Forgiveness Therapy

For years, popular culture has promoted the theory that many people possess a deep well of anger that must be drained by actions such as beating a pillow with a baseball bat, or by “venting” it – expressing one’s anger to others, sometimes in therapy groups over many years.  This perspective was illustrated by pastoral counselor Angie Boss (2018), citing the movie Analyze This, in which Billy Crystal, as a psychiatrist, tells a client, “You know what I do when I’m mad? I hit a pillow. Just hit the pillow. See how you feel.” One might think that such practices could be consistent with Scripture, for example, Ephesians 4:31: “Get rid of all bitterness, rage and anger…” (New International Version). Aren’t you getting rid of your anger with the baseball bat and pillow? However, this overlooks many other verses such as Colossians 3:13: “Bear with each other and forgive one another if any of you has a grievance against someone. Forgive as the Lord forgave you” (New International Version), and Boss cites research showing that the punching bag “doesn’t actually work.”

Bushman (1999) says that catharsis theory predicts that rumination on one’s anger while using a punching bag would lead to reduced anger, but his research shows the opposite. Subjects who were directed to think about their anger while hitting a punching bag demonstrated more anger than a control group. Boss suggests that those who practice such methods are actually “training their brains to associate anger with controlled aggression rather than compassion and reconciliation,” (Boss, 2018, citing therapist Steven Stosny), and also suggests that “the rush of anger may be addictive” (Boss, 2018).

Although not everyone uses a punching bag or pillow, belief in the concept of needing to “vent” anger is pervasive. Many therapists have long-term clients who continue to complain incessantly of how family members or others have wronged them. Some women continue to experience unresolved distress from sexual abuse that occurred decades in the past, while continuing to vent their anger week after week in therapy groups. The anger is understandable, but those who continue in unforgiveness may pay a high cost with their health (as well as spiritually).

Milburn (2015) cites research showing correlations between anger or unforgiveness and a range of adverse health conditions such as arthritis, coronary heart disease, high blood pressure, irritable bowel syndrome, addictions, eating disorders, PTSD, and suicide attempts. Because of the serious health costs associated with chronic anger and unforgiveness toward others, it is essential to understand this problem, and to facilitate resolution.  

In contrast to the ineffective catharsis approach to anger, as described above, a different approach is suggested by a large and growing body of professional literature on “forgiveness therapy” focused on helping people to forgive those who have hurt them.

Research shows that forgiveness of others is associated with improvement in health outcomes in many different illnesses and diverse types of patients. Waltman et al., 2008 showed significant improvement in cardiac function in heart patients who participated in a forgiveness intervention. A four-week forgiveness intervention was associated with improved quality of life for elderly terminal cancer patients (Hansen, Enright, Baskin, & Klatt, 2009). Carson et al. (2005) showed that forgiveness was correlated with decreased back pain. Other research shows that forgiveness of others has been helpful to many patients with a variety of mental health conditions:

“Enright and Fitzgibbons (2015) reported finding forgiveness helpful in the treatment of disorders such as anxiety, depression, substance abuse, disorders of childhood, eating disorders, mood disorders, personality disorders, and marital and family dysfunction. They reviewed empirical evidence for the impact of forgiveness interventions and found emotional health benefits for Adult Children of Alcoholics; cardiac patients; emotionally abused women; drug rehabilitation patients; men feeling injured by a partner’s decision to abort; incest survivors; and college students who grew up with an emotionally detached parent” (Milburn, 2015, p. 326).

Articles on “forgiveness therapy” utilize many different treatment protocols, and entire books have been published on “how to” do forgiveness therapy; thus, this short article will not teach you everything you need to know, but is only a starting point. However, there are excellent resources available for further reading that are practical, readable, doable, and research based. Whether you are a psychologist with 30 years experience, or a recent seminary graduate you can learn to help others to forgive. It is good to know more than method, since “one methodological size does not fit all” (Barry, 2011, p. 14, citing Thoreson et al., 2000). Also, there may be methods that are particularly suited to your professional education, for example, Milburn (2015) shows how to use the forgiveness process of Enright and Fitzgibbons (2015) within Rational-Emotive Behavioral Therapy. Enright and Fitzgibbons show applications of their model in marital and family therapy, and in cognitive therapy.

Robert Enright, a leader in forgiveness research since 1985, has authored more than 130 publications including seven books. Richard Fitzgibbons has been involved in forgiveness therapy for 40 years. Their book Forgiveness Therapy (Enright & Fitzgibbons, 2015) is a new and retitled edition of Helping Clients Forgive (Enright & Fitzgibbons, 2000); Milburn (2015) suggested there may be benefit in reading both. Forgiveness Therapy, published by the American Psychological Association, teaches therapists to lead people through four phases of a forgiveness process that may, on average, require 12 weeks to complete, though the authors caution against any arbitrary timetable, allowing people need to proceed at their own pace.

