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The Use of Forgiveness Therapy with Female Survivors of Abuse

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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.
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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 ones 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 ones 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
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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 ones 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
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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
... However, by end of her testimony, she demonstrated a noticeable decrease and a gradual increase in more positive thoughts and feelings towards her mother - Many proponents of forgiveness models in psychotherapy have argued that forgiveness does not mean that the survivor is denying or excusing the offender of any wrongdoing or denying or ignoring their own feelings of pain (Enright & Fitzgibbons, 2000;Freedman & Enright, 2017). Instead, North (1987) argues that forgiveness requires a recognition of the wrongdoer's actions and it typically involves a conscious effort on the part of the one wronged to improve themselves in relation to the wrongdoer. ...
... The excerpt above shows evidence of Asha's acknowledgement that while she had faced abuse, she was also loved and that she wants to move on from the feelings of hurt, resentment and justice-seeking. Freedman & Enright (2017) reviewed studies using forgiveness therapy with survivors of abuse and found it to be an effective way of restoring psychological health. It could be that through NET, Asha was able to process and resolve negative emotions and resentment and look towards building a more positive relationship with her mother in the future. ...
... Asha demonstrated the paradoxical ability to extend mercy and goodwill towards those who were not merciful to her, which is proposed as the foundation of forgiveness therapy (Freedman & Enright, 2017). This allows her to move on and envision a future that is not trauma-congruent or traumadependent. ...
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The current understanding of domestic violence is largely nomothetic by design and does not adequately address the treatment and rehabilitation needs of survivors. This thesis aimed to gain a qualitative understanding of the culture-specific experiences of domestic violence in south Indian female survivors, with a focus on the treatment of posttraumatic stress disorder (PTSD), and comorbid psychopathology. An interpretative phenomenological analysis was undertaken with five south Indian women to investigate the in-depth, lived experiences of domestic violence and its mental health sequelae. Responses to, and appraisals of abuse were found to be heavily influenced by pre-abuse identity, interpersonal childhood experiences, societal perceptions of, and stigmatising attitudes towards survivors. These factors impact the experience of disclosure and help-seeking among survivors, with a clear preference for informal sources of support such as family and social care organisations. Further, the findings shed light on the experience of resisting and counteracting the abuse in this context, as well as the complex, non-linear and iterative process of leaving abusive relationships. This was found to be rooted in the sociocultural framework of Indian society, patriarchal ideologies of gender roles, and the systemic and structural disempowerment of women, perpetuating the perpetration and experience of abuse and violence. The treatment protocol examined in this thesis is Narrative Exposure Therapy (NET), which is a short-form psychotherapeutic technique originally developed for survivors of war and organised violence in low-resource contexts. The comprehensive and up-to-date meta-analysis of its current evidence base along with a quality appraisal of the trials included was conducted. The findings revealed low- to medium-quality evidence of NET efficacy for the alleviation of PTSD. High heterogeneity estimates and low powered trials significantly impact the interpretation of the pooled intervention effect estimates. This review also revealed an overreliance on randomised controlled trial findings and a paucity of idiographic research investigating change mechanisms through NET. In the final study, an inductive and deductive thematic analysis was undertaken to investigate the change mechanisms through NET for survivors of domestic violence. NET was administered to seven south Indian women and was well tolerated by the sample. Paired sample t-tests revealed a statistically significant improvement in PTSD and somatic symptoms at post-test. The raw testimony data was qualitative analysed, and a theoretically-informed framework of recovery was developed through thematic analysis to elucidate the specific processes that contribute to change and underlie improvement on symptom scores. There was evidence for several proposed mechanisms based on seminal PTSD theories, as well as some data-driven mechanisms such as positive memories and a focus on future aspirations that contributed to recovery in this sample. There are no published accounts of NET’s use or efficacy in India, and practice implications include culture-specific and stressor-specific applications of NET using the template from the recovery framework. These findings complement the limited RCT evidence of NET from an idiographic perspective. Importantly, the need to consider and explore culture- and context-specific change mechanisms is demonstrated through the framework, which found additional processes contributing to recovery in this sample. Recommendations for the adaptation of individual-focused, empirically supported treatments such as NET that are culturally sensitive and consider the complex socio-ecological milieu of the Indian context are discussed.
