How Military Chaplains Strengthen the Moral Resilience of Soldiers and Veterans: Results From a Case Studies Project in the Netherlands

In spiritual care research, studies on military chaplaincy are underrepresented, and most available studies center on moral injury. This article contributes to the existing literature on spiritual care in the military by presenting a study of 13 case descriptions of spiritual care provision by military chaplains from the Netherlands. These were analyzed using the framework method, a qualitative method of systematically searching for patterns in data sets, in order to answer the question: How do military chaplains contribute to the moral resilience of soldiers and veterans experiencing moral stress? The analytical framework was constructed on the basis of Doehring’s (Pastoral Psychology, 64(5), 635–649, 2015) conceptual understanding of moral resilience as the outcome of processes of spiritual integration of moral stress in caregiving relationships. This study shows that soldiers experience moral stress when core values associated with ‘being a soldier’ conflict with expectations or actions of soldiers themselves or of others, with the way the military organization functions, or with the spiritual notion of ‘being a good, loving and loveworthy human being’. In their responses to moral stress, chaplains contribute to moral resilience by engaging in co-creating spiritual orienting frameworks which accommodate a sense of goodness of self and others and allow for nuanced, biographically rooted moral views. Soldiers experience conversations and brief encounters with chaplains as relational ‘moments of goodness’, which may also contribute to moral resilience.


