NASW Social Work Talks - EP 142 - Beyond Burnout: Understanding Moral Injury

Episode Date: April 14, 2026

In this episode of Social Work Talks, we discuss Moral Injury and how it manifests in social work with Pari Thibodeau, PhD, LCSW. Pari is a licensed clinical social worker providing therapeutic interventions for adults coping with trauma at the Stress, Trauma, Adversity Research & Treatment Center at the University of Colorado School of Medicine. Pari is also a doctorate-level social work researcher in the space of workforce well-being, with a special focus on the well-being and mental health of behavioral health providers. Pari examines the concept of moral injury as a metric of well-being. Our host for this conversation is NASW Staffer, Josh Klapperick, MSW.   According to the U.S. Department of Veterans Affairs, moral injury occurs "when individuals perpetrate, fail to prevent, or witness acts that violate their own ethical code, often leading to intense guilt, shame, and betrayal."

This episode of Social Work Talks is brought to you by the University of Central Florida, built for those who don't wait for permission to change the world. From the National Association of Social Workers, this is Social Work Talks. I'm your host, Josh Klapryk. Joining us today is Pari Thibodeau. Pari is a licensed clinical social worker providing therapeutic interventions for adults coping with trauma at the Stress, Trauma, Adversity Research and Treatment Center at the University of Colorado School of Medicine.

Pari is also a doctorate-level social work researcher in the space of workforce well-being with a special focus on well-being and mental health of behavioral health providers. Pari examines the concept of moral injury as a metric of well-being. And I am very excited for this conversation because moral injury is something near and dear to my heart and feels applicable in the world at large. So thank you for joining me today, Pari. Thanks for having me, Josh. We start every podcast by asking what drew you to social work and how has your career evolved?

Yeah, that's a great question. And it's actually really nice to be able to reflect on now. I got my master's in social work almost 10 years ago at this point. And so I have to sometimes draw back a little bit and be like, oh yeah, why did I do this? And I think it's a good reminder at times. I think what really drew me honestly to the mental health field overall, and then I'll get into social work was the human connection aspect of the work. I knew just personality-wise in the life I've had that I really wanted to be in a space where I was connecting with others. And mental health was an area in which you can actually talk to other people about their lives for your job, right? And so that really drew me to the

profession of mental health as a whole. And then when I narrowed into whether it was social work psychology, I really liked social work values. They felt really personable to me. They felt approachable. I felt like as a student and a learner in my undergrad classes, when I first was getting into mental health, they were more accessible as a learner to me in some of my psychology classes. And so I found that they were really relatable. So I chose actually for undergrad at human service studies degree at Elon University because we didn't have a BSW program. at that time. And then after that, pursued my master's in social work at WashU in St. Louis. And it was really like the hands-on internship experiences that helped me like hone specifically

into my niche area of trauma at this point, but even broader healthcare social work specifically. And I had originally thought I wanted to do more juvenile justice work and work with like the legal system and social work. And I did a few internships and I realized that for me, working with adults felt like a better fit, particularly because of the helplessness that comes with working with children that I felt like I wasn't able to create personal boundaries on that I carried home more with me. And so I pivoted a bit into healthcare social work and really found that like an intriguing learning opportunity that was fast paced that kept me on my toes. And that's where I landed.

What a fascinating trajectory. Why the pivot away from justice after choosing to work with adults? From the justice system and my training in social work at that time, which is interesting because it's changed. I think that I didn't feel equipped. I didn't have enough legal knowledge. And especially as an intern, there's always a learning curve when you're a learner, right? And so it was almost too intimidating for me at the time.