... giveness process model has been tested and shown beneficial for female survivors of abuse (Freedman & Enright, 2017) such as incest survivors (Freedman & Enright, 1996), emotionally abused women (Reed & Enright, 2006), and women with fibromyalgia who experienced parental abuse in childhood (Lee & Enright, 2014). Also, a recent pilot study, the first published study that examined the efficacy of a forgiveness intervention in Pakistan, has shown that adolescent females who were physically or sexually abused experienced benefits of forgiveness in the areas of anger and hope at the 1-year follow-up when compared with the treatment as usual group (Rahman, Iftikhar, Kim, & Enright, 2018). ...
... These results favouring the forgiveness intervention add evidence to the claim that when one forgives, it is the forgiver who benefits from the offering of forgiveness (Wade, Hoyt, Kidwell, & Worthington, 2014). These results add further evidence to the past findings that the forgiveness Process Model is an empirically supported therapeutic approach that works well with female abuse victims (Freedman & Enright, 2017) and that it is effective within the context of non-Western, male-dominated societies where victims are likely to find themselves even more vulnerable with a lack of resources and due to the power differentials between the two genders (Rahman, Iftikhar, Kim, & Enright, 2018). Furthermore, moderate to strong effect sizes reported in this study add evidence to the moderating effect of treatment modality favouring individual forgiveness sessions over group sessions (Baskin & Enright, 2004;Wade, Hoyt, Kidwell, & Worthington, 2014). ...
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Despite the traumatic effects of acid violence on its victims, treatment options are very limited. The present study was aimed at examining the efficacy of a forgiveness intervention with female survivors of acid attack violence in Pakistan. Female acid attack victims in Pakistan were randomized to either a forgiveness group (n = 8) or a treatment‐as‐usual (TAU; n = 8) control group. The forgiveness group received twice‐a‐week forgiveness sessions for 4 months while the TAU group either received typical psychological treatment sessions for acid attack victims or no treatment. All participants were assessed on their levels of forgiveness, anger, anxiety, depression, and hope four times prior to the 4‐month intervention period, twice after the intervention period, and once at the one‐year follow‐up. Post treatment, the forgiveness intervention group showed greater improvement in hope, anger, anxiety, and depression when compared with the TAU group. Upon further examinations, both groups improved on forgiveness from pretreatment to post‐treatment, but the forgiveness group had a higher baseline. From pretreatment to the 12‐month follow‐up, the forgiveness group, when compared with the TAU group, showed greater improvement in all areas except for depression. This is the first study that examined the effects of a forgiveness intervention for acid attack victims in Pakistan. Results showing the improvement post treatment as well as over a one‐year period post treatment are encouraging.
... Therefore, an introduction of a positive element, such as forgiveness, may help in alleviating negative feelings, thereby reducing the probability of drug use as a coping mechanism, and may further help in increasing their motivation to engage in treatment. Moreover, in addition to the positive effects of forgiveness on psychological and physical wellbeing as having been supported by previous research Long et al., 2020), forgiveness is as well considered an effective element to cope with maltreatment experiences in the context of trauma (Freedman and Enright, 2017). Taken together, the literature supported the positive effect of forgiveness on one's wellbeing, which is consistent with the present findings indicating its full mediating role in the association between childhood maltreatment and treatment motivation among drug addicts. ...
