Forum Discussion

Strategies for Increasing Cultural Competence with Moral Injury in Combat Veterans

Sunday, March 25
1:30 PM - 3:00 PM
Location: Indiana

War, at its very base, etymologically means to bring into confusion. For time immemorial, service members have been required to participate in acts deemed unjustifiable outside the remit of battle. Furthermore, veterans experience childhood abuse at higher rates than civilians and often present with attachment difficulties, reenactments, and dissociation. Coupled together, complex PTSD and moral injury can widen chasms between veterans’ pre and post-war selves, shattering fundamental beliefs about human capacity for goodness and evil. Moral injury is a nascent construct, separate but related to PTSD, which describes the repercussions of participation as a perpetrator, bystander, or witness in acts which severely violate individual or shared intrinsic moral codes and systems of beliefs.
We will discuss the significance of moral injury in the practice of psychotherapy, with a focus on the therapeutic relationship. The session will explore strategies for helping patients express potential feelings related to moral injury (e.g., guilt, shame) and grapple with questions about responsibility, loss of meaning, and spirituality. Conversation will foster cultural competency associated with moral injury to bridge the gap between providers and patients. Participants will be invited to share experiential knowledge of working with moral injury, as well as any barriers and countertransference reactions.

Learning Objectives:

Jessica Walsh

Psychology Extern
San Francisco VA Medical Center
San Francisco, California

Jessica Walsh, M.Sc. is a Ph.D. candidate in Clinical Psychology at Palo Alto University in California, specializing in the Trauma Program. She received her B.A. in Social Studies from Harvard University in 2010 and her M.Sc. Psychology from the University of East London in 2013. She is currently a psychology extern at the San Francisco Veterans Affairs Medical Center's PTSD Clinical Team. She has co-authored publications on terrorism, trauma, suicide, mortality, and the impact of war. Her research interests focus on trauma, aging, and resilience, particularly in the context of examining age-related cohort differences in moral injury, which will be the focus of her contribution for the session.


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Martha Schmitz

Staff Psychologist
San Francisco VA Medical Center
San Francisco, California

Martha Schmitz, PhD, ABPP is a staff psychologist on the PTSD Clinical Team at the San Francisco Veterans Affairs Medical Center (SFVAMC) and Associate Clinical Professor at University of California-San Francisco School of Medicine. Dr. Schmitz offers continuing education workshops and consultation in the treatment of PTSD and substance abuse to clinicians both nationally and abroad. She began working with Lisa M. Najavits, PhD, author of Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, at McLean Hospital-Harvard Medical School and continues to work as her associate through Treatment Innovations. She received her doctorate in counseling psychology from the University of Missouri-Columbia after earning her master’s and bachelor’s degrees from the University of California-Davis. She has collaborated on several research projects in both the United States and France. Her clinical and research interests include treatment of complex PTSD, co-occurring PTSD and substance use disorders, dissociation, and resiliency in survivors of trauma.


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Strategies for Increasing Cultural Competence with Moral Injury in Combat Veterans

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