Moral Injury Toolkit

What this is

About the workbook

Some events do not file away, because they broke something the person actually believes. This pack is written for that kind of pain — after something a person did, something they failed to do, something they were made part of or witnessed, or a betrayal by people who held their loyalty. It names veterans, nurses and doctors, first responders, drivers, parents, employees, witnesses, refugees and survivors, and whole families, on the grounds that the wound has no uniform.

It does not weigh the facts — the How to Use page says so — and its closing page states that nothing in it can establish the facts of any event, or judge any person. What it does instead is separate guilt from shame, put the whole scene back around the worst three seconds of it, ask for a part sized at neither nothing nor everything, and set out the difference between punishment and repair. Moral injury is presented throughout as a human experience rather than a diagnosis.

Alongside the description of the pack, this page explains moral injury in plain language using Canadian sources (the Department of National Defence, the Atlas Institute for Veterans and Families, and the Canadian Institute for Public Safety Research and Treatment), sets it beside moral distress and PTSD, and lists where people in Canada can get help. Like the toolkit, it is educational material, not an assessment or treatment.

What moral injury is, in plain language

Moral injury is the lasting hurt that can follow an event that went against a person's own sense of right and wrong. The Atlas Institute for Veterans and Families describes it as the psychological, social and spiritual impact of acts a person performs, witnesses or fails to prevent that conflict with their own deeply held moral beliefs and values. The Department of National Defence guide Understanding Moral Injury, written for Canadian Armed Forces members, sorts the events behind it into three kinds: acts of commission, where a person does something that violates their own values; acts of omission, where they do not do something their values called for; and acts of betrayal, often by a higher authority that acted, failed to act, or made someone act against their values.

The National Defence guide places moral injury at one end of a continuum. Moral stress is the common, usually short-lived unease of choices that pull against our values, and for the most part it does little harm. Moral distress lasts longer and runs more intense: short-term frustration or helplessness that affects how a person functions. Moral injury is the severe end, marked by lasting guilt, shame, disgust, anger, contempt and hopelessness, and in severe cases by thoughts of suicide. The same guide notes that only a small number of people who go through a morally injurious event develop a moral injury, and that its definition and causes are still debated.

It is not limited to the military. The Atlas Institute names front-line health-care workers, social workers, journalists, people in the legal field, aid workers and veterinarians, alongside serving members, Veterans, RCMP members and others in public safety, and notes that family members can be affected too. In May 2024 the Canadian Institute for Public Safety Research and Treatment (CIPSRT), based at the University of Regina, released The Moral Injury Guide for Public Safety Personnel and Leaders, adapted from earlier work by Phoenix Australia and the Canadian centre now called the Atlas Institute.

It is not a diagnosis. When that guide was released, CIPSRT's scientific director said there is no formal diagnosis for moral injury, and that a person seeking mental health care should get a separate diagnosis. The Atlas Institute's guide for Veterans and families says moral injury is not formally recognized as a mental health diagnosis, and its overview notes that people living with one can be more vulnerable to PTSD, depression and suicidal thoughts. This toolkit treats moral injury the same way: as a human experience to understand, not a label to apply. If what you are carrying includes those other difficulties, a clinician can assess them on their own terms.

Sources: Department of National Defence, Understanding Moral Injury · Atlas Institute for Veterans and Families, Moral injury · Atlas Institute, A guide to moral injury for Veterans and families (PDF) · CIPSRT, The Moral Injury Guide for Public Safety Personnel and Leaders.

Moral injury, moral distress and PTSD: how they differ

The three overlap, and one person can carry more than one. The Atlas Institute's guide says someone can experience PTSD and moral injury at the same time, because situations that challenge moral beliefs can also be traumatic, and CIPSRT describes the two as different but closely related. The table sets out the differences these sources describe. It is a reading aid, not a way to work out what you have.

What is inside the twenty-two pages

The pack runs to twenty-two pages. After the cover comes How to Use This Toolkit, then three education pages: What Moral Injury Is, Why a Working Conscience Ends Up Here, and Punishment Is Not Repair. The first of those sets out four doors in — something you did, something you failed to do, something you were made part of or witnessed, and a betrayal by people you trusted — and states that the pages ahead work for all four, with the betrayal door getting a page of its own.

The written work follows in order: Naming the Wound, The Full Courtroom, Sizing Your Part, What Punishment Has Cost, The Amends Ledger, A Letter You Choose, Self-Forgiveness: A Process, Not a Verdict, When the Injury Is Betrayal, Rebuilding Trust in Yourself, then The Violated Value, Back to Work, followed by The Spiritual Wound, Telling Someone, and When It Needs More Company. The last stretch is a 14-Day Quiet Ledger, a Weekly Reflection, a sheet of six Pocket Repair Cards, and a closing page headed Please Read: Important Information.

The order it suggests

The How to Use page gives five getting-started steps and then a suggested path. Week one is the three education pages and nothing else. Week two is Naming the Wound. Week three is The Full Courtroom, then Sizing Your Part. Week four is What Punishment Has Cost. After that, in any order and at any pace: the amends pages, the letter, self-forgiveness, trust, and the value pages. The betrayal page and the spiritual page are described as there for the readers who need them, and the ledger and the Weekly Reflection are meant to run alongside from whatever point a reader starts.

The pacing instruction is to go slower than feels necessary — its own words are that one page a week is a real pace, and one prompt a sitting is a real pace. Every page is said to stand alone, so the pack can be printed whole or a page at a time, and it flags When It Needs More Company as a working part of the toolkit rather than fine print. One instruction outranks the rest: if any harm the reader had a part in is still happening, the pack says stopping it comes before all other work in these pages, with professional help if it takes help to stop.