Introduction
Within spiritual care research, the majority of studies focus on spiritual care in the context of healthcare (Fitchett, 2017;Fitchett et al., 2018;Pesut et al., 2016).Research into spiritual care in other contexts is still relatively underdeveloped even though including a variety of contexts would yield a richer picture of spiritual care, especially given the fact that spiritual care provision by chaplains has a long history in institutions such as prisons and the military.Studying spiritual care in the military, for instance, allows for more Extended author information available on the last page of the article insight into the responses of spiritual caregivers to the violence that people may inflict on one another -an aspect of spiritual care that often remains in the background in the context of healthcare.Recently, a small but growing body of literature addresses spiritual care in the military, often focusing on military chaplaincy in a specific country (Grimell, 2020a, b;Liuski & Ubani, 2021) or on the role of military chaplains concerning the severe suffering of soldiers or veterans, such as PTSD and depression (Ramchand et al., 2016;Wortmann et al., 2017).The increase in research into spiritual care in the context of the military is in part related to the emergence of the concept of moral injury, which has quickly gained ground among researchers, mental health professionals, and policy makers (Molendijk, 2022).This concept was developed in order to describe struggles of veterans resulting from confrontation with morally unsettling situations during deployment (Litz et al., 2009;Molendijk, 2018;Shay, 2014).In most definitions of moral injury, its spiritual dimension is emphasized (Koenig & Al Zaben, 2021), and an increasing number of studies center on the support that military chaplains offer in relation to moral injury (Carey & Hodgson, 2018;Carey et al., 2016;Doehring & Ramsay, 2019;Fleming, 2021;Smith-MacDonald et al., 2018).
With this article, we aim to contribute to the existing literature on spiritual care in the military by presenting a study of 13 case descriptions of spiritual care provision by military chaplains from the Netherlands.In the Netherlands, military chaplains are employed by the armed forces and organized denominationally.Seven worldviews are represented: Protestant, Roman-Catholic, humanist, Jewish, Muslim, Hindu, and Buddhist.The denominational chaplaincy services cooperate in the task of caring for the spiritual well-being of soldiers, veterans, and their families.Military chaplains are typically connected to a specific unit and support soldiers of all worldview backgrounds.This study was part of a larger research project, the Dutch Case Studies Project, in which chaplains wrote case reports of processes of care provision and discussed these in a 'research community' consisting of several participating chaplains and academic researchers, on the basis of a set format, resulting in the final case description (Kruizinga et al., 2020;Walton & Körver, 2017).The aim of the study was to gain detailed insight into the work that chaplains do, thus working towards a stronger research base for the profession (Walton & Körver, 2017).The first two authors had a leading role in the research community focusing on military chaplaincy, and the second two were the coordinators of the project.
Given the existing focus on severe suffering, and moral injury in particular, in the literature on military chaplaincy, we expected the participating chaplains to describe cases of spiritual care provision to soldiers with moral injury in a majority of the case descriptions.It turned out, however, that, even though moral issues did play a central role in each of the cases selected by the chaplains, only a few of these were related to morally unsettling situations during deployment.In relation to some of the cases, the chaplains spoke about 'moral ripples' rather than moral shock.Moral struggles that were described in the cases often had to do with relationships with family members, interactions with colleagues, or annoyance with the military organization.
Therefore, rather than moral injury, moral stress seems to be a suitable concept for understanding the struggles of soldiers for which they sought support from a chaplain.Here, we follow Doehring's (2015) definition of moral stress -"Moral stress arises from conflicts among core values and is experienced physiologically through emotions like shame, guilt, or fear about causing harm by putting ultimate commitments in jeopardy" (p.637) -and her understanding of moral stress as encompassing moral struggles at various levels of severity: "Moral injury can be placed at one extreme end on a continuum of moral stress, with everyday moments of moral stress at the other end" (p.638).Doehring denotes the aim of spiritual care in response to moral stress in terms of resilience, understanding resilience at its core as a relational experience: "[S]piritual care fosters resilience through spiritual care relationships that help people integrate moral stress" (p.636).We designate resilience to moral stress as moral resilience in order to avoid confusion with broader notions of resilience (see, for instance, Kent et al., 2014).While the concepts of moral distress and moral resilience have predominantly been studied within nursing science (Young & Rushton, 2017), various authors have also written about resilience as an aim of chaplaincy (Doehring, 2015;Schuhmann & van der Geugten, 2017;Spidell, 2014).In the context of military chaplaincy, this raises the following research question: How do military chaplains contribute to the moral resilience of soldiers and veterans experiencing moral stress?
In this article, we explore this question from a chaplaincy perspective through a qualitative analysis of the 13 case descriptions that we collected in our study.Here, we use a mainly deductive approach, taking Doehring's (2015) conceptual understanding of moral stress and resilience as our starting point.We first elaborate on this theoretical perspective on moral stress and moral resilience before describing the analysis method -the framework method (Gale et al., 2013) -in which we use an analytical framework constructed on the basis of Doehring's theory.We then present the results of the study along three lines, addressing three sub-questions of the main question: (1) What experiences of moral stress do soldiers and veterans discuss with chaplains?(2) How do chaplains respond to these experiences of moral stress?and (3) What aspects of chaplaincy care are key in strengthening the moral resilience of soldiers and veterans?The results allow for a broad picture of military chaplaincy that shows how military chaplains address and respond to a whole range of moral issues.
Theoretical background: Moral stress and moral resilience from a spiritual and relational perspective Doehring (2015) developed a spiritual perspective on moral stress and resilience in which people's 'spiritual orienting systems' have a central place.She understands moral stress as arising from conflicts among core values, "either within persons (intrapsychic moral stress), between persons (interpersonal stress) or within systems (systemic moral stress)" (p.637).She emphasizes that moral stress is typically "energized by shame, guilt, fear of causing harm, or self-disgust (some of the so-called negative moral emotions that cut people off from social support)" (p.638).It is important to note that, in this view, moral stress is not something that necessarily or primarily happens 'within' minds; it also occurs between people or between people and institutions or society.The inherently spiritual aspect of moral stress comes to the fore in the notion of 'core values'.Doehring explains that these are not just any values but values that constitute our spiritual orientation systems.Here, she follows Pargament (2007) definitions of spirituality as a search for the sacred and of spiritual orientation systems as the frameworks guiding that search.
We may elaborate on this understanding of spiritual orientation using the work of Taylor (1989), who philosophically underpins the spatial metaphor of orientation for understanding human existence.Taylor argues that human beings are necessarily engaged in attempts to orient towards visions of a 'good' life which function as orienting systems.These attempts have a spiritual character when the visions of a 'good' life we orient towards involve what he calls 'strong evaluation': "what deserves the vague term 'spiritual' is that they involve strong evaluation -discriminations of right or wrong, better or worse, higher or lower, which are not rendered valid by our own desires, inclinations, or choices, but rather stand independent of these and offer standards by which these can be judged" (p.4).In order to make sense of our lives spiritually, we need to be able to orient towards visions of the good that we value strongly, that are decisive for determining whether or not our lives are worth living.In this view, moral stress is a specific experience of spiritual disorientation in which one is either unsure what strongly valued 'good' to orient towards -for instance, when one feels one has to choose between conflicting core values -or one feels the road towards some strongly valued 'good' is blocked -for instance, when core values come under pressure due to actions by someone else or due to systemic pressure.
According to Doehring (2015), people may develop resilience in the face of moral distress through caring relationships; she sees resilience as an "outcome of caregiving relationships that help people spiritually integrate moral stress" (p.636).In particular, she speaks about spiritual care as a practice of supporting spiritual integration of moral stress.Doehring explains the process of spiritual integration by pointing out three steps.The first step concerns identification and exploration of experiences of what she calls "goodness" (p.644).The second step consists of identifying how "intersecting social systems of oppression like racism, sexism, and classism" (p.637) affect spiritual disorientation due to moral stress.In the third step, 'life-giving' spiritual orienting frameworks are co-created, frameworks that "draw upon goodness, compassion, and love -moral emotions that connect [people] to the web of life" (p.637), thus countering the fueling emotions like shame or self-disgust involved in moral stress.In order to assess to what extent people's spiritual orienting systems are 'life-limiting' or 'life-giving', Doehring refers to four criteria, based on work by Pargament et al. (2006), which indicate that a spiritual orientation framework is life-giving rather than life-limiting.A spiritual orientation framework needs to (1) connect people to the 'goodness of life', (2) be integrated into a person's biography rather than relating only to a part or episode of a person's life, (3) allow for flexible rather than rigid responses to stress, and (4) accommodate suffering in ways that are complex rather than "simplistic or individualistic" (Doehring, 2015, p. 641).
In fact, using a theological perspective, Doehring (2015) speaks of 'lived theologies' rather than of processes of spiritual orientation, remarking that "lived theologies function as spiritual orienting systems" (p.640).In this article, we stick to the notion of spiritual orientation as this has a broader scope, applying both to people who identify as religious and those who do not.Doehring's understanding of spiritual integration resembles the notion of integrity in the definition of moral resilience that Rushton (2016, p. 112) provides in the context of nursing studies: "the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress or setbacks".However, whereas the definition of Rushton centers on the individual, in Doehring's view resilience to moral stress is necessarily relational, which is helpful for exploring moral resilience in the context of spiritual care practices.

