Moral injury and NHS talking therapies: psychological therapists and their experiences of moral challenges - a reflexive thematic analysis

The current study investigates how psychological therapists experience morally challenging events when working in NHS Talking Therapies (formally IAPT) and why these events may occur. The theory of Moral Injury was used as the guiding theoretical concept to make sense of participant’s experiences, and a Reflexive Thematic Analysis was adopted as the methodology of choice. From this, five themes were generated: (1) The Setting: Introducing the Moral Territories; (2) The Threat: Invasion of the Moral Territories; (3) The Battle: Experiences of the Invasion; (4) The Resistance: Strategies used to Survive; and (5) The Context: Age of Clinical Tyranny. An additional three sub-themes were also generated: (1) Relational Hill; (2) The Failed Strategy; and (3) The Power of Togetherness. The data supports Moral Injury as a distinct theoretical model and indicates it to be a helpful and applicable theory in understanding the moral difficulties experienced by psychological therapists in NHS Talking Therapies. Furthermore, the current research suggests this population may be at risk of Moral Injury. To understand why, links are made between (a) the moral conflicts identified by participants and (b) the wider socio-political landscape. As such, this study draws attention to the contemporary shifts in the art and science of psychotherapy and how neo-liberalism, the division of labour, and workplace alienation may be related to such shifts.