by-step process is the same for any other problem.

In my next article, I'll discuss how IFS therapy works to heal perfectionism.

Get Help in IFS Therapy

If you have been trying without success to work through your problems, you could benefit from working with an IFS therapist.

Get Help in IFS Therapy

IFS therapy can help you to heal your problems so you can be live a more fulfilling life free from your traumatic history.

About Me

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

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

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

I provide a 10-15 minute free phone call before setting up an appointment.

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

Also See My Articles:

What is Somatic IFS? 

How Does IFS Therapy Help You to Understand Yourself? 

How Can IFS Therapy Help With Anxiety? 

What is the Approach-Avoidance Conflict in Psychotherapy and How Can IFS Therapy Help?

In my prior article, Why Are So Many of Us Fearful of Change While Others Embrace It?, I mentioned the approach-avoidance conflict as it relates to making changes.

The Approach-Avoidance Conflict

In the current article, I'm focusing on the approach-avoidance conflict as it relates to many clients in therapy.

What is the Approach-Avoidance Conflict in Therapy?

As I mentioned in the prior article, although many people want to make positive changes in their life, they often experience ambivalence about the change--even when it's something they really want.

As a New York psychotherapist in private practice, I see this all the time.

Since it's a common experience, if you learn to expect it, you can learn to accept and deal with that part of yourself that might want to avoid positive change.

So, let's explore this dynamic further.

In psychotherapy, the approach-avoidance conflict is a psychological state of tension that occurs when a client is simultaneously drawn towards and repelled by the exact same goal, action or dynamic.

The approach-avoidance conflict was originally introduced by Kurt Lewin, a psychologist, who described this dynamic as a "tug of war". 

This dynamic is key to understanding why at a certain stage of therapy many clients experience anxiety and stagnation about the changes they want to make.  

What is the Typical Pattern For the Approach-Avoidance Conflict in Therapy?

This conflict often operates on a predictable pattern based on how close clients are to their goal:

• The Approach to a Goal: When clients are far away from a goal, they can see the positive benefits of their goal ("the approach"). This motivates them to move forward.

• The Avoidance of a Goal: As clients move emotionally or physically closer to the goal, many of them begin to perceive negative consequences or fears ("the avoidance") which grows sharply the closer they get to their goal.

• The Point of Stagnation: Eventually, the force of the avoidance equals the force of the approach. At that point, these clients can get stuck as they experience anxiety, indecision or behavioral paralysis.

What Are the Clinical Scenarios Where the Approach-Avoidance Conflict Shows Up in Therapy?

Here are some typical examples:

Intimacy and Relationships:

• The Approach (Pull or Desire): Craving deep emotional connection and a loving relationship.

The Approach-Avoidance Conflict in Therapy

• The Avoidance (Fear): Fear of vulnerability, rejection or losing independence.

• Resulting Behavior: Sabotaging relationships just as they become serious.

Trauma Processing:

• The Approach (Pull or Desire): Wanting to heal, gain closure and reduce traumatic symptoms.

The Approach-Avoidance Conflict in Trauma Therapy

• The Avoidance (Fear): Fear of exploring traumatic memories and emotions.

• Resulting Behavior: Missing sessions or leaving therapy prematurely as the trauma work begins.

Career Change:

• The Approach (Pull or Desire): Desiring a fulfilling, high-paying and prestigious position.

• The Avoidance (Fear): Fear of failure, longer work hours or more responsibilities.

• Resulting Behavior: Procrastination in submitting a job application or applying for a promotion.

Behavioral Change

• The Approach (Pull or Desire): Wanting a healthier body and stable life.

The Approach-Avoidance Conflict and Behavioral Change

• The Avoidance (Fear): Fear of facing reality the necessary changes involved.

• Resulting Behavior: Reverting back to unhealthy behavior, missing sessions or dropping out of therapy prematurely.

How Does IFS Therapy Deal With the Approach-Avoidance Conflict?

IFS (Internal Family Systems) Therapy is uniquely suited for this dynamic (see my article: IFS Therapy is a Gentle Evidence-Based Therapy).

IFS Therapy and the Approach-Avoidance Conflict

The IFS therapist deals with the approach-avoidance conflict by recognizing that clients who experience this dynamic have a clash between two or more parts of themselves.

Instead of trying to push through the conflict, the IFS therapist helps clients to overcome this dilemma by identifying clients' internal parts and identifying the positive intentions of each of the conflicting parts. She also helps clients to negotiate between these conflicting parts.

What is the IFS Therapy Framework For the Approach-Avoidance Conflict?

In IFS, the "approach" and "avoidance" aspects of clients are seen as separate parts of the client who have good intentions. There is a recognition that these conflicting parts have served the client in the past by protecting old emotional wounds:

• The Approach Part: This is usually an internal proactive protective part. This part wants to move forward, achieve goals or seek connection because doing so will bring safety, fulfillment or a sense of increased self worth.

IFS Therapy and the Approach-Avoidance Conflict

• The Avoidance Part: This is usually a reactive protective part. It stops progress because it senses danger. It fears that moving forward will trigger an old emotional wound, shame or trauma from the past.

What is the IFS Therapy Step-By-Step Process For Resolving Internal Conflict?

