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Logotherapy and Existential Analysis for Burnout and Moral Injury

Viktor Frankl’s Logotherapy and Existential Analysis (LTEA) can be helpful to prevent burnout as well as to manage the effects of moral injury. Burnout and moral injury are two different entities. Burnout refers to exhaustion from excessive work. Moral injury is the consequence of values transgressions.

Ottawa Institute of Logotherapy, 2020

Burnout is a phenomenon that occurs at the workplace. LTEA, with its focus on the search for meaning, can be useful in its prevention. When people have a sense of meaning and purpose, they can take care of themselves better, and participate in meaningful activities where they actualize values in their lives.

Logotherapy and Existential Analysis for Moral Injury
Ottawa Institute of Logotherapy, 2021

Moral injury refers to values transgressions. It can occur in the process of work, or everyday life, when there is a betrayal of one’s personal values by someone else or through one’s own failures. To come to terms with values transgressions it is important that a person recognizes their values and how they are in search of meaning.

In LTEA, search for meaning refers to the actualization of personal values. Values are guiding principles, but if they are not lived, one cannot find meaning in life. Therefore, it is important to recognize what are our personal values and if they are in alignment with universal values.  Examples of universal values are human rights and the dignity of the person. When one actualizes values in harmony with universal values as their guiding principles, one finds meaning in life. In the case of moral injury, there is a sense of meaninglessness. The sense of meaninglessness can lead to symptoms such as disappointment, anxiety, and distress. These symptoms are the manifestation that the person is experiencing a lack of such values. The symptoms in themselves are not pathological, but if not managed, they can lead to serious consequences, such as depression, or posttraumatic stress disorder.

LTEA, in the first place, looks at areas of freedom and how a person can respond to a situation. It explores emotions related to values. After identifying the values, a person can decide, out of their freedom of will, what is the best course of action. In certain situations, it is to reaffirm those values, those personal and universal values that a person has, and lives accordingly, or choose a different path, or acknowledge that someone else has trespassed those values. In this way, LTEA can be a helpful complement to other therapeutic modalities like cognitive behavior therapy (CBT). The issue with CBT is that we try to reappraise cognitions or look at reality from different perspectives, but in the case of moral injury, the reality is that there has been a values transgression.  As we acknowledge this reality, we recognize the emotions in relation to our values and in doing so, we search for meaning in suffering.

On the other hand, with burnout, what we are trying to do is to increase the resiliency of the person. Resiliency means that people can face life’s challenges and they don’t become broken or sick in the face of those challenges.  They can step back through self-distancing from the situation and respond according to their values. In many cases, when there is exhaustion from work, it is important that the person takes care of themselves, that they replenish their energies so they can be effective in their work.  In other situations, they can analyze what kind of work they are doing and if it is meaningful to them. Sometimes there are repetitive tasks, or monotonous work that is not meaningful, and the person loses their own sense of humanity. When we reconnect with our values, we start to see possibilities within that work environment where we can live our values: In connecting with coworkers, contributing to society, or how we face different challenges.

Burnout and moral injury if left untreated can lead to mental health problems. LTEA offers an approach that can improve life satisfaction and resiliency.

On March 23-24, 2023, Professor Edward Marshall is offering a two-day workshop at the Royal Ottawa Mental Health Centre that will focus specifically on the methods and applications of Viktor Frankl’s Logotherapy and Existential Analysis. This event is tailored toward health professionals and students who would like to deepen their knowledge and understanding of the uses of this modality in their clinical practice. Registration Page.

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Logotherapy and Existential Analysis for Moral Injury validated by Science

The December 2022 issue of the Scientific American features an article by Elisabeth Svoboda on Moral Injury: “Moral Injury is an Invisible Epidemic that Affects Millions.” The article defines Moral Injury as a “specific trauma that arises when people face situations that deeply violate their conscience or threaten their core values.” It presents recent examples from the health care setting, where ethically challenging dilemmas are part of the everyday scenario.

Scientific American, December 2022

The article reviews literature that first identified Moral Injury in the military setting, to its working definition for everyday life and clinical practice. It provides several examples that require a therapeutic approach that goes beyond traditional cognitive behavioral therapy (CBT), since the distress is genuine and not the product of distorted thinking. The article asserts that Moral Injury is different from Post Traumatic Stress Disorder (PTSD). It does not respond well to conventional trauma treatments, and it requires a more “spiritual approach” that considers the whole of the person.

Proposed models for the treatment of Moral Injury share the emphasis on the search for meaning to overcome its effects. The article reflects on the role of Viktor Frankl’s Logotherapy and Existential Analysis (LTEA) for the management of Moral Injury. This approach “bolsters a clients’ sense of purpose.” It validates the reality of values transgressions, and helps to find meaning in line with core values as guiding principles. LTEA can be applied alone, or as a complement to other treatment modalities currently employed in the treatment of Moral Injury.

The book, “Logotherapy and Existential Analysis for the Management of Moral Injury,” by Edward Marshall and Maria Marshall, published through the Ottawa Institute of Logotherapy in 2021, reviews the history of the conceptualization of Moral Injury, the development of tools for its assessment, and a review of the treatment modalities proposed for its management. In developing the case for the application of LTEA, the book reviews the evidence base of LTEA, and provides practically relevant principles and methods based on LTEA that can be useful for clinicians when treating individuals affected by Moral Injury.

Logotherapy and Existential Analysis for Moral Injury
Ottawa Institute of Logotherapy, 2021

On March 31, 2022, Professor Edward Marshall offered a workshop with over 120 participants on the application of Logotherapy and Existential Analysis for the management of Moral Injury at the Royal Ottawa Mental Health Centre, Canadian Centre of Excellence on PTSD.