And so I was like, I don't think I have the information. Maybe it's not for me. And I pivoted. Ironically, anyone who's a social worker actually is engaged with the justice system in some which way. And so we actually work with the justice system pretty closely in the clinic at start right now, especially when you're working with families who are coping with trauma. there's a lot of different things that come up like abuse and divorce and different situations that lead to an entanglement with the justice system so now as I'm like more in my career I've learned that there's not really like a way to escape one domain of a policy or institution when you're in social work because it will it all like folds together but I think I learned a lot along the way. And I think the intimidation factor got reduced as I've learned along the way too. And then I've always had an interest in healthcare. So I was just like, let me explore that a little bit to see if it's a better fit. And I felt like I was able to grasp onto some of

the learning curve of the medical system faster, which made me feel more competent at doing my job. That makes sense. I don't remember my MSW program explaining the ins and outs of the legal system. So as an intern, that had to be being thrown into the deep end. Yes, absolutely. So with this pivot, what does your practice look like during the week? Yeah, absolutely. So thinking about how I got from working in a healthcare system till now, where I work in a trauma clinic at an academic medical center, there's a bit of extra chapters that

I think would be helpful for context. So after I got my MSW, I completed my clinical training at a long-term care facility. And so working in long-term care is a unique healthcare experience because your place of employment is actually where someone lives 24-7, right? But it's a healthcare setting. So it's kind of deceiving as it being more institutional healthcare setting, but it's actually someone's home, right? until you are commuting to someone's home, which is a unique experience.

I really saw so much adverse workforce well-being in specifically the nursing staff, but not only the nursing staff, but the mental health staff. There was only two of us social workers for a facility with 250 residents. So thinking about actually your caseload of someone who needs 24-7 care, it's a lot and so not ever feeling like you can meet the need was really defeating that motivated me to get my phd and do research on like what can we do about this why are the policies the way they can they are right and so then i went over to university of denver where i pursued my phd in social work and started the study of workforce well-being amongst healthcare workers and then

honed in there on what we're going to talk about today, moral injury. And then from there, a bit of a pivot. In social work training, often when you get your master's level degree and you decide to go into direct practice, you get clinically licensed, as I'm sure everyone listening knows. But when you get PhD trained in social work, that's an emphasis on research. And often, while we know that macro and micro social work practice should not be siloed. That still sometimes happens based on the systems that have been created. When I was graduating with my PhD, most of the job opportunities are research-focused, which makes sense because that's where you're spending your research training in your PhD program.

I wanted to maintain both the clinical and the research side of things, and not many organizations or institutions support that. So where I saw a good fit for me was the School of Medicine, where physicians are doing research all the time. Right. And so that is the norm. And so that's where I got this opportunity at the university of Colorado and the start clinic doing trauma centered work and focusing on adults with trauma. So when you ask about my week, I like to describe that as a sprint and a marathon in which sometimes my clinical practice is the sprint and the research is the marathon, but sometimes it's the opposite. So I usually spend about three days a week in the clinic seeing patients or doing clinical consultation or mentorship. I do have

a social work trainee, which is one of the best parts of my job is actually teaching future generations about doing ethical and meaningful trauma therapy. So the first half of the week, I really spend in the clinic doing the patient care work. Second half of the week, I do research at that more macro level. What a wild trajectory. I'm still stuck on a caseload of averaging 125 per social worker. And I guess that kind of ties in because you said adverse workforce experience. And that brings us to our topic of moral injury. So how would you define moral injury versus an adverse workforce environment experience? Totally. Yeah. How I like to paint the picture is there's an umbrella of adverse workforce well-being or well-being at work, right? That's

the umbrella. And we can describe that in several different ways. It can be mental health, it can be burnout, it can be imposter syndrome, it can be self-compassion. There's several different ways. When I actually started my research, I was looking into burnout because that's what I was seeing, right? And that's what I was hearing. That was the buzzword. Oh, I'm so burned out. Another day, I worked another 12-hour shift.

I picked up, right? It was very burnout-centric. And I actually had a colleague in my PhD cohort say, have you seen this new term that's going around about healthcare workers about moral injury? And I was like, no. And I did a little digging with some information she shared with me, and it felt way more relevant to the actual cause of the experience, not just the experience. And so moral injury kind of in my definition that I've combined from some research scholars like Dr. Brett Litz and

