Eye on Ethics: Moral Repair and Apology
By Frederic G. Reamer, PhD
Social Work Today
Vol. 21 No. 4 P. 12

Occasionally, social workers and their clients feel remorse because they have engaged in, witnessed, learned about, or failed to address behavior that has caused moral injury. Moral injury entails harm that results when someone has perpetrated, failed to prevent, or witnessed acts that transgress deeply held moral beliefs. Examples include social workers who have violated boundaries in their relationships with clients, breached confidential client information without authorization, or delivered services to clients while impaired.

In other instances, social workers provide services to clients who struggle with remorse or guilt associated with their belief that they have caused, witnessed, learned about, or failed to address moral injury. Examples include clients who feel remorse about the way they have treated family members or acquaintances or the way they have coped with challenges in their lives, or who feel remorse because they witnessed family members or acquaintances mistreat others but did not intervene.

Moral Repair
Both practitioners and clients who wrestle with these complex issues may experience moral distress and yearn for what has become known as moral repair. Moral distress occurs when individuals feel a sense of remorse or guilt concerning their behavior or know the morally correct action to take but are constrained in some way from taking this action. Moral repair is the process of moving from a situation where harm has occurred to a situation where some degree of stability in moral relations is regained. The process of moral repair involves efforts to restore or create trust and hope in a relationship.

Some of the most ambitious efforts to facilitate moral repair in work with clients have involved social workers’ and colleagues’ therapeutic work with military service members who participated in, witnessed, learned about, or believe they failed to prevent unnecessary acts of violence in war zones. For example, social workers and other behavioral health practitioners have focused on morally ambiguous actions associated with counterinsurgency and guerilla warfare that involved uncertainty and risk of harm to noncombatants. They have implemented a cognitive behavioral therapy protocol with military service members who were deployed to war zones designed to address several morally injurious elements of combat: life-threatening trauma, traumatic loss, and moral injury. Treatment components that include attention to issues of moral distress have included the following:

• preparation and education about moral injury and its impact, as well as a collaborative plan for promoting change;

• exposure-based processing of events surrounding the moral injury;

• a subsequent careful examination of the implications of the experience for the client;

• an “imaginal dialogue” with a benevolent moral authority (e.g., parent, grandparent, coach, clergy) about what happened and how it affects the client now and their plans for the future;

• fostering reparation and self-forgiveness;

• supporting reconnection with various communities (e.g., faith, family); and

• an assessment of goals and values moving forward.

Moral Apology
For some social workers and clients, apologizing for their association with moral harm and injury is a central element of moral repair. Apologies can help individuals who feel remorse about their actions or failure to act and, perhaps, provide solace to victims.

Apologies following instances of moral injury can serve several functions. Some apologies are public, where transgressors acknowledge their wrongdoing and seek to make amends. Other apologies are more private. Also, if circumstances warrant, apologies may provide an opportunity for victims to forgive those who harmed them. And apologies may provide opportunities for those who have caused moral harm to establish or regain trust.

Direct and Vicarious Apologies
In some instances, people who feel responsible for causing moral harm apologize to victims directly. In one case in which I testified as an expert witness, a social worker was charged in criminal court, sued for malpractice, and adjudicated by his state licensing board after he became sexually involved with a deeply traumatized clinical client. During his sentencing hearing in criminal court following his conviction, which the victim attended, the social worker addressed the victim directly and apologized to her for his poor judgment and the harm he caused.

In other instances, practitioners apologize through third parties. This is known as vicarious apology. In one case, a social worker employed by a family service agency was disciplined by his state licensing board after a client filed a complaint alleging that the counselor had disclosed sensitive confidential information about her without the client’s authorization. Evidence showed that the confidentiality breach harmed the client emotionally and compromised her legal status in a complex child custody dispute.

The social worker was fired by the agency and his professional license was disciplined by the state licensing board. The executive director of the agency reached out to the victim to arrange a meeting. During the meeting, the executive director apologized to the former client for the counselor’s conduct.

In another case involving vicarious apology, a social worker at a residential treatment program for adolescents who struggle with behavior challenges was arrested following an investigation that he supplied opioids to a resident in exchange for sexual favors. The program’s director contacted the youth’s parents to formally apologize for the staffer’s misconduct.

Collective Apologies
In addition to direct and vicarious apologies, there are also what are known as collective apologies. These are issued to a broad audience on behalf of an organization or agency. For example, in 1988 former President Ronald Reagan signed the Civil Liberties Act to compensate more than 100,000 people of Japanese descent who were incarcerated in internment camps during World War II. The legislation offered a formal apology and paid out compensation to each surviving victim.

One of the best-known examples of a collective apology occurred on May 16, 1997, when former President Bill Clinton acknowledged the moral harm caused by the notorious Tuskegee Syphilis study, the 40-year (1932 to 1972) government study in which 399 African Americans from Macon County, Alabama, were deliberately denied effective treatment for syphilis in order to document the natural history of the disease. African Americans who contracted syphilis were not informed of their disease and were denied treatment while participating in an observational study. The apology was sought by the National Medical Association, an organization of Black doctors. President Clinton asked the victims and their families to forgive the federal government for the research.

In another infamous example of a collective apology, Australia’s prime minister apologized publicly for the government’s failure to protect children from sexual abuse. A five-year government investigation produced evidence that many children in the care of schools, churches, sporting clubs, and foster homes had been abused and that many institutions had gone to great lengths to shield abusers. This followed an earlier apology issued by the prime minister to Australia’s Indigenous population for policies that removed Aboriginal children from their families and compelled them to reject their cultures in favor of assimilation, creating what is known as the “Stolen Generation.”

Any professional, including social workers, can engage in conduct that causes moral injury. This is also true of social workers’ clients. When social workers or their clients cause moral injury, they may experience moral distress that warrants attention. Social workers would do well to fully understand the role of moral repair and moral apology in professional practice.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.