Friday, June 20, 2014

Forgiveness & Psychotherapy Fad or Science?

FORGIVENESS & CHRISTIAN COUNSELING:
     Is forgiveness just a fad?



“You need to forgive him,” the counselor said as he pointed to the Bible and quoted Jesus threat linked command. “But if you do not forgive men their trespasses, neither will your Father forgive your trespasses.” (Matthew 6:15)


It’s easy to see why forgiveness is a popular topic in Christian literature. It is after all at the heart of the gospel. And it is a command. Although some interpretations have led to much distress for those who fear forgiving will only encourage evildoers to continue to abuse their victims.

A few posts ago I began looking at the evidence supporting Christian Counseling and Psychotherapy. This is a post related to that quest.

FORGIVENESS AND PSYCHOLOGICAL SCIENCE
In the past two decades, psychological scientists have tested forgiveness interventions and found evidence that many people are able to forgive their offenders and experience an inner sense of peace and relief from distressing symptoms.

Forgiveness has been linked to better general health and mental health. Here’s two examples.
Self-forgiveness was related to better physical health for adults (Toussaint and others, 2001).
People who required offenders to satisfy a demand were at higher risk for mortality than people who forgave unconditionally (Toussaint and others, 2012).

FORGIVENESS IN COUNSELING AND PSYCHOTHERAPY

Julia E. M. Kidwell and Nathaniel G. Wade recently (2013) reviewed evidence of forgiveness interventions. They cite several studies documenting the effectiveness of forgiveness interventions for clients drawn from general samples and those who identified as Christian.

The authors specifically identified studies showing the effectiveness of the REACH model developed by Ev Worthington, Jr. of Virginia Commonwealth University. In addition to its effectiveness with students, the model has been studied in adult samples within the United States and other countries. Counseling resources can be found on Ev Worthington's web page.

I have presented forgiveness interventions in Pentecostal Churches and found a warm reception to Worthington's REACH model. I have also found them open to participating in research related to forgiveness and restoration (References below: Mittlestadt & Sutton, 2010; Sutton, 2010).

FORGIVENESS MODELS

There are several forgiveness models that have been found to be effective for clients regardless of religious tradition or no tradition.

Robert D. Enright offers “A Step-by-Step Process for Resolving Anger and Restoring Hope” in his 2001 book, Forgiveness is a Choice, which is published by the American Psychological Association. It is actually a self-help book. He divides the forgiving process into four phases each having multiple steps. Enright and his colleagues have published results supporting the effectiveness of his model. See below for a reference to his book and links to videos.

As mentioned above, Ev L. Worthington, Jr. has developed and tested a five step model using the acronym REACH. The model is presented in a way that would be suitable for any client regardless of religious tradition or no tradition but Worthington has specifically written articles and a book to explain how the model fits with Christian theology. He also includes specific interventions accommodating Christian beliefs and practice. See below for a link to videos by Worthington and references to his books.

There are other models. For example, Fred Luskin has a model. I have included a video by Luskin in the link to videos below.


THOUGHTS

Forgiveness counseling may not be the reason someone got better.
Improvement following a forgiveness intervention is not evidence to support the effectiveness of the forgiveness intervention.  One of the great things about counseling and psychotherapy is the importance of relationship. Just talking with a kind and accepting person who offers undivided attention and confidentiality can be very helpful. If you add a placebo effect to the relationship, a lot of people may benefit from a few visits. And one more thing—add the value of the time effect to the placebo effect and the relationship effect. People often feel better when they get some distance (read time) from a distressing event. For forgiveness interventions and any other interventions to be effective, they should add value above that accounted for by time, placebo effects, and a warm and accepting relationship.

Forgiveness is not a panacea.
Although many people do indeed benefit from forgiving those who have offended them, forgiveness may not be the most pressing need for a person seeking psychotherapy. For example, if a client was sexually assaulted as a youth, the person may experience symptoms of Post-Traumatic Stress Disorder, including a common co-occurring persistent depression years later. And forgiveness may be an important intervention. But it does not mean that working through a forgiveness intervention will relieve the symptoms of PTSD or Depression. On the other hand, forgiveness may be helpful at a later stage in treatment. Psychological scientists and experienced clinicians know this but I fear many clinicians just jump on a band wagon and use their newly found forgiveness tool (sorry about the mixed metaphor).

