The Use of Forgiveness Therapy with Female Survivors of Abuse

Abstract

Three intervention studies focusing on the psychology of forgiveness for women who have been abused are reviewed. All three incorporated the process model of forgiveness, used randomized assignment to experimental and control groups, and examined effectiveness through pre-test, post-test, and follow-up assessments. All three were conducted by different interveners. Results show that forgiveness is an effective way of restoring psychological health following abuse as well as increasing forgiveness toward the offender. For example, in Freedman and Enright’s study with incest survivors, the experimental group showed a significantly greater reduction in anxiety, state anxiety, trait anxiety, and depression, and a greater increase in forgiving the perpetrator, and in hope. Similar results were found in Reed and Enright’s study with women who experienced spousal emotional abuse. Participants who received Forgiveness Therapy, compared to an alternative therapy, demonstrated a statistically significantly greater increase in forgiving the former abusive partner, in self-esteem, in environmental mastery (everyday decisions), and in finding meaning in suffering (moral decisions), and a statistically significantly greater reduction in trait anxiety, in depression, and in post-traumatic stress symptoms. Lee and Enright’s study with women with fibromyalgia, who experienced parental abuse in childhood, additionally shows that forgiveness, can help alleviate physical symptoms as well as psychological symptoms. Specifically, the forgiveness intervention participants had greater improvements in forgiveness and overall fibromyalgia health from pretest to the post-test, and in forgiveness and state anger from the pretest to the follow-up test than the fibromyalgia health intervention participants.

Full text

The Use of Forgiveness Therapy with Female Survivors of Abuse
Suzanne Freedman1 and Robert D Enright2*
1Department of Educational Psychology and Foundations, University of Northern Iowa, Iowa, USA
2Department of Educational Psychology, University of Wisconsin and Board Member, International Forgiveness Institute, Inc., Madison, Wisconsin, USA
*Corresponding author: Robert D Enright, Department of Educational Psychology, University of Wisconsin and Board Member, International Forgiveness Institute, Inc.,
Madison, Wisconsin, USA, Tel: +1 608-262-0835; E-mail: renright@wisc.edu
Received date: April 28, 2017; Accepted date: May 08, 2017; Published date: May 25, 2017
Copyright: © 2017 Freedman S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Three intervention studies focusing on the psychology of forgiveness for women who have been abused are
reviewed. All three incorporated the process model of forgiveness, used randomized assignment to experimental
and control groups, and examined effectiveness through pre-test, post-test, and follow-up assessments. All three
were conducted by different interveners. Results show that forgiveness is an effective way of restoring psychological
health following abuse as well as increasing forgiveness toward the offender. For example, in Freedman and
Enright’s study with incest survivors, the experimental group showed a significantly greater reduction in anxiety,
state anxiety, trait anxiety, and depression, and a greater increase in forgiving the perpetrator, and in hope. Similar
results were found in Reed and Enright’s study with women who experienced spousal emotional abuse. Participants
who received Forgiveness Therapy, compared to an alternative therapy, demonstrated a statistically significantly
greater increase in forgiving the former abusive partner, in self-esteem, in environmental mastery (everyday
decisions), and in finding meaning in suffering (moral decisions), and a statistically significantly greater reduction in
trait anxiety, in depression, and in post-traumatic stress symptoms. Lee and Enright’s study with women with
fibromyalgia, who experienced parental abuse in childhood, additionally shows that forgiveness, can help alleviate
physical symptoms as well as psychological symptoms. Specifically, the forgiveness intervention participants had
greater improvements in forgiveness and overall fibromyalgia health from pretest to the post-test, and in forgiveness
and state anger from the pretest to the follow-up test than the fibromyalgia health intervention participants.
Keywords: Forgiveness therapy; Sexual abuse; Emotional abuse;
Fibromyalgia; Depression; Anxiety
Introduction
e idea of forgiveness for women who have experienced emotional,
physical and/or sexual abuse is oen met with surprise, skepticism,
and even horror. In our view, the opposition to forgiveness in this
context is based more on a misunderstanding of what forgiveness is
rather than on what forgiveness actually is. For example, some people
are concerned that if a woman forgives a perpetrator, then she will go
back into the abusive relationship [1].