Dr. Jonathan Shea is defined as the moral transgression or boundary breaking of values, right? Or of morals by either yourself or by someone in a position of power and the negative outcomes that are related to that experience. And so in describing that, that can be a little like philosophical, so I can break it down a little bit. Moral injury is when something you morally find correct cannot be upheld or is actually violated by something you have to do because it's in your job description or you're told to by your supervisor or by like an insurance policy, right? For example, an insurance policy saying, hey, that person doesn't need physical therapy. So you as a social worker in the hospital have to go tell them, hey, your insurance is not

covering your physical therapy for your hip replacement surgery. How do you tell someone that? It makes no sense. Morally, it doesn't feel right. Clinical practice, it doesn't feel right. And you're the messenger in that situation. And so then you're off in the face of receiving the reaction to of the patients. And it's something that violates your morals and has negative outcomes. So then you feel maybe helpless, powerless, you're maybe then discharging that patient into the community without adequate resources, knowing that they're maybe not as safe as they could be, not as supported, not as engaged in healing. And so that's just one example of like how moral injury can, it's kind of this pronged thing. It's a violation of morals. There's a power

factor. And then the negative outcomes, which often generates like a sense of powerlessness, hopelessness, loss of sense of purpose, right? Like, feeling like, is my job actually doing anything? Yeah, that's a very unique situation that social workers end up finding themselves in. And it brings me to something that you wrote about in your articles, which is the concept of street level bureaucrats. Can you kind of go into that concept? Yeah, absolutely. And I can offer more examples that kind of paint the picture of moral injury when I talk about street level bureaucracy. So street level bureaucracy is a theory created by Dr. Michael Lipsky, who really painted the picture of public service workers being these bureaucrats or enforcers of public policy, right? And so when a policy is created on a macro level, there is information that is shared about, let's say, how Medicaid works.

Medicaid's a pretty rigorous policy. And so there's not a lot of bending of the rules with Medicaid because they have gone down to a lot of the details, right? But maybe who can get coverage or the income requirements don't actually fit the actual needs of the individuals. Let's say someone owns a house and they're going into long-term care. Their long-term care setting actually becomes their permanent resident and you can't have two permanent residences. So you do have to then get rid of your home, which is an asset and you lose income or assets, right? So it kind of puts people in these like choice positions.

How it ties back to street level bureaucracy is like maybe Medicaid isn't the best example, but in other situations where we as social workers are enforcing some of these policies. So let's say like the social security office, let's say they're open from eight to five, right? And you're going in and you're going in to get something recertified for your disability benefits. And let's say it's 505. Technically, I don't have to see the person waiting in line, even though they've been waiting for three hours. But do I bend the rule? And do I see that person to make sure that they get benefits, recertified so they don't have a gap in income, right?

Like some of those things. And so we can be the enforcer on different policies, whether it's from the government down or even from the institution. Hey, typically we don't as a clinic, let's say this is hypothetical. We typically don't schedule something in the evening, 7 p.m., right? But because of your unique case, I'm going to make sure you get services today because of your unique job, right? And so it actually, because we're humans caring for humans, there's always discretion. And that's what street level bureaucracy says, right? A policy is not a person. It's a creative policy that often isn't in human form or best applied, right? Because all people are different, all needs are different. And so there's not a one size fit all policy that usually is effective. And there are bends that need to happen usually in order to best fit the policy to the person or situation you're serving. But then we as people have, you know, subconscious biases that come up. So who do we decide to flex that for? And that's a part of it. that is all of that internal mental math that we don't think about until we're kind of confronted

with this outside perspective and like you said it's like we have our policies that we can bend but then when it comes to things like medicaid and uh working in health care systems there's these hard and fast rules of cutoffs uh you mentioned assets for people receiving medicaid well that comes into social security and all of those other like rolling things so how would you differentiate between something like moral injury and something like burnout which you brought up and i know is a buzzword in the social work community because people say burnout and then self-care and it feels like we're talking about two actually very different concepts yes i have so much to say about this i think burnout is a real experience right and i think it's something

that people can relate to, you know, I hear new parents all the time talking about, I feel so burnt out, right? Because burnout is, you know, divided into three main constructs, right? So it's divided into emotional exhaustion, which is kind of the main domain when people think about burnout, like I'm so emotionally exhausted. Then there's depersonalization where you kind of become a little numb and disconnected from what you're experiencing. And then there's low personal accomplishment of when you feel burned out, you actually don't feel the sense of fulfillment or accomplishment in the work you're doing. You feel like there's high workload, usually low resourcing, not enough time in the day to get the work done. You're repeatedly doing something,

you become kind of numb to it, and then you also don't feel fulfilled. So that's the sense of burnout. It's a real, real experience. I think there are precursors to getting burnt out. And I think that's where the research is actually not as well-versed or helpful in knowing what the causes are. And I know in research, it's really hard to identify a cause, right? And so that's where I am really positioning more of moral injury, because I think moral injury is a real experience in itself. But I think that moral injury, my hypothesis is more so leads to burnout.

