Clinical Psychology and Moral Distress

Background: Decision-making practices are complex and within the process ethical dilemmas can present themselves. When a healthcare professional feels unable to provide the care that their ethical code deems ‘best’ for a patient, moral distress can arise. Moral distress is a phenomenon originating in, and most explored within, nursing; it captured the compromised ethical integrity nurses experienced when they were institutionally constrained from acting in accordance with their professional values. This study is believed to be the first in the United Kingdom to explore the concept of moral distress with Clinical Psychologists.
Methods: A Thematic Analysis was carried out on data collected from semi-structured interviews with 14 Clinical Psychologists working to provide mental health support to adults in the United Kingdom’s ‘socialised’ healthcare system, the National Health Service.
Results: Three superordinate and six subordinate themes emerged from data analysis. These spoke to the patterns in participants’ experiences of ‘Being in Services’ and the constraints on their attempts to ‘Do the Right Thing’ whilst observing ‘Cultural Harm’. A theme concerning ‘Power’, it’s ‘Top-Down’ enforcement, and the participants’ attempts at ‘Resistance’ followed. The final theme spoke to the role of ‘Professional Identity’ and the consequences of morally distressing experiences, such as the intent to leave a role or the NHS itself. Mechanisms for managing the values conflicts are also identified.
Conclusions: Clinical Psychologists in this study were regularly constrained from working in alignment with their personal and professional values by institutional practices. The impact of this on the participants’ own psychological wellbeing was significant.