Much of the work surrounding the crisis of sexual abuse in the Catholic Church has focused on how the abuse remained simultaneously widespread while being kept private, but not how the effects of the abuse impact the liturgy itself. Paying particular attention to PTSD, moral injury, and moral distress, this article examines how systemic clergy perpetuated sexual abuse (CPSA) has damaged liturgical efficacy for both abuse survivors and Roman Catholic laity. Focusing on PSTD, moral injury, and moral distress frames the issue in a way that illuminates the church’s ongoing role in preventing the healing of survivors and limiting the potential for grace in the sacraments. In light of the exploration, we suggest that in order for widespread healing we must move towards a relational ontology that realigns with the survivors and reject language and practices that blame survivors for their discomfort in the church, instead affirming the dignity in the options to seek grace and relationship with God outside of the Roman Catholic tradition.