Participants and procedures
As mentioned in the introduction, this study is part of a larger research project -the Dutch Case Studies Project -in which case descriptions of chaplaincy care in the Netherlands were collected with a view to the following central research question: What do chaplains do, for what reasons, and to what ends?(Walton & Körver, 2017).The project focused on cases of individual support.In the project, experienced chaplains and academic researchers collaborated as co-researchers in various separate research communities.The chaplains wrote reports of cases of chaplaincy care that they provided to individuals and that they considered to be 'good' practices.Each case report was then evaluated in the research community in which the chaplain participated, and the evaluation was included in the final case descriptions.Both the writing of the case report and of the case description followed a set format (see Walton & Körver, 2017).
The study in this article is based on data that were collected between 2017 and 2020 in the research community of military chaplains, which was led by the first two authors. 1ight military chaplains participated in the research community: three humanist chaplains, three Protestant chaplains, and two Roman Catholic chaplains.Two of the participating chaplains were female, and six were male.The chaplains wrote their case reports as soon as possible after the specific instance of chaplaincy care had taken place and at most three months afterwards.In most cases, they wrote their reports from memory as the chaplains felt that recording their conversations with soldiers would compromise the confidentiality of conversations that is essential in chaplaincy.In the results section, when we quote from chaplaincy conversations, we take these from the case descriptions written down from memory by the chaplains (the quotes were translated from Dutch to English by the first author).
As for ethical considerations, the Dutch Case Studies Project as a whole was ethically reviewed by Medical Research Ethics Committees United (W18.064;see https:// www.mecu.nl).The military chaplains participating in the military research community obtained official consent to participate from the Dutch military chaplaincy services.For each case description, the military chaplain involved in the case obtained informed consent from the soldier or veteran they provided care to.In some cases, however, that proved impossible, for instance when the soldier involved had left military service.All case descriptions were thoroughly anonymized and adjusted where needed in order to comply with both standards of anonymity in research and standards of confidentiality in chaplaincy.

Data
In total, 13 case descriptions of cases of chaplaincy care were collected, spanning a variety of military divisions within the armed forces and a variety of care settings.The military chaplains themselves decided which cases they felt were examples of 'good chaplaincy care'.Initially, that was the only criterion for including cases in the research.Later, a new criterion was introduced, which was to include cases that would help to get a broader picture of 'good' chaplaincy care in the military.That is a form of 'purposive sampling' which involves "the identification and selection of information-rich cases related to the phenomenon of interest" (Churchill, 2022, p. 35).For instance, after having described various cases of a planned one-on-one conversation with a soldier, the research community decided to include cases of chance encounters with soldiers as military chaplaincy also involves such more informal conversations.Furthermore, in one case the involvement of a chaplain in a military ritual was described.Table 1 provides an overview of the 13 case descriptions.The gender of the soldiers is not specified since all soldiers in the case descriptions were male.
Eight of the 13 cases describe one conversation in a series of encounters, in five instances the first conversation.Two cases center on a one-time planned conversation -here, the soldiers contacted chaplains whom they knew from formal conversations or informal contact in the past.Two cases describe a spontaneous encounter, and one case describes a military ritual.Furthermore, nine of the 13 cases were designated as 'characteristic cases' by the chaplain who wrote the case report, in reference both to the central topics that were discussed in these cases and to the way in which the chaplains addressed the topics.Two cases were designated as 'uncommon' because of the specific religious content of the conversation.This reflects how military chaplaincy (at least in the Netherlands) does not necessarily or primarily focus on religious issues; it has a broader scope.Two cases were designated as 'uncommon' because of the confrontational approach of the chaplains, who usually take an appreciative approach.

Data analysis
The case descriptions were analyzed by the first two authors using the framework method, a qualitative method of thematic analysis that systematically searches for patterns in data sets by comparing data both across and within cases (Gale et al., 2013).The framework method consists of several steps in which an analytical framework is constructed out of codes that are grouped into various categories.The categories and codes in the framework are then applied to all data.In each category, the data of each case is summarized, leading to a 'framework matrix', which is used in order to arrive at an interpretation of the data.The set format in which the cases are written was helpful here, as "the Framework Method cannot accommodate highly heterogeneous data, i.e. data must cover similar topics or key issues so that it is possible to categorize it" (Gale et al., 2013, p. 2).In applying the framework method to the cases, we used a largely deductive approach in which "themes and codes are pre-selected based on previous literature, previous theories or the specifics of the research question" (Gale et al., 2013, p. 3).We constructed our analytical framework on the basis of Doehring's (2015) conceptual understanding of moral stress and moral resilience that we described earlier.In particular, the framework includes the three steps of spiritual integration of moral stress (which we interpreted as three elements of spiritual integration, without necessarily supposing a temporal order) and the four criteria for assessing to what extent spiritual orienting systems are life-limiting or life-giving.We explored the issues that military personnel discussed with the chaplain in terms of elements of moral stress and the responses of chaplains in terms of elements of spiritual integration these responses are directed toward (see Table 2).