Others think that if she forgives, this will suppress her anger or
show that she is weak and not worthy of respect [2]. In contrast to such
criticisms, research on forgiveness therapy illustrates that a self-chosen
decision to forgive a perpetrator can be eective in restoring positive
psychological health for women who have experienced past abuse
[3-6].
e purpose of this article is to review the research conducted on
the eects of forgiving for women who have experienced emotional,
physical, and/or sexual abuse as well as discuss the implications of
forgiveness therapy or education for women who have experienced
abuse of any kind. Specically, three studies that focus on forgiveness
therapy with female survivors of abuse will be reviewed. Prior to
reviewing this research, the denition of forgiveness as discussed in the
literature will be given as well as briey describing the model of
forgiveness used in the research studies reviewed.
Forgiveness Dened
When discussing the topic of forgiveness for female survivors of
abuse, it is important to be clear about what exactly is meant by
forgiveness, specically what forgiveness is and is not. Forgiveness is a
complicated term that is oen misunderstood by individuals in the
general population as well as academics, helping professionals, and
religious leaders [7]. According to Enright [8] and North [9], forgiving
others encompasses two parts. First there is a willingness to abandon
one’s right to resentment, negative judgment, and negative behavior
toward one who acted unjustly. Second, forgiving involves the
voluntary fostering of the undeserved qualities of compassion,
generosity, and sometimes even love toward the one who oended
[8,9]. Forgiveness also can be more simply dened as a decrease in
negative thoughts, feelings and behaviors toward an oender and
perhaps, over time, a gradual increase in more positive thoughts,
feelings and sometimes even behaviors toward an oender can occur
[1,10]. It is important to highlight, especially to female survivors of
abuse, that forgiveness does not mean that you deny or excuse the
oender of the wrongdoing or deny and ignore one’s feelings of pain.
As Smedes [11] states, we forgive in contexts of deep, personal, and
unfair hurt. e injury might be psychological, emotional, physical or
moral. When one forgives, she admits that the injury occurred and that
she was hurt. One also recognizes that what was done to her was
wrong as she works through her feelings of pain, anger, and
resentment. Admitting that the past abuse occurred and working
through one’s negative feelings is not easy. It is oen easier to deny,
ignore, or displace the pain resulting from one’s past physical,
emotional, and/or abuse.
Journal of Women's Health Care Freedman and Enright, J Women's Health Care 2017, 6:3
DOI: 10.4172/2167-0420.1000369
Review Article OMICS International
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369

Although as stated by Arnold-Ratli [12] in a discussion on both
the diculty and the importance of admitting to and dealing with hurt
feelings,
“You realize that when you refuse to feel pain, you wind up
feeling it forever; you nance it, setting up an installment plan to buy
decades of chronic anguish”
. Admitting that the abuse happened and
dealing with one’s negative feelings is one of the rst steps in the
forgiveness journey [8,13].
What Forgiveness is Not…
Forgiveness oen is confused with reconciling, forgetting,
pardoning, and/or accepting [14,15] even though it is dierent than all
of those terms. Some people criticize forgiveness because they think
that advocating forgiveness leads to further abuse or hurt. Safety is the
rst and most important consideration. us, a survivor of any type of
abuse would not be encouraged to forgive her abuser until she was safe
and removed from the abusive environment [6]. When one forgives,
she does not give up her right to a just solution; forgiveness and justice
occurs together [13]. Forgiveness is one person’s response;
reconciliation is a coming together in trust by two or more people [16].
For example, a woman can be abused by her partner, leave him,
forgive him, but not reconcile with him. Forgiveness can include a
willingness to reconcile or waiting in the hope that the abuser changes
his behavior and/or apologizes. Forgiveness is something the injured
can do on her own without any response from the abuser.
Reconciliation is dependent on a change in the oender’s behavior and
oentimes includes an admittance of wrongdoing and/or an apology.
e following quote by a survivor of domestic abuse claries well the
dierence between forgiving and other concepts including
reconciliation, “Upon forgiving, I have not forgotten what happened.
