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Mary Krome, Psy.D., is a 2026 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

  • Shannon L. McIntyre, PhD, Chairperson
  • Rose Hitchings, PsyD, Committee Member
  • Cynthia L. Whitaker, PsyD, Committee Member

Keywords

moral injury, moral harm, continuum model of moral stressors and outcomes, Moral Injury and Distress Scale, mental health therapists, interpretative phenomenological analysis

Document Type

Dissertation

Publication Date

2026

Abstract

Moral injury refers to the psychological, social, behavioral, and spiritual consequences that may result from experiences involving perceived violations of deeply held moral values and beliefs. Although research on moral injury has expanded beyond military populations, limited attention has been given to the experiences of mental health therapists, and qualitative investigations of this phenomenon remain scarce. Therefore, this project provides a qualitative assessment of mental health therapists’ lived experiences of moral injury, using an ecosystemic approach and accounting for biopsychosocial factors that influence experiences of moral injury. Six mental health therapists completed the Moral Injury and Distress Scale and endorsed experiencing a potentially morally injurious event and subsequent distress. Semi-structured interviews were analyzed according to interpretative phenomenological analysis, yielding four superordinate themes: (a) Therapists Cope with Moral Injury in a Variety of Ways, (b) Detrimental Effect on Therapist Wellbeing, (c) Interaction between Identity and Structural Factors Influences Moral Injury, and (d) Value and Importance of Moral Injury. Participants described a range of emotional, cognitive, relational, and professional consequences associated with moral injury, as well as diverse approaches to coping and meaning making. Findings suggest that experiences of moral injury are shaped by complex interactions between personal values, professional identity, organizational contexts, and broader systemic factors. Implications indicate the need for formal prevention and recovery efforts occurring within multiple ecological levels, namely mental health therapists’ workplaces, clinical training programs, and individual’s engagement with protective and curative factors. This dissertation is available in open access at Antioch University Repository and Archive (https://aura.antioch.edu) and OhioLINK Electronic Theses and Dissertations Center (https://etd.ohiolink.edu).

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ORCID iD: 0009-0004-4165-3494

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