How to Wound and Heal a Psychodramatist: Moral Injury, Ethical Anger, and Telic Empathy
Author: Claudia Vau
This document is an abstract
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Introduction
What injures a psychotherapist most deeply is not, in my experience, exposure to trauma. It is knowing what ethical, compassionate practice requires, and being unable to act accordingly. Not because of personal failing, but because of organisational cultures that privilege procedural compliance over authentic human encounter; because of impossible contradictions between institutional policy and clinical care; because of the experience of raising concerns and finding oneself more isolated for having done so.
In the last 12 years, my professional experience included working as a psychodrama group psychotherapist within a prison-based therapeutic community, the National Health Service, and a private addiction rehabilitation clinic. Across all of these settings I encountered trauma, ethical dilemmas and organisational pressures. At some point, I began to experience a sustained tension between my ethical and clinical responsibilities, and the responses available within organisational systems.
These cumulative experiences led me to conceptualise what happened to me not just as vicarious trauma and burnout, but as moral injury, which fundamentally reshaped my understanding of therapeutic practice and moral agency in wider systemic contexts.
The moral injury construct enabled me to nurse professional wounds and think about what happens when professional values, moral agency and organisational processes become difficult to reconcile. My professional experience became a starting point for theoretical inquiry, research and reflection, leading to the development of a reflective practice model.
What is moral injury?
Moral injury was first described in the context of military psychology and has since extended to healthcare, social care, prison staff, and other professions where people act within complex systems that may conflict with their deeply held values. It is distinct from burnout, compassion fatigue, and vicarious trauma, though all four may co-occur. Burnout arises from chronic occupational stress. Compassion fatigue from prolonged empathic engagement. Vicarious trauma from repeated exposure to others’ traumatic experiences. Moral injury is different: it develops specifically from experiences that violate one’s moral beliefs, or from being prevented from acting in accordance with one’s ethical values (Dean et al., 2019; Litz et al., 2009).
Crucially, moral injury is not solely an individual phenomenon. Recent scholarship emphasises that it emerges within organisational and systemic contexts — when institutions produce double binds, impossible demands, and structures that make ethical action unavailable (Molendijk et al., 2022). From a systemic perspective, what appears as individual psychological distress may also be understood as an injury arising within relational and organisational contexts.
Tele and the disruption of authentic encounter
Psychodrama offers a distinctive lens through which to understand moral injury. Moreno (1953/1993) proposed that psychological health depends upon tele: the reciprocal and realistic perception that enables authentic encounter between people. Tele is not simply rapport or empathy — it is the living relational fabric that makes genuine human connection possible.
I have proposed that moral injury is not only an injury to conscience, but an injury to tele itself (Vau, 2026). Organisational cultures that replace authentic encounter with procedural compliance — that reward compliance over conscience — may progressively erode spontaneity, creativity and reciprocal connection. The practitioner continues to function professionally while losing, gradually and often invisibly, the relational ground that makes therapeutic work alive. The injury is simultaneously moral, relational, and existential.
Ethical anger: Bringing a Morenian concept into the published literature
Each time I have spoken of moral injury in supervision with Marcia Karp, she has spontaneously associated it with a concept articulated by Zerka Moreno: ethical anger. Zerka Moreno introduced this concept in an unpublished commencement address delivered at Lesley College Graduate School on August 31, 1983. To my knowledge — and to Marcia Karp’s — it has never previously appeared in the published psychodrama literature. The address was transcribed from a reading by Marcia Karp in February 2026, and exists solely as a private archival document. Marcia Karp and I share scholarly responsibility for bringing it into the published record.
There are actions which are suitable in one context, and totally unacceptable in another. With this concept of ethical anger, Moreno gave us a new category of understanding, as well as of behaviour, namely that there are certain moments in our life when we are justified to be angry by not permitting things to happen which our conscience could not allow, and by acting upon its prompting, we are in fact being a model for others to think about and emulate. (Z. T. Moreno, 1983)
Zerka Moreno distinguished ethical anger from righteous indignation and destructive aggression. It is not the anger of retaliation. It is the passionate, spontaneous expression of conscience in the face of injustice — an anger that arises from the same source as creativity and spontaneity, and that refuses to permit the violation of deeply held human values. On the psychodramatic stage, it may be enacted as catharsis in surplus reality. In everyday life, it can only find legitimate expression through ethical action.
This concept reframes something that the moral injury literature tends to pathologise or overlook: the anger of the morally injured practitioner is not evidence of disorder. It may be evidence of conscience.
Telic empathy and the process of moral repair
In earlier clinical work within a prison-based therapeutic community, I proposed the concept of telic empathy to describe an emotionally permeable and reflexive clinical stance, involving responsibility, containment and creative processing in surplus reality, which ultimately enhances reciprocal connection between therapist, group, and organisational context (Vau, 2019). Reconsidered through Moreno’s concept of tele and Zerka Moreno’s ethical anger, telic empathy becomes more than a therapeutic attitude. It becomes the relational process through which disrupted tele may be restored, creating conditions in which moral agency can re-emerge.