Topics that soldiers and veterans bring up in chaplaincy conversations
In two cases the conversation centers around religious questions (case 9 and case 11), and in two other cases morally injurious events during deployment in the past are brought up in the conversation with the chaplain (case 5 and case 3).However, most of the questions, struggles, and problems that soldiers bring up in the case descriptions fall into two categories: they either concern frictions with the military organization or have to do with family members or loved ones.Regarding the first category, soldiers express a lack of appreciation from the organization or a lack of support for work-related struggles.For instance, in one case, a soldier struggling with physical problems due to deployment feels humiliated for having been placed in a position of lower rank (case 5).In another case, a soldier who has just learned that he is to be dismissed expresses his discontent: "I do not want to judge, but then I see colleagues perform worse than me, and I wonder: why me?" (case 1).Sometimes, frictions with the organization are interrelated with difficulties with colleagues, for instance in the case where a soldier feels "treated like a child" by superiors (case 2).As for the second category, in a majority of the cases problems with or worries about loved ones or family members are the central issue.Often, soldiers struggle with a romantic relationship, wondering whether or not to end the relationship, or they struggle with the impact that their work has on their family life.Sometimes, issues from both categories are interrelated.In case 1, for instance, a soldier who is about to be dismissed also worries about the effects the news will have on his wife and child.
'Being a soldier' as a core value in systemic, interpersonal, and intrapsychic moral stress Many of the issues that soldiers bring up in conversations with chaplains -lack of recognition, support, or care from the organization where they are employed and relational issues -may seem to be relatively common issues that people struggle with.If we take a closer look from a perspective of moral stress, however, we see that the military context often plays a central role in these issues.Frictions between soldiers and the military organization, for instance, can be understood as experiences of systemic moral stress, where core values associated with 'being a soldier' conflict with the way in which the military organization functions.In the case descriptions it is often emphasized that, for soldiers, working in the military means more than just having a job.Often, they have spent all of their working life in the military, and their job has become a vital part of their identity.One soldier phrases this as follows: "When I started working for the Ministry of Defense, this gave my life structure.I felt at home.Actually, there is no other job that I am good at.I really thought I would grow old working here" (case 1).'Being a soldier' represents a core value of soldiers, not just in their working life; it is something they identify with as a person.Therefore, a lack of recognition or care from the military organization is especially painful and unsettling.It leads to feelings of indignation and humiliation that fuel experiences of systemic moral stress.In one case, a soldier points out that he has always been loyal to the organization and has made sacrifices while working, losing his health and eventually becoming unable to work (case 6).It is extremely painful for him that these losses were never taken seriously by the organization for which he made the sacrifices.The importance of 'being a soldier' is also emphasized by the reluctance of soldiers in several case descriptions to consider the possibility of working outside of the military even though they feel unappreciated by the military organization.At the interpersonal level, moral stress similar to that at the systemic level is at play in friction with colleagues.Core values associated with 'being a soldier' conflict with the actions and attitudes of colleagues who, for instance, do not recognize that the soldiers are good at their job or who do not provide collegial support.Again, feelings that soldiers express in relation to these types of moral stress are indignation and humiliation.Issues that soldiers raise in relation to family and loved ones also represent interpersonal moral stress.In a few cases, these issues are common problems that are not typical for soldiers, for instance when a soldier struggles with the death of his mother (case 10).In most cases, however, core values associated with 'being a soldier' again play a role, conflicting with notions that the other has of 'having a good relationship' or 'being a good family member'.At times these conflicts have to do with the specific demands and circumstances of the military profession -in particular, being away from home for extended periods of time.
For instance, in one case a soldier who is on training for a few weeks tells the chaplain that he has ended his relationship with his girlfriend (case 7).He has done this quite abruptly, by phone, even though he is not sure whether he wanted the relationship to end and feels this was not a good way to end a relationship.However, his girlfriend demanded clarity, and he did not see another option: "It's not ideal, I know, but I had no choice -everything here [work during his training] has to go on".In another case, a veteran who had served during World War II and in the Dutch Indies speaks about the pressure that his military past had put on his relationship with his late wife (case 3).He calls her "pure goodness" and explains that he could not bring himself to tell her about his experiences as a soldier.He expresses feelings of shame and guilt, emotions which can also be found in other case descriptions where interpersonal moral stress derives from the notion of having wronged a loved one.
In the cases, moral stress at an intrapsychic level is always related to either interpersonal or systemic moral stress.Interpersonal moral stress is intertwined with intrapsychic moral stress when core values associated with 'being a soldier' not only conflict with the other's view of what a 'good relationship' between them should look like but also with the soldier's own view.For instance, the soldier in case 7 who ended his relationship by phone tells the chaplain that he keeps wondering whether he did the right thing: "It constantly occupies my mind".And the veteran in case 3 struggles profoundly with his own actions as a soldier and, according to the chaplain, suffers from moral injury.The moral stress of the veteran in this case also seems to have a systemic dimension that does not derive from a lack of recognition from the military organization, as in the examples of systemic moral stress described earlier, but from a conflict between the core values of 'being a soldier' and 'being a good citizen'.Not only in the relationship with his wife but also in civil society in general, there was no place for stories about what he had experienced as a soldier.
This case also illustrates how moral distress is an experience of spiritual disorientation.What is ultimately at stake for the veteran is the question of whether he is a 'good human being' or whether his actions as a soldier have cut off his path towards being a good human being.The spiritual dimension of moral distress also explicitly comes to the fore in another case when a soldier tells the chaplain in a despondent voice: "I feel like I have nothing left to go for.Sometimes I wonder why I am here on earth" (case 8).Spiritual disorientation also obviously plays a role in a case where a soldier contacted the chaplain in order to discuss the meaning of a profound religious experience.In the conversation with the chaplain, the soldier explores whether he still fits in the military organization now that he has embraced faith, feeling that his newly found religious orientation might be at odds with his work in the military.