Enright and Fitzgibbons (2015) say the process starts with an “uncovering” phase in which the person gains insight into the effects of the injustice and injury they have experienced, recognizing: “I have been wronged, it hurts, and I wish to do something about this” (Kindle location 1161). Next is a “decision” phase in which a change of heart begins, forgiveness is considered as an option, and then, a commitment is made to forgive the offender. During the “work” phase, the person develops empathy for the offender. In the “deepening” phase, the person finds meaning in what has been suffered and possibly new purpose in life, for example, incest survivors becoming counselors for other incest survivors.  Although this model can be used with people of any religious faith, or none, the authors provide tie-ins with the Bible and Christian belief. They give case examples, and show how the method can be applied to clients with various psychiatric disorders. Suggestions are given regarding use of journaling assignments between sessions.

Rev. Dr. Michael Barry, Director of Pastoral Care at the Cancer Treatment Centers of America (CTCA), uses a brief program for cancer patients that could be adaptable to other patients and other settings. This program was designed so that it could be completed in three hours (or longer) and within three days. It requires “one hour in the office going over the material, a one-hour homework assignment, and after engaging with the material, another hour with the department to process the patient’s experience” (Barry, 2011, p. 13). This process also involves helping patients to develop empathy for the offender.

The CTCA program uses “narrative therapy” based on the research of Pennebanker, in which patients are asked to write about the trauma they have experienced, according these guidelines:

1. Write in the safety of their home, hotel, or hospital room.
2. Write three times for twenty minutes each within a twenty-four- to thirty-six-hour period.
3. Be sensitive, during the writing, to irrational thoughts or judgments made about the people who harmed them. Often what keeps us trapped in anger are irrational thoughts or untruths we tell ourselves. We believe the truth will set our patients free from their pain if they honestly seek it.
4. Writing is nondirected. We do not tell people what to write about, though we do share that writing in letter form has proved helpful.
5. We ask that they write about the same situation or experience each time. If there are multiple forgiveness issues or various perpetrators, we ask them to focus on just one situation at a time.
6. We ask that the letter not be sent to the perpetrator.
7. We never ask to read the letter. In fact, we encourage them to…throw it away if they would like to do so. These are private, personal moments…often accompanied with tears.
8. We ask them to pray during the process.

(Barry, 2010, pp. 156-157).

Barry (2011) states that the education that takes place prior to the writing assignment is as essential as the writing, in order to help the person to understand what forgiveness is, to dispel myths, and to help the person to be able to enter into the process without fears, and with realistic expectations. 

The CTCA method is sound, though it is not the only way that letter writing can be done. In Rachel’s Vineyard, a weekend retreat for women and men who have experienced distress from a past abortion, letter-writing is also utilized, with the understanding that the letter is for them to be able to express their emotions, but is not to be sent to the person who hurt them. However, at these retreats, men and women are given the opportunity to read the letter aloud in the group though reading the letter is not required. Most people find it helpful. After reading the letters, some additional processing of the emotions is also helpful.

One common misunderstanding about forgiveness is the idea that you must go to the other person to do it, and restore the relationship with that person. But that may not be safe, or even possible. Barry (2011, p. 100) states:

“You may never again see the person who harmed you, but that doesn’t mean you can’t find it in your heart to silently whisper these words to yourself: “I wish you well with your life, and I hope and pray you will cause no more damage to me or anyone else. Go in peace.”

Jayne and her husband, while working in a foreign country, were kidnapped. Jayne was released but her husband was held for ransom and tortured for many months before eventually being released. While undergoing cancer treatment, Jayne “worked very hard to forgive the men who abducted her husband—but she never has to face them again” (Barry, 2011, p. 100). “Some people are so incredibly toxic that…we should not see them again” (Barry, 2011, p. 100).

Several authors make a clear distinction between forgiveness and reconciliation. “Forgiveness involves only one person: you. Reconciliation involves two or more people. To reconcile means “to reestablish a close relationship between,” or “to settle or resolve” (Barry, 2011, p. 144). But, “You can let go of the anger and forgive without having to see, or spend time with, the other person again” (Barry, 2011, p. 146) Shuping and McDaniel (2007) give an example of a woman who became pregnant after being raped, who later forgave the rapist. There are many circumstances where further contact is not possible or appropriate, and other circumstances that are less clear, that may require prayerful discernment over time.

