Abstract
Moral injury is increasingly recognised across occupational settings, yet structured treatment approaches remain limited outside military and emergency contexts. Workers navigating prolonged compensation processes often experience cumulative moral harms through betrayal, procedural injustice, and system-induced trauma. Developed by a psychologist working exclusively within the workers’ compensation system, the Eight-Dimension Moral Injury Therapy (8D-MIT) framework provides a structured, trauma-informed, and practice-derived approach to recognising and addressing moral injury within these complex environments.
The 8D-MIT framework extends existing moral-repair models (Litz et al., 2009; Shay, 2014; Gray et al., 2012) by integrating lived clinical experience with trauma science and occupational-recovery principles. It comprises eight therapeutic dimensions, Recognition, Regulation, Reactivation, Rumination, Rage, Reconstruction, Reconnection, and RISE, that guide clients from violation through recovery to moral repair and growth. RISE represents self-actualisation, restored integrity, and moral resilience: the ability to transform pain into wisdom and purposeful advocacy.
Healing within compensation contexts is dynamic rather than linear and is often disrupted by systemic demands that reactivate distress and moral conflict. Repeated external stressors, such as Independent Medical Examinations, adversarial correspondence, delays, financial strain, denied treatments, and inadequate organisational support, can reopen moral wounds and undermine therapeutic progress. These systemic stressors mirror findings that moral injury is not solely individual but organisational, requiring reforms grounded in fairness and supportive leadership (French et al., 2022; Hines et al., 2021). Moreover, moral injury frequently co-occurs with PTSD, necessitating flexible, multidisciplinary treatment approaches (Griffin et al., 2019; Nauman & Qureshi, 2021).
Developed through extensive front-line clinical practice, 8D-MIT offers a practical guide for both therapist and client, supporting structured yet adaptable therapy. While practice-derived and not yet empirically validated, validation planning is underway. The proposed research will evaluate feasibility, safety, and outcomes within Tasmanian workers’ compensation, incorporating ethical safeguards, clinician-training protocols, and attention to cultural context. Outcome measurement will draw on occupationally contextualised tools, including the Occupational Moral Injury Scale (OMIS) and Moral Injury Distress Scale (MIDS). The companion 8D-MIST Screener, developed to align with these measures, provides a clinically grounded tool for assessing and monitoring moral injury across the eight dimensions and will form part of the next phase of validation and outcome research.
When therapy addresses the full moral and psychological dimensions of injury, recovery deepens, clients rebuild trust and agency, and systems are encouraged to strengthen their integrity by minimising preventable harm through trauma-informed, compassionate processes. In doing so, prognoses improve, outcomes become more durable, and recovery evolves into sustained healing and moral growth, for clients, practitioners, and the systems in which they work.