Addressing interpersonal and intrapsychic moral stress: Opening up moral space
In nine of the 13 case descriptions, interpersonal moral stress, whether between the soldier and colleagues or between the soldier and family members or loved ones, is a central issue.As pointed out above, interpersonal stress is often intertwined with intrapsychic moral stress when soldiers or veterans wonder whether they acted rightly in relation to others or when they need to make choices about how to act in relation to others.Chaplains address these kinds of moral stress by what may be understood as 'opening up moral space' in conversation with the soldiers: making space for clarifying, exploring, questioning, and possibly revising their spiritual orientation frameworks, their visions of the 'good'.They do so in a variety of ways, attuning to the specific relational struggle, the specific soldier, and the conversational situation.In all cases, the starting point is to carefully listen to the other's story.As one chaplain phrases it in relation to a case where a soldier is struggling with his relationships with both a superior and his girlfriend: "I try to help Patrick as much as possible to tell his story, to blow off steam, by listening, summarizing, searching for meaning" (case 2).Another common feature of the chaplains' responses to interpersonal moral stress is their commitment to nuanced, subtle moral views.This is especially visible in cases where soldiers express strong, unambiguous opinions about others or about their actions towards others.Here, chaplains open up moral space by suggesting a more subtle viewpoint.For instance, in a case where a soldier, after having had a profound religious experience, has rigorously broken off contact with his brother and friends, the chaplain cautiously questions this decision by taking up a metaphor that the soldier uses: Chaplain: "That are many people to say goodbye to . .."Jos: "Well, I am a bit black and white."Chaplain: "How do you deal with grey?" Jos: "Good one, that is difficult for me."Chaplain: "Don't you lose too much when you don't do grey?"Jos: "Possibly . .." (case 9) In another case, in which a chaplain shares a short car ride with a soldier who tells him he has just ended his relationship with his girlfriend by phone, the chaplain's expression of bafflement, "By phone?", leads to an exploration of the morality of that decision (case 7).The intervention allows the soldier to express and explore his own doubts, both about ending the relationship and about the way in which he ended it.
In the case descriptions, soldiers generally tend to make firm statements when they feel wronged or not recognized by others.Here, chaplains open up moral space by adopting an attitude that they themselves, in the group discussions about the cases during the project, denote as 'multidirectional partiality', referring to the contextual approach to family therapy by Iván Böszörményi-Nagy and its integration into pastoral and spiritual care (Meulink-Korf & van Rhijn, 2016).They neither go along with nor contradict the opinions of soldiers about others but affirm the goodness of both the soldiers and others and represent the view that one should not give up too easily on efforts to establish or repair relationships.In a case where a soldier feels belittled by a superior while on an exercise for several weeks, the chaplain suggests entering into conversation with the superior and putting his grievances on the table, implicitly suggesting that the superior is a reasonable person who will listen to the grievances (case 2).The multidirectional partiality of the chaplain is also present in a case describing a military ritual -the so-called "flower greeting" that is traditionally organized a year after the passing of an active soldier (case 12).In this case, members of the division of the deceased soldier attended the ritual, including two soldiers of the company who had been expelled because of an ongoing investigation into drugs trade.The two expelled soldiers were not allowed to wear a uniform nor to have contact with the other soldiers of the division, and they stood a bit apart from them.The chaplain literally crossed the space between the soldiers wearing a uniform and the expelled soldiers, talking to both groups in turn.
In those cases where soldiers experience interpersonal moral stress because they feel that they have wronged others and are struggling with guilt and shame, the chaplains adopt a mild attitude and emphasize that they see goodness in the soldier.For instance, in the case where a veteran expresses regret in relation to how his late wife suffered because of his PTSD -"She had to swallow down so much because of me" -the chaplain stresses the love that the veteran shows for his wife: "Still you always speak affectionately about your wife, with very much love" (case 3).Furthermore, chaplains open up moral space by helping soldiers explore how their actions towards others which they feel guilty or ashamed about fit within their broader biographical picture.For instance, when a young soldier tells the chaplain that he regrets having been unfaithful to his girlfriend and wonders why he cheated, the chaplain, with empathy and without any moral judgement, supports the soldier in finding answers to this question (case 4).The soldier explains that he finds it scary to get older and fears getting cut off from his life with friends and family when moving in with his girlfriend.When the chaplain replies, "You are growing up?", this seems to offer the soldier a perspective from which to better understand his infidelity in terms of marking a transition towards a more grown-up life period.In another case, a soldier, during a chance meeting with the chaplain, mentions that he has just moved out of his family home and feels guilty that he can no longer provide care to his family members as he has done in past years (case 13).Together with the soldier, the chaplain explores the ways the soldier still takes care of his family members and expresses his love for them, suggesting that besides being a rupture in his biography, moving away from home also involves biographical continuity.