I've done a systematic review on the different outcomes of workforce well-being and looking at their associations and there are a lot of like correlations and associations with moral injury and burnout so we know they're related we don't know in what direction or what causes what but I think that the experience of moral injury where you experience like a fracture or a moral wound that kind of like ouch feeling or that didn't feel so good if you experience that repeatedly. And then it turns into more of a continuous experience of distress or moral distress at work. I think that can then perpetuate burnout, right? Like I think that when you're repeatedly injured by your workplace or by the work that you're doing, then you can feel

emotionally exhausted, lose that sense of purpose, become disconnected. And moral injury is really like this internal turmoil experience of like what am i doing because it's not aligning with what i believe in right and burnout is more of um an overall exhaustion not that deeper moral questioning that happens does that feel helpful yeah it seems like moral injury is something that can lead to burnout, but they are not one in the same. You also mentioned moral distress. What is the difference between that and moral injury? Absolutely. So moral distress has been a concept that's been around for a long time. And it really is rooted from the nursing workforce and research. And it's an experience,

in short, that's really described by knowing the ethical thing that you could do, but not being able to do it because of internal or external constraints for some reason. So moral distress, and there's a lot of debate in the literature actually, is what healthcare workers experience actually moral distress, right? Not moral injury. Because moral injury, on the other hand, is rooted in the military population. And the definition of moral injury really stems from a very severe, high-stakes situation. And so they're talking life and death, right? And so all of this, when I started doing my research and questioning of like, can healthcare workers or specifically social workers experience moral injury, I did get a lot of pushback of like, well,

they're not necessarily dealing with life and death. But as you and I know, we actually are Mental health is something that people die by. And so while there might not be direct combat, and I don't want to discredit military moral injury, that is a real unique experience that's not the same as healthcare moral injury, but our patients do die, right? Mental health does kill people. And so we are talking about high stakes situations, especially when we're talking beyond mental health, but as health holistically, people die. And we are talking about that life and death and access to care, right? And so there are these social determinants of health factors that impact people's health and lives. And so I think that's where I kind of root myself. And actually,

we are talking about life here. And so moral injury is a real experience. now moral injury the way i see it again debate in the literature and by researchers is that it's an experience in which there's a violation that actually occurred distress can be the pressure that continually builds over time and sometimes there's an injury that occurs but it's more of a prolonged experience. So I imagine like moral distress is like timeline and injury as like different time points on the timeline that can happen time and time and time again. But moral injury, you're able to say that's what happened in that specific experience. Again, some people will talk about it in the other direction. And I think it's just about framing and language that

we're using. But I think they are two different but very closely related experiences that are entangled yeah and the comparison of well i guess the focus on military versus everybody else reminds me a lot of the way that people have viewed trauma throughout the years where it's like military ptsd was the introduction and that was like if you don't have that then you don't have trauma and the definition has slowly moved across and it seems like you've seen a similar start to understand you with moral injury, where it was that. And then it's like, well, there are versions of this. Like you said, people still, there's life and death. So that comparison is, I feel a lot more apt. This episode of Social Work Talks is brought to you by the University of

Central Florida, built for those who don't wait for permission to change the world. The fully An online Master of Social Work at UCF is a powerful next step to advance your career and make a greater impact. Offering hands-on field experience and internship connections, the degree is accredited by the Council on Social Work Education and available as a three-year track or 16 months if you earned a BSW in the last six years. So join UCF in daring to innovate what's next for your career, your field, and beyond. visit ucf.edu forward slash online.

