The REAL journey: a meaning-oriented approach to moral injury care

This paper describes three theoretical models that focus on meaning-making as a foundation for moral injury conceptualization and care, as manifested in the Reclaiming Experiences and Loss (REAL) moral injury group therapy. The philosophical foundation of the REAL group is Viktor Frankl’s logotherapy, which emphasizes the role of the human spirit and posits that meaning is achieved through living out one’s fundamental responsibility to actualize whatever values are available in a given moment. Constructive psychotherapy operates from core assumptions about client autonomy, an inherent drive toward meaning, the influential impact of experiences with others, and a capacity to live within one understanding of reality while simultaneously considering other possibilities. These assumptions shape the format and processes of the REAL group. Finally, meaning reconstruction provides the overarching structure for processing grief and loss that retains sufficient coherence around shared tasks and experiences to facilitate a group experience, while also maintaining space for each person’s particular journey of lamenting and reckoning with the aftermath of a moral violation. The REAL group therapy model promotes healing by emphasizing each person’s unique and particular opportunities for meaning while underscoring the common, shared human capacities and responsibilities that are fundamental to human existence.