Pages to fill in, and pages to cut out

The three education pages are reading. Most of the middle is written work filled in once: the outline on Naming the Wound with its checklist of what the injury broke and the value it violated, the witness questions on The Full Courtroom, the three-row table on Sizing Your Part that divides what happened between the situation, other people and institutions upstream, and the reader's own part, and the three-row Amends Ledger of direct, symbolic and living amends, with a column for what could be done and a column headed First small step, and when.

One page carries a reprint instruction: the Weekly Reflection says to print a fresh copy each week and date the corner. Two more are built for entries over time. The 14-Day Quiet Ledger gives a numbered row for each of the fourteen days and four entry columns beside it — a promise kept however small, the value at work or one repair entry, punishment declined that day, and one contact, a person or a practice — with a look-back question once the fourteen days are full. Rebuilding Trust in Yourself carries a promise ledger of its own — five rows, with columns for the promise, whether it was kept, and what it proved. The Pocket Repair Cards are six wallet-sized reminders to cut along the dashed lines.

What it is built on

The closing page states the sources plainly: widely used ideas in the study of moral injury and moral repair, including context examination, proportionate responsibility, amends-making, values-based action, and self-forgiveness as a gradual process. Two distinctions carry the structure. Guilt says I did something that violated my code, and points at an act that can be examined, sized and repaired; shame says I am the kind of person who does that, points at a whole self, and is described as the engine that stalls repair, because a person in hiding cannot make amends or keep promises. The second is that punishment is pain aimed at the self while repair is good aimed at the world, and the pack turns on treating them as opposite directions rather than two versions of the same thing.

Sizing Your Part is called the hinge of the pack, and it asks for a part that is neither erased nor inflated, on the reasoning that an inflated part is too heavy to answer and an erased one leaves the conscience unconvinced. The Amends Ledger sets three rules before its table: direct amends are for the harmed person's benefit rather than the reader's relief and belong only where contact is safe for them and welcome to them, and the page adds that welcome is the harmed person's to signal, not the reader's to test — if the only way to find out would be to reach out, the answer is to be treated as no, and where the harm was violence, assault, or a relationship the harmed person chose to end, direct contact is not the reader's to initiate; forgiveness from others is theirs to give or not give; and ongoing harm stops first. Symbolic amends are good aimed at people like those harmed, and living amends are the violated value practised deliberately where a person's life actually happens.

What the pack refuses to do, and how it handles hard ground

It never adjudicates. The How to Use page says it will not weigh the facts, that no workbook can, and that this one will not pretend to. The closing page repeats it in its own words: nothing in the toolkit can or does establish the facts of any event, or judge any person. There is no verdict of guilt or innocence anywhere in it — Sizing Your Part hands the sizing to the reader and asks only for rough shares, noting that the honesty matters rather than the arithmetic. The closing page states that moral injury as used here describes a human experience, not a medical or psychiatric diagnosis. The page What Moral Injury Is separates it from PTSD, saying the two can share a house and that a clinician can help sort the household. Self-forgiveness is defined as ending the internal war rather than an announcement of innocence, and is explicit that it does not overturn what the sizing page found.

The deep pages carry the same printed stop-skill: eyes open, both feet on the floor, name five things you can see, and put the page down. The How to Use page adds that stopping is not failing. Naming the Wound adds that paper has no confidentiality, and that if what happened could ever be a legal matter the page should stay at the outline level and a lawyer, not a worksheet, should hold that dimension. Sizing Your Part carries a check for the reader whose part keeps shrinking toward nothing — that what is being carried may be misplaced blame, and that a trauma-informed therapist is the right company for it. Crisis information appears on the deep pages and again at the end: call or text 9-8-8 (Canada, 24/7), and the same number in the US; 911 or the nearest emergency department if danger is immediate; Crisis Text Line in the United States by texting HOME to 741741; Kids Help Phone for young people in Canada at 1-800-668-6868 or text CONNECT to 686868; in Canada the VAC Assistance Service at 1-800-268-7708; and in the US the Veterans Crisis Line, 988 then press 1, or text 838255. The final page states that the toolkit is an educational self-help resource, that it is not psychotherapy, counselling, medical care, spiritual direction, or mental health treatment, and that using it creates no therapist-client or other professional relationship with its creator.

Where people in Canada get help

If you are in danger right now, call 9-1-1. The services below are run by other organisations, and each one sets its own eligibility. The descriptions follow what each operator publishes on its own website, so check there for current details. None of them is part of TEO.

How to cite this toolkit

For a reading list, course outline or resource page, this is a suggested citation.

Common questions

About using this workbook

This workbook is educational. It is not therapy, not an assessment, and nothing in it is a diagnosis. If you are in crisis, call or text 9-8-8 (Canada, 24/7); 911 in an emergency. Kids Help Phone (for young people): 1-800-668-6868, or text CONNECT to 686868.

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Published by TEO Counselling Services Inc.

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Working on this with someone

A workbook can be useful on its own. If you would rather not work through it alone, TEO Counselling offers online therapy from home, anywhere in British Columbia, Ontario, Alberta, Saskatchewan, Manitoba and Newfoundland & Labrador — there is no office to visit. Individual sessions are $150 and couples sessions $175, each 60 minutes, seven days a week from noon to 9:00 pm Pacific. The first step is a free 15-minute consultation on a video call or a scheduled phone call, with no obligation afterward.

Therapy for what this workbook covers: Trauma therapy · Therapy for first responders · PTSD and CPTSD therapy.

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