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Moral safety is a subject that is even more difficult to describe. It is a search and a process. It is an attempt to reduce the hypocrisy that is present, both explicitly and implicitly, in our social systems. A morally safe environment is one that permits an ongoing ethical dialogue, a search for higher meaning and purpose. Such a setting articulates and manifests in practice the values that it represents – honesty, compassion, a search for integrity, kindness, courage, justice, an honoring of the past and hope for the future. Exposure to interpersonal violence is fundamentally about the abuse of power and it shakes the very foundations of meaning and moral purpose, the very deepest spiritual and philosophical beliefs. A health-promoting, morally safe environment therefore, is one that wrestles constantly with the issue of power and how power can be utilized in ways that promote health and healing instead of sickness, abuse and decay. It is an environment that attempts to minimize the abuse of power through the routine employment of democratic principles of practice. The therapeutic environment must be able to thoroughly analyze and address abuses of power on the part of both patients and staff in ways that promote learning, growth, and change. It is a fundamentally important quest for patients who are victims of abusive power because their internal systems of meaning have become confused and contradictory. A morally safe environment engages in an on-going struggle with the issues of honesty and integrity. In any environment this means beginning with a self-evaluative look at our therapeutic presumptions, our training, our rationalizations, and our fixed beliefs, as well as our practice. Each system must look at its own issues with authority and become willing to participate in, not just manage, the relational web that forms the structure of the program, willing to ask questions like, “What do we really believe in?” “What is it that we are actually doing, and what are we trying to achieve?” “Will the means get us to the desired ends?” “Do the means justify the ends?” “Do the activities we are prescribing lead to autonomy, connectedness, and empowerment or dependence, alienation and helplessness?” Similarly, our clients must confront the breaches in moral integrity that characterize the specific systems within which their normative behavior developed, be it their family, a religious organization, another form of a cult, or an institution. A morally safe approach also entails looking at the way our society is organized around unresolved traumatic experience – what I have called the “Nine A’s of Trauma” - and manifests this dysfunction through disrupted attachments, unmodulated affect, poorly managed aggression, abusive authority, diminished awareness, multiple addictions including an addiction to trauma, automatic repetition of destructive behaviors, avoidance of feelings and accountability, and alienation from self and others (Bloom, 1997; Bloom and Reichert, 1998).
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