In remembering I make dierent choices in my intimate relationships.
I do not condone what was done to me. It was morally wrong and
undeserved. is forgiveness is not pardon, for I do not excuse his
behavior or pretend it never occurred. My process of forgiveness was
not reconciliation. In fact, mine was the opposite. It is a fracture that
will never be mended [17].
e Process Model of Forgiveness
Several models of forgiveness are described in the literature [18,19].
Enright and the Human Development Study Group [20] developed one
of the most comprehensive models of interpersonal forgiveness and to
date it is the only forgiveness model that has been tested successfully
with one-on-one interventions between the intervener and the
participant [19] and the one that focuses on abused women. It consists
of four phases and 20-units (initially included 17-units) and is the basis
for the Forgiveness erapy and research studies discussed in this
paper.
In brief, the rst phase is the Uncovering phase (units 1-8) and deals
with the awareness of one’s deep hurt and feelings associated with the
abuse, such as anger, shame and guilt, and cognitive rehearsal or
replaying the event in one’s mind over a long period of time. e
decision phase (units 9 to 11) is next in which the injured person
recognizes the way she has been coping is no longer eective and
begins to explore forgiveness as an option for healing before making
the commitment to forgive. is includes exploring what forgiveness is
and is not. Although one makes the commitment to forgive, this does
not mean she feels forgiving at that time. e Work phase (units 12-15)
is where the injured actively engages in processes such as reframing
who the oender is, which includes broadening one’s view of the
oender as well as recognizing the inherent worth of all individuals,
including the abuser, developing empathy and compassion for one’s
abuser (which takes time and patience), and accepting and absorbing
the pain of her injury rather than passing it onto others. As stated by
one of the incest survivor’s in Freedman and Enright’s [3] study 17
years following the forgiveness intervention,
“
ere is not a day that goes by where I don’t think about how much
my participation in your group changed my life and my attitude.
Forgiveness is not just an act-it’s a way of life. My strongest beliefs are
not necessarily religious ones, but ones rooted in Mother eresa’s idea
that ‘we cannot hate someone whose story we know.’ Part of what I
learned from you was that opening myself to more about what may
have happened to my father in his own childhood made it possible for
me to understand that he, too, may have been a victim of abuse
” [7].
is phase includes some of the most dicult units in the process
model and leads to the outcome or discovery phase (units 16 to 20) in
which the injured nds meaning in her suering and the forgiveness
process, realizes that she has needed others’ forgiveness in the past,
that she is not alone in her pain and that she may have a new purpose
in life because of her experience. e forgiver also realizes that as she
gives the gi of forgiveness to the oender, she is healed as
experienced by decreased negative feelings and thoughts towards the
oender and perhaps, increased positive feelings and thoughts toward
the oender.
It is important to note that forgiving takes time. is is especially
true in situations of deep hurt, such as physical, sexual and/or
emotional abuse [17]. Previous research conducted on Forgiveness
erapy illustrates that the longer the duration of the counseling or
education, the stronger the results [18,19].
According to Worthington, et al. [21],
“Anything done to promote
forgiveness has little impact unless substantial time is spent at helping
participants think through and emotionally experience their
forgiveness”
.
Research on Forgiveness erapy and Intervention with
Female Survivors of Abuse
ree studies of women suering abuse of dierent kinds are
reviewed here. All incorporated the process model of forgiveness, were
randomized trials, and employed one-on-one interventions between
interventionists and the participants.
