Creating moral space: How military chaplains in the Netherlands support veterans with moral injury.

Introduction: The concept of moral injury has drawn attention to the role of military chaplains (MCs) in supporting veterans. While international research has explored military chaplaincy interventions, collaboration with mental health professionals, and institutional influences, longitudinal, process-oriented insights into military chaplaincy practice remain scarce, particularly in the Dutch context, which combines secularization, pluralized worldviews, and a unique institutional position of MCs. Methods: This study employs a qualitative longitudinal design, analyzing the practice of 6 Dutch MCs in their counseling work with post-active veterans over a period of 3-12 months. Data consists of detailed conversation reports from each dyad and quarterly group reflections with participating MCs. Analysis included cross-sectional and longitudinal approaches, identifying both patterns in how MCs address moral injury in one-on-one meetings with veterans and how these meetings unfold over time. Results: Three interrelated dimensions characterize Dutch MCs' practice: presence - encompassing the physical setting and relational quality of encounters; their institutional position which we characterize as an embedded independent position within the military and healthcare systems; and moral reflection - referring to attuned pathways of how MCs address moral struggles. Longitudinal analysis revealed four typologies of contact development: (1) clear request and alignment, (2) emerging focus, (3) development through the relationship, and (4) minimal responsiveness with story-sharing focus. Breakthrough moments were observed primarily in types 1-3 and required sustained engagement. Discussion: The study emphasizes the moral significance of relational presence and the embedded independent position of MCs in addressing moral injury. Dutch MCs create a 'moral space' allowing veterans to explore moral concerns, re-establish self-trust, and recognize broader sociopolitical dimensions of moral injury. These findings highlight the importance of attuned, politicized, and confidential care in addressing moral injury, with implications for professional development, interdisciplinary collaboration, and the quality of veteran care.