You've mentioned healthcare workers. Are there other social workers or people you found in your research that are likely to experience moral injury, whether it's official or not, or arguable? Yeah, so I actually get my research itself is centered on healthcare social workers. So it's the intersection of both social work

and healthcare. But I think that actually in my next studies, I want to focus on behavioral health clinicians, right, all together, not just social workers, but the umbrella of all of us. And especially because we experience a lot of, I would say, secondary trauma. And I think that, like you mentioned, the relation and the thread of trauma starting in the military population and then actually becoming more of a general experience that a lot of people relate to and we're seeing clinical symptoms for. I think moral injury is following that in a lot of ways. And so I even wonder, not even just like social workers, but

anyone, that's my next question is like, can anyone feel moral injury? Does it have to be a work-related experience, right? Because right now we're examining it in the workplace. And right now while there's a focus on healthcare population and especially because of COVID, right? Like when I started my research on it in 2019, and then COVID happened three months later or so. And so there was this huge impetus for focusing on the healthcare workforce, right? And then there's this secondary pandemic of mental health crisis, right, after. And so then there's the focus on the behavioral health clinicians. But there are other people I think about.

I think about the invisible healthcare workforce. I think about housekeeping. I think about the people who work in the kitchen. I think about people who work in the lab, you know, the pharmacists who maybe don't get the frontline recognition. I think about the occupational physical therapists. There are several other people who keep a healthcare system operating. And then outside of healthcare, I think about teachers and think about education and child welfare workers and thinking about the people who are in this like their unique sandwiched predicament of policy and people and how do they make it work. And we talk all about, right, curriculum and values and beliefs and what are we teaching our future generations. And I think that puts teachers in that street level bureaucracy position to often be at risk of experiencing moral injury. So I think that there are plenty of people in the workforce. And then I think actually on a personal level, this might be a bit off topic, but it's related, I think, is experiencing global distress actually a type of moral injury? And specifically, I'm thinking about when there's oppression, when there's racism, when there's sexism. And I never think that moral injury should replace those terms. I think oppression is oppression and we should call it what it is. But I think that is moral injury actually an experience that happens as a byproduct or result,

right? Or similarly, is moral injury in our general lives more like secondary traumatic experiences or secondary traumatic stress, right? Maybe something's not directly happening to us right now, but we're witnessing something so unjust that's bringing up the sense of powerlessness, helplessness, and questioning of purpose. What am I doing, right? And I see that with political administration, with the ICE raids, with overturn of Roe v. Wade. I see that with war and violence and a lot of maybe it's not impacting our general day-to-day bubble, but it does impact us. And obviously, it does impact different people with different identities in different ways more directly versus the secondary lens on it. So I have a lot of questions there of like,

do we all experience some type of moral transgression or hurt in our personal lives when things seem unjust? And is that a way that we need to pay attention to our well-being as people? Yeah, it immediately made me think of the concept of vicarious trauma. And we focus on, once again, healthcare workers and behavioral health workers who are staring at that every day. But in our modern age, where you have all the trauma directly onto your phone, where does the line get drawn? because you're staring at it either way just because it's not in a workforce setting does not mean that there's not like a societal push to be aware of these atrocities that are occurring and once again if you're staring at that trauma what does that look like absolutely i think the technology aspect is huge right like i mean i love advancement in science in general and technology faults under that umbrella. So on one hand, there's like a moral alignment, but then there's

also so much moral questioning and values questioning of like, what am I looking at? Or I'm doom scrolling, right? We all know what that is. And actually I feel worse. I feel a little depressed. I feel actually a little more anxious, right? When I'm getting off my phone, getting off Instagram or other things, right? And so I think with advances in technology, we need to have advances in mental health. And I think that we can't leave one without the other. And that's why I think social workers are even more important as we advance right into this like technological future. That's like involves AI and all of these things. I think our mental health treatment needs to advance with it too. I couldn't agree more. Speaking of which,