Forgiveness Intervention with Incest Survivors
Freedman and Enright [3] conducted an individual educational
intervention using forgiveness as the goal with 12 incest survivors from
a Midwestern community. is research was the rst study to
empirically examine the role of forgiveness as a treatment for incest
survivors and the rst to identify a relationship between forgiving and
improved psychological health [3]. e average age of the 12
participants was 36 years with a range of 24 to 54 years. All
participants were Caucasian and the average education was 15 years
with a range of 12-19 years. For six of the participants (50%) their
perpetrator was their natural father; for 8% their stepfather; for 16%
their brother; for 16% their grandfather, and for 8% an uncle [3].
e design of the study was a yoked, randomized experimental and
control group design in which pairs of participants were matched as
closely as possible on nature of abuse, abuser, age abuse began,
Citation: Freedman S, Enright RD (2017) The Use of Forgiveness Therapy with Female Survivors of Abuse. J Women's Health Care 6: 369. doi:
10.4172/2167-0420.1000369
Page 2 of 6
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369

duration of abuse, current age of the survivor, SES status, and
education level. One participant from each yoked pair was randomly
selected to be in the experimental group (receive the forgiveness
intervention rst) and the other participant to be in the control group
(receive the forgiveness education aer one’s yoked partner completed
her forgiveness education). Freedman and Enright’s [3] study was
unique in that there was no specic ending point for participants and
the intervention lasted as long as it took for the participants to forgive.
Because the intervention was individual, experimental subjects met
weekly with the rst author for 60 minutes until they had progressed
through all 17 units in the process model [20].
At the time of this study, the model included 17 units rather than 20.
Each experimental participant was given a manual that described each
unit in the process model and oered examples applicable to incest
survivors. When a participant had experienced all 17 units and
reported that she had forgiven she was given the Self-Report
Forgiveness Measure [3], which included three denitions of
forgiveness taken from the literature and ve questions the survivor
responded to regarding her feelings and thoughts toward the abuser in
relation to the denitions of forgiveness. If the participant stated she
had forgiven and her responses were logical and rational, her
forgiveness was considered genuine.
Although Freedman and Enright [3] acknowledge the benets of
group therapy for incest survivors, they explain that the,
“…advantages of individual sessions for this specic intervention
outweighed the advantages of group therapy. Because each participant
continued with the intervention to criterion, each participant had
diering amount of time within the intervention”,
and were able to
spend as much time as necessary on a specic unit. As stated by
Freedman and Enright [3], one survivor who felt particularly guilty
and ashamed about the abuse was able to spend four weeks discussing
her feelings related to this unit.
Once the experimental participant had completed her individual
intervention, she and her matched control participant were given the
dependent measures and then the yoked control participant began the
intervention and followed the same procedure as the original
experimental participant. e average length of the intervention was
14.3 months (range of 10 to 16 months), illustrating that forgiveness is
not a quick x for deep hurts. Both the therapist or educator and client
must be willing to invest the necessary time it takes to work through all
the units in the forgiveness model.
Results illustrated that post-intervention participants were more
forgiving toward their abusers, had decreased anxiety and depression
and increased hope for the future as well as greater self-esteem
compared to those who had not experienced the forgiveness education
and themselves pre-intervention [3]. In addition, experimental
participants were assessed again when their matched control
participant completed the intervention and they had maintained their
change patterns on all dependent scales illustrating that there was no
washout eect 14-months post-intervention. To show the eectiveness
of this approach, the participants not only improved in psychological
depression but also that depression was reduced to normal levels which
were maintained 14 months aer treatment ended.
Forgiveness erapy with Emotionally-Abused Women
In a similar study Reed and Enright [6] examined the use of
forgiveness therapy on depression, anxiety, and post-traumatic stress
with women who experienced spousal emotional abuse and compared
it to an active control group who received a dierent treatment. ey
hypothesized that Forgiveness erapy may be more eective than
other treatments because it focuses on decreasing resentment and
feelings of revenge towards one’s abusive ex-partner as well as the
development of goodwill toward the abuser. Reed and Enright [6],
emphasize that Forgiveness erapy does not encourage nor require
reconciliation, a frequent criticism of forgiveness in the literature
[22,23].
Forgiveness erapy allows women who have been abused to
choose a moral response to injustice and deep hurt which is both
empowering and eective in decreasing the negative psychological
outcomes of emotional abuse as one is validated for their anger and
other negative feelings and then helped to move beyond them [6].