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Studies have reported high rates of childhood maltreatment among individuals with drug addiction problems; however, investigation about the potentially protective factors to mitigate the effects of maltreatment experiences on motivation to engage in addiction treatment has received less attention. This study aims at exploring the mediating effects of forgiveness and self-efficacy on the association between childhood maltreatment and treatment motivation among drug addicts. A total of 360 male drug addicts (mean age = 33.34, SD = 7.25) were recruited from three mandatory inpatient rehabilitation centers in Malaysia. Participants completed a package of self-report questionnaires including measures of childhood maltreatment experiences, forgiveness, self-efficacy, and motivation for treatment. The analysis conducted using the structural equation model (SEM) revealed that childhood maltreatment significantly predicted lower treatment motivation, while forgiveness and self-efficacy played a fully mediating role regarding the effect of childhood maltreatment on treatment motivation. In conclusion, these findings suggest that combining the element of forgiveness and self-efficacy in treatment programs appears to benefit the drug addicts with childhood maltreatment history.
... Forgivenessbased interventions may reduce negative thoughts and feelings and increase positive thoughts and feelings about a transgressor, increase forgiveness self-efficacy (i.e., forgiving without external pressure), and even increase the likelihood that forgiveness will generalize to new situations (Harris et al., 2006). Additionally, forgiveness-based interventions may be effective in helping females who have survived abuse (Freedman & Enright, 2017) and students who experience emotional breakdowns (Mohammadi & HajiAlizadeh, 2017). Secondly, hope interventions and Hope Intervention Programs (HIP) focus on decreasing an individual's feelings of helplessness, powerlessness, and despair while increasing feelings of self-esteem (Shin & Park, 2007). ...
Chapter
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Positive Psychological Interventions are activities that have been demonstrated to cause a positive change in a population by increasing a positive variable (e.g., optimism). Although these activities come in a variety of forms and focus on a wide range of positive variables, researchers tend to concentrate their efforts on seven popular and well-researched categories of PPIs that are as follows: meaning, gratitude, strengths, savoring, optimism, empathy, and kindness. Collectively, the PPIs in these domains have been shown to alleviate depressive symptoms, increase pro-social spending and social connectedness, reduce suicidal ideation, increase subjective well-being or happiness, and many other positive changes across diverse populations. Still, there are many questions that warrant discussion for future research such as sex and cultural differences, long-term effects, and antithetical or unexpected reactions to activities. Along with examining these benefits and critiques of PPIs, we discuss the background and state of replicability for each domain.
... Individuals who have forgiveness will have better mental health because they are able to be more positive about a problem (Freedman & Enright, 2015). Because they need forgiveness to increase individual life satisfaction. ...
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This study was aimed to determine the relationship between forgiveness and life satisfaction among undergraduate students in Indonesia and China. The subjects of the study were 113 undergraduate students in Indonesia and 193 undergraduate students in China. Transgression-Related Interpersonal Motivations Scale--12-Item Form (TRIM-12) by McCollugh (α=0.928, N=12) for measure forgiveness and Satisfaction with Life Scale by Dinner, et al (α=0.836, N=5) for measure life satisfaction. Statistical results used the Spearman Rho technique showed that there was a significant negative correlation between forgiveness and life satisfaction among undergraduate students in Indonesia and China (p = 0,000, r = -0.187). The relationship between the two variables showed that the higher forgiveness shown by undergraduate students in Indonesia and China, the lower the life satisfaction of their life. We also analyze difference of forgiveness and life satisfaction among undergraduate students in Indonesia and China with Mann-Whitney Rank Test. Result showed there was a significant difference between forgiveness of undergraduate students in Indonesia and China (p=0,000) and also life satisfaction of undergraduate students in Indonesia and China (p=0,019). Keywords: Forgiveness, life satisfaction, undergraduate students, Indonesia, China
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Organisational injustice, betrayal, moral transgression, wrongdoing, or breach of deeply held values and beliefs can manifest in frontline staff as Post Traumatic Embitterment Disorder (PTED), Moral Injury and/or PTSD (Post Traumatic Stress Disorder). PTED and Moral Injury are fundamentally the same and could not be discriminated from each other. The constructs of PTED and Moral Injury can be assimilated into that of PTSD, rather than exist as comorbid conditions. Chronic embitterment is of clinical significance and often a symptom of PTSD, which may be inextricably linked to the traumatic incident(s) and often expressed as persistent blame of self or others, in DSM-5 diagnostic criteria for PTSD, D2 and D3. Chronic embitterment and moral pain can maintain PTSD symptoms.