Addressing systemic moral stress: Emphasizing the 'goodness' of the other
In five cases, systemic stress related to a lack of recognition or support from the military organization is the central issue.Here, chaplains address soldiers in ways that we may understand in terms of empowerment, emphasizing that they see them as good, valuable people, thus countering their feelings of being humiliated or belittled.Sometimes the chaplains communicate this directly to soldiers.For instance, in a case where a soldier receives a letter informing him that he will be dismissed, the soldier tells the chaplain in a raised voice: "I got rejected.Apparently, I am good, but not good enough..." (case 1).When the soldier states that he does not see a future for himself outside of the military, the chaplain responds: "As I know you, you have sufficient and more than enough good in you to find your way through this situation".In another case, where a chaplain pays a home visit to a soldier who got sidetracked due to physical, social, and psychological problems, the chaplain emphasizes that he is amazed at his resilience and admires the way he has kept taking care of his sick wife (case 6).When the soldier replies that he does not think there is anything special about his attitude, the chaplain repeats his compliment again: "You keep going, you remain positive.That does not seem easy to me."Sometimes, the chaplain's view of the other as a good person remains more implicit.In a case where a soldier struggles with PTSD after deployment and feels that there is no recognition of his symptoms by the organization, the chaplain challenges the soldier to not just point at others and the organization but to explore his own part in his current situation (case 5).In the case description, she states that she was guided by a basic trust that the soldier would be able to handle this and felt that, in her actions, she was expressing this trust to the soldier.
What the chaplains do not do, when addressing the systemic moral stress of soldiers and veterans, is to further explore their critical view of the military organization.If we look back at Doehring's (2015) steps towards moral resilience, we see that the step of identifying how social systems give rise to and sustain moral stress is missing, at least with respect to the military system.Chaplains do not express a critical view of the organization in the conversations; they address systemic moral stress primarily at an intrapsychic level by emphasizing the value and potential of soldiers.Still, the case descriptions show that the chaplains do have a critical view of the military organization and do have an eye for soldiers' experiences of marginalization and exclusion.A comment from one of the chaplains that was supported by the whole research community was: "What are we doing in the military, when we send people on missions, people who come back injured and then work in the organization again with their injuries?How can we ethically justify that?"This critical view remains implicit in the conversations and is explicated primarily in the reflections of the chaplains on the cases.For instance, one chaplain states that he is keenly aware of how the lack of societal appreciation for veterans plays an important role in the problems that veterans experience (case 3).And in one of the cases, the chaplain keeps visiting a soldier at home over years, even though the soldier is no longer actively at work and has no other active connections with the organization, partly because the chaplain feels indignant about the way in which the soldier got sidetracked (case 6).

'Knowing the chaplain, knowing the soldier': Moral resilience starts with trust
In the case descriptions, we see that if soldiers are to talk about experiences of moral distress, it is essential that they 'know' and trust the chaplain.Here, the chaplains emphasize the importance of the time they spend on what they call 'presence care'.Presence care refers to the way in which chaplains are present in the military lifeworld: "the chaplains walk around at the base, they partake in sport activities, they travel with soldiers to participate in training camps and they join the unit for deployment abroad.Without being a soldier, they live a soldier's life" (Pleizier & Schuhmann, 2022, p. 5).In this way, soldiers can get to know the chaplain in an informal way, in everyday situations of military life.According to the chaplains, the more formal one-on-one conversations between chaplains and soldiers that were central in most of the case studies are embedded in and cannot be seen apart from presence care: "every contact is part of an ongoing story".Within this 'ongoing story' between chaplain and soldier, brief, chance encounters may also attain the character of counseling sessions, as case 7 shows.Furthermore, in various cases the soldier contacts a chaplain he knows from a previous posting or from deployment, with whom he has a shared history, instead of the chaplain of his own unit.The shared history of fleeting encounters and shared activities seems to be the foundation of a trusting relationship in which the soldier feels safe to also put more serious problems on the table.
In several case descriptions, chaplains explicitly refer to this shared history in conversations with the soldiers.For instance, in one case, the chaplain, expressing his trust in the soldier's ability to find his way outside of the military, starts his response by saying, "As I know you" (case 1).When chaplains, in response to systemic or interpersonal stress, emphasize that they see the soldier as a 'good' -valuable, resilient, or loving -person, they are not making empty statements but are expressing appreciation rooted in a shared history, in 'knowing the soldier'.Furthermore, the trust that has been built between chaplain and soldier also allows the chaplain to be direct when opposing black-and-white moral views of soldiers and putting forward alternative moral viewpoints, without running the risk that the soldiers will feel rejected or belittled.