Participants in Reed and Enright’s study included 20 psychologically
abused women, ranging in age from 32 to 54 years (with a mean age of
45) in a Midwestern city who had been divorced or permanently
separated for at least two years from their abusive spouse or romantic
partner. Five (25%) of the participants had remarried and 15 (75%)
had not remarried or started a new relationship with a live-in partner.
e psychological abuse reported included criticizing; ridiculing;
jealous control; purposeful ignoring; threats of abandonment; threats
of personal harm; and threats of harm to property or pets. Six
participants (30%) also disclosed experiences of sexual abuse.
As in Freedman and Enright’s [3] study, a matched, yoked and
randomized experimental and control group design was used. Ten
pairs were formed from the 20 participants and matched as closely as
possible on age, duration of abusive relationship, and time since
permanent separation or divorce. Participants were randomly assigned
to either the Forgiveness erapy (FT) group in which they received
one hour weekly individual sessions based on Enright’s 20-unit
forgiveness model or the control group in which they received one
hour individual sessions of an alternative treatment (AT) focused on
current life concerns, validating survivors’ anger, strategies for making
healthy choices, and interpersonal relationship skills. Participants in
both groups received a treatment manual that included a protocol on
FT or the AT. e Forgiveness erapy was criterion based, as in
Freedman and Enright’s [3] study, and was completed when each
participant reported that she had forgiven her abuser. e matched
control participant ended the therapy at that time as well and the mean
treatment time for all pairs was 7.95 months with a range of ve to 12
months.
Gain scores from pretest to post-test on all dependent variables for
the two treatment groups were analyzed using matched-pair t-tests.
Results illustrated that Forgiveness erapy participants demonstrated
a statistically signicantly greater increase in forgiving the former
abusive partner, in self-esteem, in environmental mastery, and in
nding meaning in suering and illustrated a statistically signicantly
greater reduction in trait anxiety, in depression, and in post-traumatic
stress symptoms compared to the participants in the control group
who experienced the alternative treatment. Follow-up assessment for
the Forgiveness erapy participants also indicates that there was
maintenance of gains from post-test to follow-up. is research is
signicant as it is the rst study to demonstrate that Forgiveness
erapy is eective as a treatment for women who have experienced
spousal psychological abuse and were experiencing long-term negative
consequences. is study also illustrated that Forgiveness erapy is
signicantly more eective in improving psychological health than an
alternative treatment recommended in the literature for emotionally-
Citation: Freedman S, Enright RD (2017) The Use of Forgiveness Therapy with Female Survivors of Abuse. J Women's Health Care 6: 369. doi:
10.4172/2167-0420.1000369
Page 3 of 6
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369

abused women [6]. is study also attempted to control confounds that
were present in previous research such as equal treatment duration for
the two conditions, presentation of only psychological abuse, and
complete separation from the abusing spouse for at least two years
before the start of treatment.
Reed and Enright [6] hypothesized specic benets of the
Forgiveness erapy to survivors of spousal psychological abuse that
may not be present in other forms of therapy. ese include a specic
focus on decreasing resentment towards the abuser as well as the
validation of one’s anger, the acknowledgement that the survivor is a
person of worth and the abuse does not change that worth, and that
the survivor is also a person of courage because of her willingness to
relinquish her resentment and recognize that her abuser is also a
person of worth [6].
e Forgiveness erapy also was found to be instrumental in
helping survivors of spousal psychological abuse engage in relevant
social justice issues and causes with positive energy as well as nd new
purpose in helping others who are in pain or are experiencing
injustice. is is important to point out because Forgiveness erapy
and education has been criticized in the past because of the
assumption that it prevents female survivors of abuse from assuming
an activist role against such abuse and injustices [22].
Forgiveness Intervention for Women with Fibromyalgia
e third study illustrating forgiveness as an eective form of
treatment with female abuse survivors was conducted by Lee and
Enright [5]. is research compared the ecacy of a forgiveness
intervention based on Enright’s [8] process model with a bromyalgia
health intervention, focusing on healthy lifestyles and diets, and sleep
and stress management, on women with bromyalgia (FM) who had
experienced physical, or sexual abuse, and emotional or physical
neglect in childhood by one of their parents. Previous research on
forgiveness illustrates that forgiveness is eective in improving physical
as well as mental health [24,25]. e participants in Lee and Enright’s
study were 11 women diagnosed with FM for 1 to 20 years (M=8.91)
and ranging in age from 21 to 68 years old (M=43.55). Participants
were all volunteers recruited from newspaper advertisements as well as
yers and mass e-mails.