However, there is no consensus about the precise definition of forgiveness. Barry says:

“Some might argue that there are two kinds of forgiveness: decisional and emotional. Decisional forgiveness equates to mere mental consent, which I would argue is sub-Christian in that Jesus requires forgiveness from the heart. Beyond theological differences, decisional forgiveness seems to push back against most secular research on the subject, which supports the idea that forgiveness is a process that begins with a decision to forgive and ends with a change of heart toward the perpetrator. Further, ’empirical research has shown that this [i.e., ‘decisional forgiveness’] approach is marginally effective in improving a client’s stress levels or emotional health’.”
(Barry, 2011, pp. 148-149, citing Barbara A. Elliott).

Thus, some experts take the position that you forgive by using your will to make a decision (giving “mental consent” to forgiving, and intending to forgive, while others say, you have not truly forgiven till you feel forgiving, as Barry says: “Forgiveness is not merely speaking the words. Instead, an emotional shift must take place in the forgiver” (2011, p. 149). But here is the problem. If someone robbed you, or your husband was kidnapped, or you were raped – of course no one in those circumstances “feels” warm and fuzzy toward the perpetrator. No one automatically “feels” forgiving, and no one can manufacture those feelings on their own, on demand. If you have to “feel” forgiving in order to obey what Scripture commands (“Love your enemies and pray for those who persecute you,” Matthew 5:44, New International Version), then who could do it? And if that were the standard, perhaps few would even try to forgive such serious offenses. Yet, since Jesus clearly requires forgiveness, of course there is a way for us to do this – he would not expect us to do the impossible. Thus, some authors consider that expressing the decision to forgive in prayer and/or choosing to pray for the perpetrator is the definitive act of forgiveness, with the understanding that feelings can change over time. The process described by Enright and Fitzgibbons (2015) incorporates a decision phase, and additional steps to facilitate emotional resolution and a change of heart. Like Enright and Fitzgibbons, Harper (2008) also recognizes that even though there is a moment of decision in prayer, it can take a period of time before forgiveness is truly complete.

The Bible study, SaveOne (Harper, 2008), is used by those who have been affected by a past abortion, or other reproductive losses, and is usually led by lay leaders. One chapter focuses on forgiving others who were involved in the abortion.  For example, there is a strong association between abortion and intimate partner violence, with some women experiencing violence aimed at coercing them to have an abortion (American College, 2013; Chamberlain & Levenson, 2012; Fisher et al., 2005; Hall, Chappell, Parnell, Seed, Bewley, 2014; Hathaway, Willis, Zimmer, Silverman, 2005). Men who wanted the child though their partner chose abortion may experience distress and have difficulty forgiving the woman (Coyle & Enright, 1997).  The model of forgiveness used in this chapter could also be adapted for those in other circumstances:

“Make a list of every person involved in your abortion experience to whom you still harbor ill feelings. Think back to the decision-making and all the way up through to the present day. Write the names of everyone. It could be the father, the doctor who performed the abortion, society for making abortion legal, or a family member for throwing the abortion in your face. Take your time and write…until you get every name down on paper.

“Now take each of these names and say a prayer to God. Individually, ask God to help you forgive them. Be specific; ask Him to take your thoughts captive when you think of the person in a negative way. Ask Him to help you love them and soften your heart toward them. Then pray for something positive to happen in their life. Take this prayer very seriously because it can change your life…

“Now that you have asked forgiveness for all these things, that doesn’t mean you won’t have feelings and thoughts come up again toward these people. If and when that happens, don’t tell yourself you failed, or that it didn’t really work. Instead, remember this time and your prayer. God heard you and will bring your prayer to fruition if you continue to guard your heart and keep bad thoughts of these people away.”
(Harper, 2008, p. 73).

Another barrier to forgiveness can be misunderstandings concerning the issue of justice. If you were hit by a drunk driver, or if you were raped – does forgiving mean that you refuse to cooperate in prosecuting a crime? “Forgiveness does not negate the consequences of breaking the law. Forgiveness does not mean there are no consequences for someone’s behavior” (Barry, 2011, p. 146).  After being injured by the drunk driver, you can pray for him, and wish him well, while cooperating with the legal process, to assure that the driver doesn’t hurt someone else, or  die from the substance abuse and dangerous driving. Barry cites Romans 13:1-2 regarding the responsibility to cooperate with authorities. We can forgive, and still take steps so that perpetrators are held accountable.

Dr. Christine Puchalski, M.D., is Director of the George Washington University Institute for Spirituality and Health. A 6-page paper she wrote (2002) integrates research, clinical practice and Christian faith, and is a highly useful resource including many additional references.

Storytelling is an important tool that Jesus often used. Enright (2015) reports on his research in which stories from published children’s literature were incorporated into a series of lessons on “forgiveness education.” When these were taught in Northern Ireland homes, both parents and children showed increases in measures of forgiveness. This curriculum could be incorporated into church or Christian school educational programs. Beyond that, stories are powerful tools within a counseling session, from the pulpit, or in adult Sunday school classrooms.

