David, a 42-year-old journalist, sturdily built with a rugged demeanor, was sent to my psychotherapy practice by his internist. David told me he has trouble sleeping and suffers from chronic stress, exhaustion, and stomachaches. For more than a decade, David has been covering conflicts and crises around the world. To his surprise, he recently found he couldn’t continue to function as a journalist covering crisis situations due to his debilitating symptoms. He sought the evaluation with his internist to determine whether he could qualify for a leave of absence.

In particular, he is haunted by images of children in Afghanistan who were crushed when their school building was hit by a bomb and collapsed. He vividly recalls seeing their small feet protruding from the rubble. While he was able to continue his work for a decade, David’s post-traumatic stress is now easily triggered by world events that he sees on the news. Based on his evaluation, David’s physician prescribes time off from work and recommends psychotherapy to address his current distress.

As I get to know David, he reports feelings of anxiety, grief, and guilt because he was not able to save the schoolchildren. He experiences intrusive flashbacks, sees jarring images, and engages in relentless self-criticism about his inability to be as professional and objective as he once was. Consequently, he has experienced feelings of detachment and disengagement from his profession for the past year.

Moral distress is a term that has been used to describe conflicting personal and professional values in healthcare professions (Hamric, 2012). More recently, however, the........

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