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The aim of this study was to examine psychological and relational variables such as dependence, forgiveness (both in their positive and negative dimensions), and hope that may explain why women reconciliate with abusive partners. We administered a questionnaire to women victims of violence. Relational dependence was indirectly associated with greater intentions to return to the violent partner via benevolent forgiveness and hope of a change in the partner. The positive dimension of forgiveness (benevolence) could represent a phase of the cycle of violence, during which the hope for change in the partner can increase the probability of reconciliation.
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Bu çalışma esas olarak dijitalleşmenin ağırlık kazandığı dijital çağda, işletmelerin liderlik ihtiyacı ve liderlik faaliyetleri üzerine odaklanmaktadır. Çalışmanın temel amacı, liderlik kavramının dönüşümüyle birlikte, dijital çağda işletmelerin ihtiyaçlarına yönelik gelişmeye başlayan dijital liderliğin özelliklerini ortaya koymaktır. Bu bağlamda çalışma, dijital liderliği ele alan teorik ve amprik çalışmalardan müteşekkil bir literatür taramasını içermektedir. Çalışmaya Çizgi Kitabevi: http://www.cizgikitabevi.com/kitap/1171-sosyal-bilimlerde-guncel-konular-ve-arastirmalar ulaşabilirsiniz.
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The Process Model of Forgiveness, first described in Enright and the Human Development Study Group (1991) and first empirically tested by Hebl and Enright (1993), has been shown through randomized experimental and control group clinical trials to improve emotional well-being in multiple settings across diverse cultures. We start first with the definition of forgiveness toward others who have been unjust. The Process Model then is described, followed by a summary of the empirical findings. We conclude with the latest application of the model: forgiveness education with children and adolescents. Implications for improved mental health across the lifespan are discussed.
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Abstract Discusses interpersonal forgiveness, examining the questions: 1) What is interpersonal forgiveness; 2) Can we devise a model to help people forgive; and 3) What are the psychological outcomes for those who forgive. The authors express some concerns about the direction the field of forgiveness studies seems to be taking regarding each question.
Article
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In recent years, forgiveness research, education, and therapy have received a great deal of theoretical and empirical attention. Past research illustrates the potential benefits of and interest in forgiveness therapy (Enright & Fitzgibbons, 2000; Legaree, Turner, & Lollis, 2007). Misunderstandings and misconceptions about what it means to forgive are linked to criticism aimed at the use of forgiveness therapy and education. The 3-fold purpose of the current study is to explain the value of forgiveness as a therapeutic approach, address misconceptions of forgiveness and forgiveness therapy, and describe a model of forgiveness that has been used effectively with a variety of populations. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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An intervention, with forgiveness toward their abuser as the goal, was implemented with 12 female incest survivors. The women, from a midwestern city, were 24 to 54 years old, and all were Caucasian. A yoked, randomized experimental and control group design was used. The participants were randomly assigned to an experimental group (receiving the forgiveness intervention immediately) or a waiting-list control group (receiving the intervention when their matched experimental counterpart finished the intervention). Each participant met individually with the intervener once per week. The average length of the intervention for the 12 participants was 14.3 months. A process model of forgiveness was used as the focus of intervention. Dependent variables included forgiveness, self-esteem, hope, psychological depression, and state-trait anxiety scales. After the intervention, the experimental group gained more than the control group in forgiveness and hope and decreased significantly more than the control group in anxiety and depression. When the control group then began the program they showed similar change patterns to the above, as well as in self-esteem improvement.