Screening measures were used to identify 16 participants (dropped
to 11 by the end of the study) who completed the pretests and then
were randomly assigned to either the forgiveness or a FM health
intervention. As in the Freedman and Enright [3] and the Reed and
Enright [6] studies, participants engaged in individual sessions,
although the limit was set at 24 sessions for both groups. Sessions
occurred once weekly for one hour with the same intervener. e
treatment manual for the participants who received the forgiveness
intervention was Enright’s [8] book, Forgiveness Is a Choice.
Participants (N=5) in the FM health intervention received a 290-page
manual consisting of 32 book chapters selected from 15 books, three
journal articles, and one outline resource as well as a 10-page syllabus
including learning objectives and summaries of all sessions developed
by the rst author. e intervener had extensive knowledge in both the
forgiveness process and the FM [5].
What is unique about this study is that the FM intervention
participants completed weekly quizzes to assess their understanding of
the readings and both the FM and forgiveness intervention
participants completed nal tests in FM and forgiveness. According to
Lee and Enright [5] the weekly quizzes and nal tests were important
motivators for participants to read their materials before each session
and know that the intervener was intent on helping them learn as
much as possible about FM healthy practices and forgiveness. Results
illustrate that the forgiveness group participants showed greater
improvements in forgiveness, overall FM health, and state anger
compared to participants in the FM health group. A follow-up
assessment occurred 12 weeks following the intervention and results
showed greater reduction of state anger in the forgiveness group. Lee
and Enright [5] hypothesize that forgiving parents also may have
gradually reduced the forgiveness participants’ situational anger [5].
Subjective comments from the forgiveness intervention participants
lend additional evidence to the eectiveness of the forgiveness
intervention for these women who had FM and experienced some type
of parental abuse. Forgiveness intervention participants found the
intervention therapeutic, they beneted from learning to view their
parents with respect, the forgiveness process appeared to positively
impact their FM health, and they appreciated learning about
forgiveness as a way to cope with both their past abuse and FM.
Learning to forgive for the participants, who experienced both some
form of parental abuse as well as FM, not only changed participants’
views of their abuser but also impacted their physical and mental
health.
Clinical Implications for Psychological Depression
across the ree Studies
From a clinical perspective, the women in the Forgiveness erapy
condition across all three studies went from clinically depressed (mild
to moderate depression) to non-depressed at the follow-up testing
time. e well-established Beck Depression Inventory served as the
dependent variable in each study. e results, seen in Figure 1, are
important because depression can be dicult to ameliorate and the
reported ndings occurred not just directly aer the intervention but
at follow-up when the participants were without the forgiveness
treatment for 14 months in Freedman and Enright [3], 3 months in Lee
and Enright [5], 8.3 months in Reed and Enright [Figure 1] [6].
Figure 1: Cut-o scores for BDI-II [0-13: Minimal depression;
14-19: Mild depression; 20-28: Moderate depression; 29-63: severe
depression].
Citation: Freedman S, Enright RD (2017) The Use of Forgiveness Therapy with Female Survivors of Abuse. J Women's Health Care 6: 369. doi:
10.4172/2167-0420.1000369
Page 4 of 6
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369

Discussion
Research illustrates the potential eectiveness of Forgiveness
erapy and intervention for women who have experienced sexual
abuse and incest, spousal emotional abuse, and some type of childhood
abuse from a parent. ese three studies were similar in that the
intervention was individual for all participants, each study used some
type of written manual or guide and for two of the three studies, and
individuals were able to spend as much time as necessary in working
through the forgiveness model. ese factors may be an important part
of Forgiveness erapy and intervention in addition to the specic
forgiveness content.