I guess, treatment for moral injury. What does that look like presently? Where do you see it going? Yeah. So moral injury, I'll place the emphasis on while it's a deeply personal experience, because we all have different moral compasses, right, that are uniquely catered to ourselves. It's actually an experience that results from systems, fractures, and gaps that then we're not able to bridge or band-aid right so i think moral injury is personally impactful but the biggest most important intervention i think is actually a macro level change or even a meso level change right like hey my patient keeps coming and saying that our building is really hard to access like are we attaching a map every time we're sending them information

about an appointment are we telling them where they can park and you know things like that like are we are there actually like institutional level changes that are not that big that we can actually bridge some of the harm of accessibility obstacles so i think there's some of those things that exist so i think it's actually like when there's a bad policy can we create a better one right that's like i think the most foundational thing to prevent moral injury moving forward when someone has already experienced moral injury i think there are several levels of things that we need to think about so there is current not um i would say well research but current practice of using trauma-based treatment for moral injury because moral injury is a concept that is rooted

in the trauma experience as well because you see something that's violating or harmful or right? Like leads to a negative outcome. And so that experience, I think it does make sense to have some individual therapy, right? Like let's do some trauma treatment. There's also evidence for acceptance and commitment therapy being helpful in kind of like accepting what's within our control and what's out of our control and processing the experience as well. So both of those individual level therapeutic experiences have started to be trialed. And some people have found it helpful. There's not a ton of evidence there. And so I think there needs to be more research on that. And so I'm not saying either way, it's the best practice or not. But what I think with the nature

of moral injury is this like questioning of your purpose and your role and feeling helpless. It can be really isolating and lonely to experience that and so I think there's actually a nature of moral injury treatment that needs to be rooted in more group-based intervention and a lot of like in healthcare settings a lot of departments do like what we we've called like moral rounds where you have like a debriefing session and different institutions call it different things where you debrief like what went well what was hard is there any unresolved grief or you know questions that need to be discussed as a team the research shows that like that is helpful what i hear narratively from people is that sometimes that turns into a complaint session

which makes them feel even more helpless because everyone's it's collective helplessness and so i think that there needs to be a pillar of that that is solutions focused even on the smallest level to restore power to be like this is what went wrong what can we do next time what is needed in the future even if it's case by case in the future or if it's a policy right like that can be changed and so i think having time to process but then there needs to be a so what there needs to be an actionable so what and so i think that's part of an intervention and then i've kind of like circling back to what you had mentioned about self-care earlier and how self-care burnout have become these buzzwords especially in social work right um something

that stands out to me is that actually in 2021 with the new code of ethics from nasw there's an explicit call for self-care. And so how it's actually like an ethical thing to care for your professional well-being and to take care of yourself so you can be a good social worker. I do firmly believe in that, but my reaction over the years of processing and teaching my students, whenever I bring up the self-care class, I get a wave of eye rolls. I'm like, here we go again. Another professor telling me that I should take care of myself, But how can I take care of myself when I feel like it's so out of my control, right? And so I think I really believe that social work is a profession rooted on relationships

and on community and on being together. And then you throw the word self-care in there, which actually feels like a moral opposition to the community and collectivism of social work. And so I wonder what collective care actually looks like and how do we teach that for interventions? How do we actually process together and create solutions together? I do believe we as individuals do need to take care of ourselves, but I don't know if that's the curriculum that needs to be pushed. I think we need to brainstorm together. How can we do this together? I feel like that feels more aligned for the profession of social work is collective care. And so thinking about, does that look like group therapy for moral injury? Does that look like advocacy work? I'm not really sure what. But I hope in my research agenda to actually in my next step, do some like interviews with social workers and behavioral health clinicians to imagine what a solution could look like and then test an intervention on it. That was long winded, but I think that it's all relevant. No, it's a really good insight because, I mean, my question inherently had a flaw because I was asking, how do you individually address something that we have discussed as being a societal, systemic, meso, macro level breakdown?