Article
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This pilot study compared the efficacy of a forgiveness intervention with a fibromyalgia (FM) health intervention on women with FM who have experienced emotional, physical, or sexual abuse, and emotional or physical neglect, in childhood by one of their parents. Eleven women with FM between the ages of 21 and 68 were randomized to the forgiveness intervention (n = 5) or the FM health intervention (n = 6), and completed the once-weekly individualized program for 24 weeks. The participants completed measures assessing forgiveness, overall FM health, depression, anger, anxiety, self-esteem, and coping strategies at the pretest, the posttest, and the 12-week follow-up test. They also completed the forgiveness intervention and FM health intervention final tests at the posttest, which assessed their knowledge on forgiveness and FM health. The forgiveness intervention participants had greater improvements in forgiveness (p < .001) and overall FM health (p = .046) from the pretest to the posttest, and in forgiveness (p = .018) and state anger (p = .027) from the pretest to the follow-up test than the FM health intervention participants. Moreover, the forgiveness intervention participants scored higher on the forgiveness final test than the FM health intervention participants (p < .001), and the FM health intervention participants scored higher on the FM health final test than the forgiveness intervention participants (p < .001). The results indicate that the forgiveness intervention was potentially helpful in improving forgiveness and overall FM health, and in decreasing state anger of this particular sample of women with FM.
Article
Numerous accounts of research on promoting forgiveness in group settings have been published, indicating that forgiveness can be promoted successfully in varying degrees. Many have suggested that empathy-based interventions are often successful. It takes time to develop empathy for an offender. We report three studies of very brief attempts to promote forgiveness in psychoeducational group settings. The studies use ten-minute one-hour, two-hour, and 130-minute interventions with college students. The studies test whether various components-namely, pre-intervention videotapes and a letter-writing exercise-of a more complex model (the Pyramid Model to REACH Forgiveness) can produce forgiveness. Each study is reported on its own merits, but the main lesson is that the amount of forgiveness is related to time that participants spend empathizing with the transgressor. A brief intervention of two hours or less will probably not reliably promote much forgiveness; however, one might argue that it starts people on the road to forgiving.
Book
This book argues that forgiveness has been accepted as a therapeutic strategy without serious, critical examination. It hopes to provide a closer, critical look at some of these questions: why is forgiveness so popular now? What exactly does it entail? When might it be appropriate for a therapist not to advise forgiveness? When is forgiveness in fact harmful? It includes many previously unpublished chapters by both philosophers and psychologists that examine what is at stake for those who are injured, those who injure them, and society in general when such a practice becomes commonplace. These chapters offer cautionary tales about forgiveness therapy, while others paint complex portraits of the social, cultural, and philosophical factors that come into play with forgiveness. The value of this volume lies not only in its presentation of a nuanced view of this therapeutic trend, but also as a general critique of psychotherapy, and as a valuable testimony of the theoretical and practical possibilities of an interdisciplinary collaboration between philosophy and clinical psychology.
Chapter
Our purpose in this chapter is to address the possible health connections of forgiveness, which we view as one way of expressing altruism (see Post, 2003). Because attempts to forgive may not always be born out of purely altruistic concerns, and definitions of forgiveness vary, it is important to present our view of forgiveness and to distinguish it from what it is not. Links with health are likely to hinge on a view of forgiveness that distinguishes it from pseudoforgiveness. For example, it is important not to confuse granting forgiveness with forbearing (McCullough, Fincham, & Tsang, 2003), denying, ignoring, minimizing, tolerating, condoning, excusing, forgetting the offense, suppressing one's emotions about it, or reconciling (see Baskin & Enright, 2004; Enright & Human Development Study Group, 1991). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In this meta‐analysis, 9 published studies (N = 330) that investigated the efficacy of forgiveness interventions within counseling were examined. After a review of theories of forgiveness, it was discovered that the studies could logically be grouped into 3 categories: decision‐based, process‐based group, and process‐based individual interventions. When compared with control groups, for measures of forgiveness and other emotional health measures, the decision‐based interventions showed no effect, the process‐based group interventions showed significant effects, and the process‐based individual interventions showed large effects. Consequently, effectiveness has been shown for use of forgiveness in clinical and other settings.