The IFS therapist will guide the client through the following process to overcome the client's behavioral conflict:

Differentiating the Internal Parts: Instead of saying, "I want to change, but I can't", the therapist helps the client to reframe it: "A part of me wants very much to move forward, and another part of me is terrified to do it." In addition, the therapist helps the client to discover and embody Core Self, which is the compassionate and curious part of the client. This enables the client to look at both of these internal parts without taking sides.

• Honoring The Avoidant Part (The Protector): Traditional psychotherapy often wants to override the client's avoidance. IFS does the opposite: It focuses on the avoidant part first. The IFS therapist asks the client to get curious about the avoidant part by asking: "How is this part protecting you?" and "How did it protect you in the past?". Also, "What is this part afraid will happen if you take this step?" By validating that the avoidant part has a positive intention (e.g., protecting the client from rejection, failure or an old emotional wound), the protecting part usually loosens its grip. This usually doesn't happen immediately because the avoidant part must first learn to trust the Core Self of the client as well as the intention of the therapist.

IFS Therapy and the Approach-Avoidance Conflict

• Facilitating Internal Negotiation: Once each of the conflicting parts feels heard and seen by the client's Core Self and the therapist, the therapist helps the client to invite these parts to talk to each other. The Core Self might ask the avoidant part, "If I promise to go very slowly and protect you, would you be willing to allow the approach part to take a small step?" Since this protective/avoidant part is no longer being resisted or ignored, it usually agrees to soften or step aside temporarily.

• Working With the Wounded Part: Ultimately, the avoidant part is hypervigilant because it's protecting the wounded part of the client. Once this protector feels safe enough to step aside, the IFS therapist guides the Core Self to witness, work through the original trauma and heal. When the underlying emotional pain and trauma have been resolved, the avoidant/protector part usually drops the avoidant behavior because the underlying danger no longer exists.

Clinical Vignette

The following clinical vignette illustrates how the approach-avoidance conflict is overcome in IFS therapy:

John

When John met Donna, he felt a strong attraction to her and he asked her to go out on a date.

As they got to know each other, they both enjoyed each other's company and the new relationship energy that comes with being in a new relationship.

A few months later, as the relationship became more serious, Donna wanted a commitment from John but, even though he knew he loved Donna, he felt himself pulling away from her and he didn't understand what was happening to him.

At that point, Donna's friends told her she should end the relationship because they thought John was a "commitment-phobe".  But Donna felt John was struggling with some kind of internal conflict and she wanted to give him a chance to overcome the conflict, so she suggested that he get help in therapy.

IFS Therapy and the Approach-Avoidance Conflict

Since John also wanted to understand why he felt so conflicted about making a commitment with Donna, he started therapy with an IFS therapist.

John had never heard of IFS therapy, but he was curious as to how it might help him to overcome his internal conflict.

Over time, as they explored John's family history, they discovered that John had an unresolved trauma related to his mother's anxiety and depression. When he was a child, John felt he was unlovable because his mother was emotionally distant and his father was often away on business.

With the help of his therapist, John realized that this old emotional wound was making him feel emotionally vulnerable with Donna in a way where a part of him wanted to escape the relationship, but another part of him wanted to remain, which reflected his ambivalence.

The work in therapy was neither quick nor easy, but John was motivated to work through his internal conflict about making a commitment to Donna. With the help of his therapist, he was able to see the good intention of the avoidant part of him and how it protected him in the past when he was a child.

His therapist guided John into feeling curious and compassionate towards this avoidant/protector part so that, eventually, it softened enough so he and his therapist could work on his traumatized wounded child part.

Over time, John was gradually able to let go of his fear because he had an embodied sense that, unlike when he was a child, he was now safe and more capable of being in a committed relationship with Donna.

Once he was freed from his traumatic history, John made a commitment to Donna and they moved in together with the eventual goal of getting married.

Conclusion

Although many people want to make positive changes in their life, they often experience an ambivalence about the change as the change becomes more of a reality--even when it's something they really want.

In psychotherapy, the approach-avoidance conflict is a common psychological state of tension that occurs when a client is simultaneously drawn towards and repelled by the exact same goal, action or dynamic.

This is a common experience in therapy. 

In traditional psychotherapy, therapists often try to push through the ambivalence, which can make a client feel even more ambivalent, so this usually doesn't work.

An IFS therapist recognizes that we all have many different internal parts and some of these parts are polarized so they are in opposition to each other. They also recognize that this is often outside a client's awareness, so they reach for the ambivalence so it can be worked on.

IFS therapy is ideally suited for dealing with the approach-avoidance conflict.

Get Help in IFS Therapy

If you are stuck in an approach-avoidance dilemma, rather than struggling on your own, you could benefit from working with an IFS therapist.

Get Help in IFS Therapy

Being able to work through the conflict provides you with an opportunity to live a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, IFS Parts Work Therapist, EFT Couples Therapist, 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 telephone call before setting up an appointment.

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

Also See My Articles:

Fear of Change 

Overcoming Recurring Patterns of Self Sabotaging Behavior 

Strategies For Making Major Changes in Your Life 

What is Somatic IFS?

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?

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.