The story of Joseph in the Bible who forgave his brothers is included in the books by Enright (2015) and by Harper (2008). But not all great forgiveness stories are in the Bible. Harper recounts the story of Walter Everett, whose son was murdered. Initially consumed by rage, Walter later wrote a letter to extend forgiveness toward Mike, the murderer, then in prison. This led to Mike to ask for forgiveness from Jesus, and led to a long-lasting and healing friendship between Walter and Mike.

Corrie ten Boom was imprisoned in a Nazi concentration camp. After the war, she preached forgiveness, but was tested when she met a former Nazi prison guard. After a quick prayer, she was able to act in God’s forgiveness toward him (Enright, 2015; ten Boom, Sherrill, & Sherrill, 2000). Stories model forgiveness for us, showing us what is possible, when we see how others have forgiven. Stories of forgiveness “inspire the rest of us to press onward toward the goal of offering mercy to those who have not exercised justice toward us” (Enright, 2015, p. 27).

REFERENCES:

American College of Obstetrics and Gynecology, Committee on Underserved Women. (2013, February).

ACOG committee opinion: Reproductive and sexual coercion. Committee Opinion (Number 554). Washington, DC: American College of Obstetricians and Gynecologists.

Barry, M.S. (2011). The Forgiveness Project: The startling discovery of how to overcome cancer, find health, and achieve peace. Kindle edition. Grand Rapids: Kregel Publications.

Boss, A. (2018). The psychology of releasing anger. Retrieved from
http://psychologydegreeguide.org/anger-psychology/

Bushman, Brad J., (1999). Does Venting Anger Feed or Extinguish the Flame? Catharsis, Rumination, Distraction, Anger, and Aggressive Responding. Journal of Personality and Social Psychology, 28(6), 367-376.

Carson, J.W., Keefe, F.J., Goli, V., Fras, A.M., Lynch, T.R., Thorp, S.R., Buechler, J.L. (2005). Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. Journal of Pain, 6(2), 84-91.

Chamberlain, L. & Levenson, R. (2012). Addressing intimate partner violence, reproductive and sexual coercion: A guide for Obstetric, Gynecologic and Reproductive Health Care Settings (2nd ed.). Washington, DC: American College of Obstetricians and Gynecologists.

Coyle, C.T., & Enright, R.D. (1997). Forgiveness intervention with postabortion men. Journal of Counseling and Clinical Psychology, 65(6), 1042-1046.

Enright, R. (2015). 8 Keys to Forgiveness. New York: W. W. Norton & Company. Kindle edition.

Enright, R.D., & Fitzgibbons, R.P. (2015) Forgiveness Therapy: An empirical guide for resolving anger and restoring hope. American Psychological Association (APA). Kindle Edition.

Enright, R.D., & Fitzgibbons, R.P. (2000). Helping clients forgive: An empirical guide for resolving anger and restoring hope. Washington, D.C.: American Psychological
Association.

Enright, R. D., Knutson, J. A., Holter, A. C., Baskin, T., & Knutson, C. (2007). Waging peace through forgiveness in Belfast, Northern Ireland II: Educational programs for mental health improvement of children. Journal of Research in Education, Fall, 63–78;

Fisher, W.A., Singh, S.S., Shuper, P.A., Carey, M., Otchet, F., MacLean-Brine, D., Gunter, J. (2005).  Characteristics of women undergoing repeat induced abortion. Canadian Medical Association Journal, 172(5), 637-641.  doi:10.1503/cmaj.1040341 .

Hall, M., Chappell, L.C., Parnell, B.L., Seed, P.T., Bewley, S. (2014). Associations between intimate partner violence and termination of pregnancy: A systematic review and meta-Analysis. PLOS Medicine. doi: 10.1371/journal.pmed.1001581.

Hansen, M.J., Enright, R.D., Baskin, T.W., Klatt, J. (2009). A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients. Journal of Palliative Care, 25(1), 51-60.

Harper, S. (2008). SaveOne. A guide to emotional healing after abortion. Garden City, NY: Morgan James Publishing.

Milburn (2015). “To forgive is sane and realistic”: Contributions of REBT to the psychology of forgiving. Journal of Rational-Emotive Cognitive-Behavioral Therapy, 33, 325–340.

Puchalski, C. (2002). Forgiveness: Spiritual and medical implications. The Yale Journal for Humanities in Medicine. (Obtained by request through the author at
https://smhs.gwu.edu/gwish/about/dr-puchalski

Shuping, M., & McDaniel, D. The Four Steps to Healing, Non-Denominational Edition. High Point: Tabor Garden Press.

Ten Boom, C., Sherrill, J., & Sherrill, E. (2000) The Hiding Place. Uhrichsville: Barbour Books.