you can't micro affect a macro issue and i think it kind of relates back to what you said about that self-care eye roll it's like it doesn't stop me from watching people not being able to eat because i started doing yoga it kind of comes with that same thing of like you're depressed have you tried taking a walk where it's just like neat wow uh groundbreaking kind of a thing so you can't kind of like feel better about something that you're seeing as a systemic failing of the world so you need that bigger picture intervention and oddly enough it seems like you have found yourself in a wonderful role where you can kind of take that micro thing and be like that's a yikes breakdown of the system what can i look at for that meso macro level

intervention that might be able to address this micro issue that I'm seeing? Yes, absolutely. Yeah, I think that my role is, you know, a really privileged position to be able to do both, right? Like, because when I see something with my patients that feels extremely helpless, I can resource, I can consult, I can brainstorm solutions, I can actually lean on peers within social work or outside of social work and say, hey, how can we make this better, right? And advancing mental health is part of that is like doing it together, right? Not alone. And I think that social work has always fundamentally been that way. But I think that we do need to update the language around self-care and especially academically, like what are we teaching to our

students about caring for themselves? Because I think that they probably get enough about self-care from TikTok, you know? So I think like, actually, what do we talk about instead, right? Like, I think that we can talk about a lot more and have a lot more impact. And I find at least in the students I've taught is when I acknowledge a name that some of this is out of their control, it is actually more liberating than saying you need to go take a bubble bath or take a walk or write like any of those things. And it doesn't mean it frees them from responsibility, but it frees them from the pressure of when the world is on fire, I can do something about it when I take care of myself. And that will change how I feel because that won't change that larger feeling of helplessness. Does it make you at a better place to then do something about it? Sure. But I think there needs to be more acknowledgement and conversation about the different driving factors that are

impacting our well-being and not just the one thread of are we taking care of ourselves? Yeah. And I think that is the interesting difference between like moral injury versus burnout is burnout always felt like a victim blaming where it's like you as a provider are not emotionally strong enough or whatever to be managing these. So go take care of yourself so that you can continue to do this when you are seeing these systemic breakdowns. And I'm not going to like, you can't teach somebody to budget when they don't have enough money. And that is kind of like, you can't yoga your way out of having to tell somebody that sucks.

Sorry, you can't eat every day. Yes, exactly. Do it. It's just like, it's actually just not related, right? Like, and I think sometimes we stretch the relation. I do believe in taking care of ourselves in that, like mind body connection. All of that is great. I do believe in it, but I think we're at a place where we need to advance further and that our values are clear, that it is collective. It's not an individual effort. And so what are we dreaming up of as a better solution to make people feel better in doing the work? Because now more than ever, we need social workers and the career has high turnover, high bad outcomes related to the work because of how distressing it is.

But I think if we talked about what the actual distress was and how to actually acknowledge those pain points and create change and care for each other in that, I think people will stay longer and we need them and we need them to completely agree. i think there's just a certain validity that comes to experience when there's something like moral injury or moral distress being discussed versus burnout because one is like okay no you're seeing the cracks in our society that leave people falling through versus you just can't handle this you can't tough it out and that is i guess where do you see the research and information about moral injury going as it progresses since it seems like it's pretty new to start expanding it to outside of the military in general yeah i have several dreams i want it to go um and i know i can't do it all so i'm always looking for collaborators and

ideas to you know i think all of us who are interested in it should move the agenda forward right it's not again not a one-person job here but i think that um i'm really curious about treatment at this point i think we have a clear clear enough definition of what it feels like to be morally injured but the so what what do we do about it how do we like treat people who are morally injured right i think that i would love to see clear evidence on that um of what works right? What works in making people heal from moral injury? And of course, I want the prevention side of it as well. But I do think treatment is real because people are actually experiencing pretty high levels of moral injury. So I think treatment intervention is really where I hope

to go next. And then I would love to kind of study the experience of moral injury in parallel to that secondary traumatic stress experience. And I've done a little bit of studying on this. I did a secondary data analysis of some survey data that I collected a few years ago. And I compared trauma and moral injury symptomology. And what we really found is that there's an overlap between secondary traumatic stress. And so I would love to like replicate or do more intentional research because again, that was a secondary data analysis. And so I would love to do more intentional primary data collection on what are the overlaps like in these experiences. Again, they're not one in the same experience, but if someone is experiencing moral injury by witnessing