Awareness of Moral Injury is increasing as examples locally, and globally amount. Validation for the use of LTEA as an evidence-based method for addressing the symptoms arising from moral injury is a welcome sign that the scientific community embraces LTEA to offer a purposeful and meaningful contribution to the treatment of moral injury, one that puts humanity at the forefront of responding to suffering arising from values transgressions. 

On March 23-24, 2023, Professor Edward Marshall is offering a two-day workshop at the Royal Ottawa Mental Health Centre that will focus specifically on the methods and applications of Viktor Frankl’s Logotherapy and Existential Analysis. This event is tailored toward health professionals and students who would like to deepen their knowledge and understanding of the uses of this modality in their clinical practice. Registration Page.

Logotherapy and Existential Analysis for Moral Injury

Logotherapy and Existential Analysis for the Management of Moral Injury

New Book by Edward and Maria Marshall (2021)

Logotherapy and Existential Analysis for Moral Injury

The COVID-19 pandemic brought Moral Injury (MI) to the forefront of clinical attention and research. This multi-dimensional syndrome has been first described in the military context and is now understood to affect people in other occupations such as health care, business, education, law enforcement, the legal profession, disaster relief, international aid, social justice, as well as other areas of social and occupational functioning. Moral injury occurs when deeply held beliefs, ethical and moral principles have been trespassed. The violation of universal values and personal principles can be committed by oneself or by others. Witnessing potentially morally injurious events gives rise to guilt, shame, remorse, anger, disgust, feelings of betrayal, spiritual struggles and disorientation, loss of meaning, and despair. The secondary symptoms of moral injury may include anxiety, depression, and post traumatic stress. The symptoms of moral injury can vary in intensity and can present from mild to severe, seriously impairing functioning. Moral injury is not considered a mental illness but a syndrome that warrants clinical attention.


Employing a phenomenological hermeneutic method of systematically reviewing pertinent texts, the present study explores the lived experience of moral injury in relation to assessment and treatment methods currently available. Conceptually, research indicates that self care, moral resilience, and social support are linked with factors such as resiliency, post-traumatic growth, and self-transcendence. These factors are correlated with meaning, a key factor in wellness following existential frustration and distress. Thus, a holistic body, mind and spirit approach to the assessment and response to moral injury is warranted.


Viktor E. Frankl’s Logotherapy and Existential Analysis (LTEA) is an evidence-based meaning-centered approach to psychotherapy and counselling that has been successfully applied in the treatment of conditions involving existential issues. The present research examines the contribution of LTEA to the conceptual understanding of moral injury and to its related symptomatology. It details the application of LTEA principles and structured meaning-centered interventions in responding to moral injury. The applications are illustrated with examples that help to position this method into a holistic framework promoting re-connection, renewal, and health.

Culture and Personality

There is a role for education to help individuals develop their personality throughout life. Beyond the influences from the somatic and psychological dimensions, the person has the capacity to reflect and decide how to respond to life. The freedom of will of the human spirit also influences culture, since culture is amenable to develop over time. Personality relates to the individual whereas culture relates to the community. Within the community individuals exercise their freedom with responsibility. Their lives and response to life have consequences on other members of the community.

There has been an emphasis on the discoveries of determining factors in society. To have a complete picture of what humans are capable these factors need to be complemented with acknowledging the human capacity to decide a meaningful response to the environment. To bring awareness of the human capacity to freely respond to reality in spite of conditioning factors according to reasonable judgment is one of the roles of education and psychotherapy.

For example, we may reach conclusions through statistical research about the influence of the economy on mental health and how an economic crisis situation can precipitate a mental health deterioration on predisposed individuals. The person can feel excluded from the community or develop low self-esteem because it becomes impossible to keep up with expectations of society. On the other hand each individual can develop the capacity not to be completely determined by such external factors. This is the time to look outwards to what can be done to improve the situation which may benefit the community as a whole.

The person needs to take the initiative beyond expectations in their particular circumstances to the benefit of the community even though the community is not expecting much from the person. Leaders in position of power have it easier to exercise this capacity of outreaching to the community since this is what is expected from them, but individuals suffering from lack of employment, failure, marginalization, the effects of immigration, minorities, chronically ill, disabled, etc., are not expected to contribute much to the community, and their input is perceived at times bothersome and unwelcome. These are the individuals who require to mobilize the resources of the human spirit the most in order to reaffirm their dignity, uniqueness and humanity. In essence, to become leaders, or agents of change in their own right.

The first step to strengthen the capacities of the human spirit is an invisible change that happens inside the person to perceive the world not as a threat but as a place to explore and improve. From the time the person starts to think about how to reach out to others rather than focusing only on personal problems there starts to be a benefit for the community. This internal spiritual change, may translate into action, to alleviate the suffering of those around the person.

According to personality theories, there are certain types of personality which may have it easier to develop this outward way of thinking. This doesn’t mean that this change is not possible or available to any individual.

Breaking the barrier from changes in interior life to visible action can also have its difficulties, since there would be a reaction from other members of the community, not necessarily encouraging or welcoming. There may be reluctance that the change comes from the so called marginalized, since the majority of the community have excluded those individuals in the first place. It is then when the individual needs to put to the test the defiant power of the human spirit fighting for what is right. This is a psychological fight rather that a physical one. The individual needs to adapt and be flexible to aim at what is possible within their means to promote peace, compassion, and love, to those afflicted by suffering. Encouraging peer support, community building, friendship and love are possible targets in most situations.

Personal and community development are about learning how to respond to life situations meaningfully. Personality and culture are developing in the right direction when there is a process put in place involving the search for meaning. Most of the times to find the right answer to the world problems requires a search for the best option, since it is very difficult to get it right at the first attempt, with subsequent initiatives required, to respond adequately to the same or unprecedented problems.