e power of forgiveness to impact the survivors’ psychological and
physical health was illustrated in all research reviewed. As a moral
response to injustice and deep hurt, forgiveness focuses on more than
just decreasing anger and increasing self-esteem. Forgiveness includes
a focus on the paradoxes of extending mercy and good will toward
those who were not merciful to the participants. is approach enables
female survivors of abuse to see their oenders as human beings who
deserve respect despite their hurtful actions. According to Enright and
Fitzgibbons [1,10], Forgiveness erapy helps clients better understand
their oenders as well as make a morally good response toward those
oenders. As Freedman and Zariar [17] emphasize,
“e role of the
therapist is critical in educating clients about the forgiveness process as
well as supporting clients in their decision to forgive and during their
forgiveness journey”
.
In an article discussing patient empowerment and the use of care
managers in the treatment of 1160 patients living with cardiovascular
disease, diabetes, heart failure, and/or at risk of cardiovascular disease
in Italy, it was shown that partnerships and collaboration of all health
professionals as well as having a care manager for each patient not only
improved patients’ disease-related health but also empowered and
motivated patients to be more proactive regarding their health
behavior [26]. is model could be applied to Forgiveness erapy in a
way that could help women who have experienced some type of abuse
recognize that forgiveness can be an important component of their
healing and provide them with support during their forgiveness
journey.
If more medical professionals are aware of Forgiveness erapy as
an option for healing, women who might potentially benet from
forgiving could be targeted early in their treatment by their primary
care physician or a care manager. e primary care physician can refer
women with a past history of abuse to a professional serving as a
“forgiveness” care manager. is “forgiveness” care manager could help
women, who have been abused, become educated about forgiveness
and support them on their journey as necessary. Women with more
complicated issues and past abuse experiences could be referred to a
mental health professional with expertise in Forgiveness erapy. is
mental health professional as well as the care manager and primary
physician can all support the client during her journey toward
forgiveness. e processes in the forgiveness model would be applied
to forgiving the specic oender as well as being discussed and
highlighted as a way to live a more forgiving life [14]. As in Ciccone et
al. [26] research, clients can be empowered to recognize their anger
and do something about it before it becomes unhealthy as well as
motivated, for example, to use the idea of reframing (seeing the worth
in others, including those who abuse) to develop more compassion and
empathy when interacting with others or to accept and absorb their
pain rather than pass it on to someone else.
Not only does Forgiveness erapy change one’s psychology for the
better but also the results reviewed here are strong enough for mental
health professionals to begin thinking about incorporating this form of
therapy into their practices as stated above. We say this because, for
example, depression not only can be reduced but also actually can fall
to normal levels in women experiencing the serious injustice of incest
and other forms of abuse. It is rare for any kind of treatment to show
such eects. By our providing more information about Forgiveness
erapy and the forgiveness process in this article, it is our hope that
professionals in the mental health eld both recognize and use
forgiveness as an eective form of therapy for female survivors of
abuse. It further is our hope that more primary care physicians will
recognize women who have been abused and who could benet from
Forgiveness erapy and refer them to appropriate mental health
professionals. We encourage more researchers to enter this new and
potentially healing area of work so that more replications occur in the
published literature. Such eorts could go a long way in alleviating the
suering of too many women who experience injustice.
References
1. Enright RD, Fitzgibbons R (2015) Forgiveness therapy. APA Books,
Washington DC.
2. Lamb S (2002) Introduction: Reasons to be cautious about the use of
forgiveness in psychotherapy. In: Lamb S, Murphy. Before forgiving:
Cautionary views of forgiveness in psychotherapy, Oxford: Oxford
University Press pp: 3-14.
3. Freedman SR, Enright RD (1996) Forgiveness as an intervention goal
with incest survivors. J Consult Clin Psychol 64: 983-992.
4. Freedman S (2008) Forgiveness education with at-risk adolescent: A case-
study analysis. In: Malcolm W, Decourville N, Belicki K. Women’s
reections on the complexities of forgiveness, New York, NY: Routledge
pp: 93-119.
5. Lee YR, Enright RD (2014) A forgiveness intervention for women with
bromyalgia who were abused in childhood: A Pilot Study. Spiritual Clin
Pract 1: 203-217.