Unlike affective empathy, which risks emotional contagion, or cognitive empathy, which can privilege understanding over encounter, telic empathy preserves authentic connection whilst enabling therapist and client to co-create the conditions for restoring moral agency. Ethical anger is its moral safeguard: the expression of conscience that prevents telic empathy from collapsing into either detachment or self-sacrifice.
The model I propose is a relational sequence: moral injury disrupts tele and moral agency; ethical anger gives expression to the moral response that refuses ethical compromise; telic empathy creates relational conditions in which that response can be encountered without either suppression or destructive enactment; and the re-emergence of spontaneity expands the possibilities for moral agency and repair.
Healing is not an individual achievement. It is a relational and systemic process, emerging through ethical encounter. From a systemic perspective, it may also catalyse first, second, and ultimately third-order change within organisations — an enduring capacity for ethical reflexivity.
Moral injury in action: reflections from the BPA conference
I have recently had the opportunity to present and explore these ideas experientially at the BPA Psychodrama and Sociodrama Conference 2026 — Wellspring: Re-sourcing Ourselves and Our Collective (Vau, 2026). The conference took place at The Old Swan Hotel, Harrogate between 31 July and 2 August 2026.
Ten delegates participated in the Moral Injury workshop I facilitated at the BPA Conference, bringing the theoretical propositions described above into dialogue with lived experience on a sociodramatic and psychodramatic stage.
In the action stage of this session, role reversal became crucial in the exploration of the roles moral injury renders fixed or constrained. Moving between positions enabled perspective-taking and allowed for messages that previously remained unvoiced to be voiced and heard. The enactment made visible how the effects of a morally injuring event may extend beyond the individual — they reverberated across relationships and social systems, affecting practitioners, service users, families, colleagues and those occupying positions of authority within hierarchical structures.
What interested me particularly was that greater understanding did not immediately produce movement or change. Roles remained entrenched even after different perspectives were understood. A significant shift occurred when the role of spontaneity itself was named, held, and given a voice.
This brought me back to Moreno’s definition of spontaneity as the capacity to produce an adequate response to a new situation, or a new response to an old situation (Moreno, 1953/1993, p. 42). Moral injury may constrain precisely this capacity, which stands between anxiety and adjusted, creative action.
Without spontaneity, practitioners and their ethical congruence can become caught between role-responses: comply or protest, belong or withdraw, remain silent or risk exclusion. Indeed, the expression of ethical anger and the relational conditions of moral agency (such as telic empathy itself) cannot occur in the absence of spontaneity.
In the BPA Conference workshop, spontaneity widened possibility. It did not resolve moral dilemmas or erase what had happened. Rather, it opened the possibility that the existing roles and role-responses were not the only ones available.
Closing Note
This introductory article draws upon a more comprehensive theoretical paper, Wounding and Healing the Psychotherapist: Moral Injury and Repair Through Psychodramatic and Systemic Lenses, currently in peer-review for publication. The full paper develops the theoretical and systemic model of moral repair in greater depth. For correspondence or to request a preprint, contact: info@claudiavau.com
The theoretical formulation introduced here is informed partly by the author’s own experience as a psychodramatist and systemic practitioner. Organisational examples have been generalised, and no judgement of particular systems or individuals is intended here.
The Moral Injury workshop at the BPA Conference 2026 allowed me to bring the proposed model into a shared space of reflective practice. What emerged has further developed my thinking: the restoration of tele and moral agency through ethical anger and telic empathy may also depend upon the restoration of spontaneity within the moral and relational field.
From a psychodramatic perspective, moral repair may therefore involve not only being heard and understood, but recovering the capacity to create a new response where previously no ethically viable response seemed possible.
References
Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury not burnout. Federal Practitioner, 36(9), 400–402.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans. Clinical Psychology Review, 29(8), 695–706.
Molendijk, T., Kramer, E. H., & Verweij, D. (2022). Contextual dimensions of moral injury: An interdisciplinary review. Military Psychology, 34(6), 742–753.
Moreno, J. L. (1993). Who shall survive? (2nd ed.). Royal Publishing. (Reprint of 1953 edition).
Moreno, Z. T. (1983, August 31). Commencement address [Unpublished lecture transcript]. Lesley College Graduate School, Cambridge, MA. Transcript read by Marcia Karp and transcribed by Claudia Vau, February 2026. Private archive.
Vau, C. (2019). Pain and empathy: Long-term group psychodrama in a prison-based therapeutic community [Unpublished clinical paper, London Centre for Psychodrama].
Vau, C. (2026). How do you wound and heal a psychodramatist? My journey into moral injury, ethical anger, and telic empathy. British Psychodrama Association Conference Programme 2026. https://www.psychodrama.org.uk/wp-content/uploads/2026/07/Moral-Injury-by-Claudia-Vau.pdf
Information about the author:
Claudia Vau
Psychodrama Psychotherapist in Private Practice, London and Kent, United Kingdom
Systemic Psychotherapist in Training, Tavistock Centre, Academic Partner of the University of Essex. UK Council for Psychotherapy (UKCP) | British Psychodrama Association (BPA) | Association of Family and Systemic Psychotherapy (AFSP)