Transcending military moral frameworks: 'Looking at and going for the human being'
The participating chaplains often designate their position within the organization in terms of 'one foot inside and one foot outside of the military'.On the one hand, military chaplains 'live a soldier's life', as indicated earlier; just like the soldiers, they are employees in the military organization, an organization with strong military values that may be at odds with values in civil society.Like the soldiers, they often see their work as more than 'just a job', which means that they also experience moral distress.One chaplain remarks: "As a chaplain, too, you are at risk during deployment: PTSD, moral injury, etc.What's sauce for the goose is sauce for the gander...".Their entanglement with the military organization implies that they have an inside understanding of what it takes to work in the military.In particular, they recognize the moral stress that is explicitly or implicitly present in the stories of soldiers and veterans and understand how experiences of moral stress are related to working in the military and the core value of 'being a soldier'.That seems to be important for the soldiers when contacting a chaplain; it is easier to speak confidentially with someone who does not need much background information.In one case, this is expressed explicitly by a veteran (case 3).Conversations he had with a pastor elsewhere were not helpful to him because the pastor did not speak and understand 'military language'.With the chaplain, however, he could talk "from soldier to soldier.You are not an ordinary pastor".
At the same time, the chaplains emphasize that they also represent an outsider perspective that does not fit within but transcends military values and goals.They designate this as a spiritual perspective that allows them to never see soldiers as just soldiers but "to look at and go for the human being".In the two cases where soldiers have religious questions, they explicitly contact a chaplain because of this spiritual outsider perspective (case 9 and case 16).According to the chaplains, their spiritual orientation is always present in their work.It can be perceived in the way they make space for a mild perspective on soldiers and others and for moral ambiguity, which do not represent standard military values.In the case where a chaplain keeps visiting a sidetracked soldier at home, the chaplain acts counter to the way in which soldiers who are unable to work usually disappear from view (case 6).And in the conversation with a veteran with severe moral injury due to war experiences, the chaplain represents a view of wholeness in which there is a place for the possibility of spiritual integration in the sense of integrating the contrasting values of 'being a soldier' (who has killed others) and 'being a good, loving and loveworthy human being' (case 3).

Conversations with the chaplain as 'moments of goodness'
Not only do military chaplains support moral resilience through their interventions within the conversations with soldiers and veterans; the act of having a conversation with a chaplain in itself seems to contribute to moral resilience of soldiers.In most case descriptions, the soldiers indicate that they experience the conversations as beneficial.In one case, a soldier points this out by comparing the chaplain's response to his problems to reactions from his colleagues: "They just say: well, good luck with that!" (case 1).Conversations with a chaplain seem to be relational 'moments of goodness' in their own right in which soldiers feel connected with the 'goodness of another'.