Forgiveness and reconciliation are still confusing ideas.
Despite the efforts of psychological scientists and clinicians to separate forgiveness from reconciliation, people still link the two ideas. I suspect the reason for the confusion is the fact that we often need to get along with the people who hurt us. In everyday experience, when we forgive someone it is usually in the context of a relationship such as in a marriage or at work. 

It is however important to keep the concepts of forgiveness and reconciliation separate when serious offenses have happened. Recommending a woman return and reconcile with her abusive husband can be a disaster. And disastrous consequences can happen in any situation when people believe they must live their lives as victims of abuse if they are to forgive the abuser.

The idea of forgiving a dead offender can help some people see the difference between forgiveness and reconciliation. A person can reach the point of forgiving a person who hurt them years ago. But if that person is dead, there is no reconciliation possible.

Forgiveness may or may not be a Christian Counseling Intervention
The scientific evidence supports the beneficial effects of forgiveness interventions in counseling. The existing models have been effective with Christian and non-Christian clients. It makes sense that a Christian client would feel more comfortable working through forgiveness with a Christian counselor who was comfortable citing relevant scriptures and praying for God’s grace to assist in the often difficult process; however, the interventions that have scientific support are not presented as Christian per se. Rather, they may be called religious accommodative or more specifically, Christian-accommodative. The distinction does not matter to many who care about what works. And as long as an intervention does not attempt to upset or destroy one’s religious beliefs, what’s the harm? Nevertheless, some Christians are wary about counseling that is not strictly biblical counseling or developed as a specifically Christian intervention.

QUICK NOTES

Forgiveness is not reconciliation.

Forgiveness is not a panacea.

Forgiveness is not the treatment of choice for PTSD and depression.

Forgiveness interventions offer an opportunity to consider the question,
 What does it mean to do Christian counseling?

The idea of forgiving a dead offender can help some people see the difference between forgiveness and reconciliation.

RELATED POSTS










VIDEO LINKS

I have a Forgiveness Playlist on my YouTube page. The list includes talks and stories related to this post and others you may find interesting.

REFERENCES

Enright, R. D. (2001). Forgiveness is a choice: A step-by-step process for resolving anger and restoring hope. Washington, DC: American Psychological Association.

Kidwell, J.E.M. & Wade, N.G. (2013). Christian-accommodative group interventions to promote forgiveness for transgressions. In E. L. Worthington Jr., E. L. Johnson, J.N. Hook, & J.D. Aten (Eds.), Evidenced-based practices for Christian counseling and psychotherapy (pp. 325-346). Downers Grove, IL: CAPS/IVP Academic.

Mittelstadt, M. & G. W. Sutton (eds.) (2010) Forgiveness, reconciliation, and restoration: Multidisciplinary studies from a Pentecostal perspective. Eugene, OR: Pickwick Publications. http://wipfandstock.com/pickwick_publications

Sutton, G. W. (2010). The Psychology of Forgiveness, Reconciliation, and Restoration: Integrating Traditional and Pentecostal Theological Perspectives with Psychology. In M. Mittelstadt & G. W. Sutton (eds). Forgiveness, reconciliation, and restoration: Multidisciplinary studies from a Pentecostal perspective. Eugene, OR:
Pickwick Publications. http://wipfandstock.com/pickwick_publications
Amazon Kindle edition





 Toussaint, L. L., Owen, A.D., & Cheadle, A. (2012). Forgive to live: Forgiveness, Health, and Longevity, Journal of Behavioral Medicine, 35, 375-386. doi: 10.1007/s10865-011-9362-4

Toussaint, L.L., Williams, D. R., Musick, M.A., & Everson, S.A. (2001). Forgiveness and health: Age differences in a U.S. probability sample. Journal of Adult Development, 8, 249-257. doi: 10.1023/A1011394629736

Worthington, E. L., Jr. (2006). Forgiveness and reconciliation: Theory and application. New York: Brunner-Routledge.

Worthington, E.L., Jr. (2003). Forgiving and reconciling: Bridges to wholeness and hope. Downers Grove, IL: Intervarsity Press.


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