6. Reed G, Enright RD (2006) e eects of forgiveness therapy on
depression, anxiety, and post-traumatic stress for women aer spousal
emotional abuse. J Consulting and Clin Psychol 74: 920-929.
7. Freedman S, Chang W (2010) An analysis of a sample of the general
population's understanding of forgiveness: Implications for mental health
counselors. J Mental Health Counseling 32: 5-34.
8. Enright RD (2001) Forgiveness is a choice. APA Books, Washington, DC.
9. North J (1987) Wrong doing and forgiveness. Philosophy 62: 499-508.
10. Enright RD, Fitzgibbons R (2000) Helping clients forgive: An empirical
guide for resolving anger and restoring hope. APA Books, Washington,
DC.
11. Smedes L (1984) Forgive and forget. Harper and Row, San Francisco.
12. Ratli KA (2015) Do I feel my feelings? O’ e Oprah Magazine 16: 94.
13. Enright RD (2015) 8 keys to forgiveness. Norton, New York.
14. Enright RD (2012) e forgiving life: A Pathway to Overcoming
Resentment and Creating a Legacy of Love. APA Books, Washington, DC.
15. Enright RD, Freedman S, Rique J (1998) e psychology of interpersonal
forgiveness. In: Enright RD, North J. Exploring forgiveness. Madison, WI:
University of Wisconsin Press pp: 46-62.
16. Freedman S (1998) Forgiveness and reconciliation: e importance of
understanding how they dier. Counseling and Values 42: 200-216.
17. Freedman S, Zariar T (2015) e psychology of interpersonal
forgiveness and guidelines for forgiveness therapy: What therapists need
to know to help their clients forgive. Spirituality in Clinical Practice 3:
45-58.
18. Baskin TW, Enright RD (2004) Intervention studies on forgiveness: A
meta-analysis. J Counseling Development 82: 79-90.
Citation: Freedman S, Enright RD (2017) The Use of Forgiveness Therapy with Female Survivors of Abuse. J Women's Health Care 6: 369. doi:
10.4172/2167-0420.1000369
Page 5 of 6
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369

19. Wade NG, Hoyt WT, Kidwell JEM, Worthington EL (2014) Ecacy of
psychotherapeutic interventions to promote forgiveness: A meta-analysis.
J Consulting Clin Psychol 82: 154-170.
20. Enright RD, e Human Development Study Group (1991) e moral
development of forgiveness. Handbook of moral behavior and
development, Hillsdale, NJ: Erlbaum 1: 123-151.
21. Worthington EL, Kurusu TA, Collins W, Berry JW, Ripley JS, et al. (2000)
Forgiving usually takes time: A lesson learned by studying interventions
to promote forgiveness. J Psychology eology 28: 3-20.
22. Lamb S (2006) Forgiveness, women, and responsibility to the group. J
Human Rights 4: 45-60.
23. Arenofsky J (2011) Swept up in forgiveness. Herizons Magazine 2: 2-35.
24. Witvliet CVO, McCullough ME (2007) Forgiveness and health: A review
and theoretical exploration of emotion pathways. In: Altruism and health:
Perspectives from empirical research Oxford university press, New York
pp: 259-276.
25. Worthington EL, Scherer M (2004) Forgiveness is an emotion-focused
coping strategy that can reduce health risks and promote health
resilience: eory, review, and hypotheses. Psychol Health 19: 385-405.
26. Ciccone MM, Aquilino A, Cortese F, Scicchitano P, Sassara M, et al.
(2010) Feasibility and eectiveness of a disease and care management
model in the primary health care system for patients with heart failure
and diabetes. Vasc Heath Risk Manag 6: 297-305.
Citation: Freedman S, Enright RD (2017) The Use of Forgiveness Therapy with Female Survivors of Abuse. J Women's Health Care 6: 369. doi:
10.4172/2167-0420.1000369
Page 6 of 6
J Women's Health Care, an open access journal
ISSN:2167-0420
Volume 6 • Issue 3 • 1000369