something happening, not that it directly happened to them or it's something that they had to do, but maybe you saw a supervisor do something that violated your morals or a colleague or maybe a trainee, right? Like do something differently than you would do. It still impacts you. And what we've learned about secondary traumatic stress is it doesn't really matter if it's PTSD or secondary traumatic stress, you still have the symptoms of PTSD and you still, the treatment is still PTSD treatment, right? Like it's still trauma treatment. And so it doesn't matter what the sources for the treatment to be effective, but it's helpful to differentiate what happened and to who and what the power roles are. And so I think it would be helpful to understand

similarly in the general population outside of the workforce, are people experiencing a semblance of moral injury, maybe specifically related to the political infrastructure and global situation right now, too. So there would have to be some more balance on my research because I know it's not pie in the sky. But I'd be curious what people describe moral injury as outside of the workplace as well. It's going to be fascinating to watch it because, like you said, there's the vicarious trauma part of it. And it is something that, as we've talked about, it's happening in civilian populations all of the time so where do we start drawing that line of like no this is a workplace moral injury versus the this is impacted by the societal workplace injury that

we are all witnessing essentially being forced into by the world in which we live so it feels like that line is a little bit blurrier, whether it's something that can just occur in the workplace versus outside of it. But finding the way to navigate that along with like systems of oppression without throwing the baby out with the bathwater seems like, like you said, pie in the sky and starts to get really complicated as we dig into something new. Yeah, absolutely. And I think that the experience of moral injury or a lot of like adverse well-being or mental health are best told by people, right? And so that data collection is a unique and long process, right? This is where I say my research is a marathon, right? Because if you're going to do good research, when you

want to study a phenomenon or experience, you engage in that qualitative storytelling and data collection, and that takes time because it's so valuable. So you can't throw a scale or an instrument at the situation and be like, hey, what are we measuring? That storytelling piece is crucial to the data and the representation of what's actually happening. And so I think it takes time and has to, you know, there's so many bounds and important variables to consider in research as well. So that's my hope one day to get to even like a drop in the bucket of exploring moral injury as a concept outside of the workplace. And before we do that, I think we have to have some trial interventions so we know when we're finding something, how we can offer direction to

people yeah because being able to recognize it is awesome but essentially we need something to give people other than a thumbs up after we've confirmed that they are experiencing that absolutely yeah i give them a sense of hope yeah and a direction for hey i know it's challenging and all of this but tada rather than once again uh fighting another version of go do yoga or self care for folks. Yeah, exactly. Awesome. Well, any final thoughts, things we've skipped over that you wanted to make sure we touched on? I don't think so. I think it's a really interesting topic. Obviously, I'm biased because it's my area of research. But, you know, I actually see it in my research world, obviously, with my research participants. But I hear my patients talk about

it a lot. And some of them work in healthcare and some of them don't. And whether they're using explicit words of moral injury or just describing some of these powerless, helpless feelings, I think it's relevant and centering what we believe in is really important to us as humanity, right? And it's a guide of everything we do. And so I think having these metrics to name when we're feeling injured on those fronts, it's important. But yeah, I'm excited. I hope the research continues to move forward and hopefully we can have some evidence-based treatments on it. Well, I can say as a former direct practice person, reading your qualitative studies and just hearing quotes that could have been directly out of my mouth of the struggle of

doing that dance is, you're right, that that has a lot more impact than seeing like, oh, 7.8 on this scale that we measured found it was rough it's a lot more healing to be like hey somebody's seen something that i'm seeing even if there's not a ta-da maybe wave a magic wand resolution yes absolutely yeah that and again that collective experience of i'm not the only one experiencing this is validating and especially in like we said if we're going to expand it to the world at large we're all staring at it so just having that collective communication which once again technology it's it allows us to have these wonderful conversations states apart but it also means that we can have conversations and not have that connection so finding that middle

ground seems like a worthy cause absolutely well thank you for joining me pari and it was wonderful chatting with you uh is there anything you want to shout out or point folks to that we can add to the show notes? I'm happy to share a link to that article, right? The qualitative article. If people wanted to read that narrative experience or any additional studies, we're happy to share some of those data points so people can start reading the literature qualitatively and quantitatively. I think that's a great thing to include. Sounds perfect. We'll get that added. Otherwise, thank you for joining us. Of course. Thanks, Josh. Thank you.