Bioethics Blogs

Moral Stress in Mental Health Practice and Research

Dr. Adam Fried

By: Adam Fried, Ph.D.

Mental health practice, assessment and research can be highly fulfilling, but also emotionally demanding. In recent years, the field of psychology has made a concerted effort to educate psychologists about the effects of various types of caregiver stress (including secondary traumatic stress and vicarious traumatization in which the professional internalizes or is otherwise personally affected by the trauma experienced by those with whom the professional works) on their mental health and professional work (Collins & Long, 2003; Figley, 2002). Extreme cases can lead to a phenomenon known as compassion stress/fatigue (Figley, 2002), which can often be accompanied by a decrease in professional self-efficacy and a reduced willingness to help (Figley, 2002; Newell & MacNeill, 2010).

Stress can take many forms. One type that has received increased attention occurs when professional, institutional or legal rules and constraints prevent the practitioner from doing what they believe is right or most beneficial for the client/patient. Known as moral stress, these experiences describe ethical and emotional impasses experienced by professionals who may feel unable to provide the assistance they believe is truly necessary to address the client’s issues while also maintaining appropriate boundaries and adhering to ethics codes and laws.

Originally developed within the nursing community (Jameton,1984), this type of stress has been studied across many “helping” professions, including social workers, psychologists, and palliative care providers. Within psychology, it isn’t difficult to imagine a variety of moral stress situations within practice, assessment and research settings, although the nature of moral stress may differ in terms of the role of the professional, the setting and the nature of the mental health condition or focus of intervention.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.