Discussion
This study shows how soldiers experience systemic, interpersonal, and intrapsychic moral stress arising from conflicts between core values associated with 'being a soldier' and expectations or actions of themselves or others, the way the military organization functions, or the spiritual notion of 'being a good, loving, and loveworthy human being'.A schematic overview of the results of the study is given in Table 3.For the soldiers in the case descriptions, 'being a soldier' generally represents more than having a job; on the one hand, it is related to core values that structure their life and provide a source of meaning, but on the other hand, when those core values come under pressure, 'being a soldier' may be experienced as a source of moral stress.In a way, the spiritual disorientation that is at the heart of moral distress seems to be entangled with working in the military as 'being a soldier' involves the mandate to use violence, which seems difficult to reconcile with the spiritual notion of 'being a good, loving, and loveworthy human being'.For chaplains to be trustworthy conversation partners in relation to moral stress, it seems crucial that they both 'live a soldier's life' and represent a spiritual perspective beyond the military that points to the possibility of the spiritual integration of 'being a soldier' and 'being a good human being' (see also Grimell, 2020b).This fits in with the view of chaplains as representing "the faith that it makes sense not to give up on goodness even though goodness is fragile" (Schuhmann & Damen, 2018, p. 414).
Furthermore, this study shows how chaplains support soldiers experiencing moral distress by co-creating spiritual orienting frameworks, aiming for specific shifts from 'lifelimiting' to 'life-giving' frameworks in the sense of the four criteria of Pargament et al. (2006) that Doehring (2015) mentions (see the section on theoretical background).When responding to systemic moral distress, chaplains focus on integrating the notion of the goodness of the soldier into their spiritual orienting framework.Often, when systemic moral stress reflects discontent over the military organization, this 'goodness' refers more to strength, resilience (in a more individualistic sense), or capability.It is unclear whether in these cases the response of chaplains is informed by a spiritual notion of 'goodness' or by the military ethic of being strong and not giving up in difficult situations.This question is further fueled by the observation that, in conversations with soldiers who feel neglected or tossed aside by the organization, chaplains do not critically question the military organization even though they do criticize the organization when reflecting on their work.In relation to interpersonal moral stress, we see four different shifts that chaplains aim at in co-creating spiritual orienting frameworks: a shift towards integration of 'goodness of oneself' (in particular when soldiers feel they have wronged others, such as when they are struggling with moral injury); a shift towards biographical integration (in particular when soldiers feel wronged by others); a shift towards integrating the notion of 'goodness of others', countering individualistic views (in particular when soldiers feel wronged by others); and a shift towards more complexity and flexibility in general.Intrapsychic moral stress was only found in relation to either interpersonal or systemic moral stress, and chaplains responded to it accordingly.This raises the question of how intrapsychic, interpersonal, and systemic appearances of moral stress interlock, in particular in the context of the military.
As moral stress is a phenomenon that occurs in a variety of work contexts, the question of how spiritual caregivers may contribute to the moral resilience of employees is relevant beyond the military context.In the context of healthcare in particular, moral distress has been studied for several decades (Morley, 2018).Here, it is usually understood as arising "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action" (Jameton, 1984, p. 6).In relation to the COVID-19 pandemic, experiences of moral distress of healthcare professionals have also been interpreted in terms of moral injury (Rosen et al., 2022).The existing literature suggests that chaplains may play an important role in supporting healthcare professionals struggling with moral distress and moral injury (Guthrie, 2014;Jack & Kotronoulas, 2023).
Our study points at potential similarities between moral distress experienced by healthcare professionals and soldiers; in both cases, a strong identification with core values associated with one's profession seems to be involved.However, there is also an important difference: the moral distress of healthcare professionals is related to 'knowing the right thing to do', while the moral stress of soldiers is often related to uncertainty about what is the right thing to do or to feeling that what seemed to be the right thing to do at the time in hindsight seems questionable or wrong.Therefore, in order to translate insights about military chaplains' contribution to the moral resilience of soldiers to the context of healthcare -and vice versa -it seems important to carefully distinguish between various types of moral stress and to examine how the specific context impacts which types appear.Studying chaplains' responses to moral stress and moral resilience thus fits in with the call to compare chaplaincy across contexts (Pleizier & Schuhmann, 2022).For instance, our study shows that the responses of chaplains to moral stress are grounded in and obtain meaning from previous 'presence care' where trust between chaplain and soldier was built.This supports Doehring's (2015) view of moral resilience as the outcome of a process that requires trusting relationships while also raising the question of how chaplains build trusting relationships in other contexts, and whether some type of 'presence care' plays a role in these contexts as well.
Interestingly, our study shows no obvious differences between the responses of humanist, Protestant, and Roman Catholic chaplains to the moral stress of soldiers.Also, in the majority of the cases, the conversations between chaplains and soldiers did not focus explicitly on religious issues.In recent decades, in multifaith and secularizing societies, chaplains have been increasingly explaining and legitimizing their work in terms of multifaith spiritual care rather than religious care (Cadge & Rambo, 2022;Schuhmann & Damen, 2018).In the context of healthcare, chaplains have become part of healthcare teams where they cooperate with other healthcare professionals to provide spiritual care to patients (Kruizinga et al., 2023;Orton, 2008).This has led to discussion within the profession about the relevance (or irrelevance) of representing a religious or worldview tradition when providing spiritual care (Glasner et al., 2022;Nolan & MacLaren, 2021).
Our study suggests that sometimes, in relation to specific issues, it is important for soldiers that chaplains represent a religious tradition.However, the study also suggests that, generally, it is the 'lived religion or worldview' of the chaplain that is crucial.It is through providing presence care that trust is built between soldiers and chaplains.As chaplains are present in the lifeworld of soldiers, the soldiers sense whether chaplains 'practice what they preach', that is, whether they embody a spiritual vision that allows them to look beyond 'the soldier' and see 'the human being'.It seems worthwhile to include the perspective of 'lived theology' -or 'lived worldview' -and of embodiment in the discussion about the role of representation of religion and worldview in chaplaincy.

Limitations of the study
The first limitation of this study concerns the fact that the cases only used input from the chaplains providing the care and not from the soldiers themselves.We had to rely on descriptions by chaplains of the struggles of soldiers when deciding whether core values were at stake in these struggles and could not check this with the soldiers themselves.Furthermore, the question of whether or not the soldiers actually felt that chaplaincy care strengthened their moral resilience would require a different research design.A second limitation concerns the fact that only Christian and humanist chaplains participated in the research.Even though these groups constitute the vast majority of military chaplains in the Netherlands, inclusion of Buddhist, Muslim, and Hindu chaplains seems relevant.As we mentioned earlier, there are no obvious differences between humanist, Protestant, and Roman Catholic chaplains in how they respond to the moral stress of soldiers.The question is whether the inclusion of chaplains from other denominations would change this picture.A third limitation has to do with the focus on one-on-one conversations in the study.Other activities of military chaplains which may be aimed at strengthening moral resilience, such as presence work, group work, or training, remained outside the scope of our study.

Further research
Within the chaplaincy literature, military chaplaincy is underrepresented and most of the existing studies on military chaplaincy center on moral injury.This exploratory study suggests that it may be fruitful to take a broader perspective on military chaplaincy and study the contribution of military chaplains to moral resilience in a broader sense.In particular, further research might focus on how the soldiers themselves experience chaplaincy care.Furthermore, activities of chaplains other than one-on-one conversations may be explored for their contribution to the moral resilience of soldiers.In particular, it seems worthwhile to look deeper into training activities by chaplains that focus on moral education and also into 'presence care'.Finally, further research may study military chaplaincy in other countries to find out how, for instance, the religious landscape (given that the Netherlands is a very secularized country) and the way in which military chaplaincy is organized influence the practices and outcomes of military chaplaincy care.

Table 1
Overview of the Case Descriptions

Table 2
Analytical Framework Used for Analyzing the Case Descriptions

Table 3
Schematic Overview of the Results