Jesus Perez, Psy.D.

Satori waters

&

Katherine Ortega, M.S.W.

His house children’s home

Forgiveness Therapy for Substance Use Disorder

Henry’s Story

Henry, age 37, had a long hx of alcoholism and cocaine abuse. He had been through several rehabilitation efforts and was aware that his anger and need to rebel played a major role in subsequent relapses. Even though he had known for years that forgiving his father for being controlling and punitive would help diminish his anger and benefit his recovery, he was unable to take the next step.

Why?

Why Forgiveness?

Forgiveness is about transformation of people (Enright & Fiztgibbons, 2000)

Has been shown effective in reducing client’s anger, anxiety, and depression while increasing their sense of hope and self-esteem. (Enright & Fiztgibbons, 2000).

Forgiveness is one of the ways of dealing with angers born out of injustice in a way that is constructive and healing.

There is no professional protocol other than forgiveness therapy, that offers a systematic approach for dealing with the injustice and working through anger toward emotional health. (Enright & Fitzgibbone, 2000).

The Big Book of Alcoholics Anonymous says resentment destroys more alcoholics than anything else because deep resentment leads to futility and unhappiness and shuts us off from the "sunlight of the Spirit."

Importance of Forgiveness

Fitzgibbons (1986) demonstrated that teaching clients to forgive can help reduce anger and increase self-esteem.

Enright and Zell, (1989), and Smedes, (1984) pointed that those who forgive tend to have more positive emotions (e.g., compassion and love) and lower negative emotions (e.g., resentment, sadness, anxiety, and anger).

Enright & Fitzgibbons (2000) stated that based on the clinical evidence forgiveness decreases excessive anger.

Case studies and therapist observations both suggest that forgiveness of deep offenses from other people can be psychologically healing in many ways. (Fitzgibbons, 1986)

Forgiveness Intervention

Gordon & Baucom (1998), forgiveness has become a major topic of discussion and scientific study within the field of psychology.

McCullough and Hoyt (2002) indicate that when people forgive, they experience (a) reduced motivations to seek revenge, (b) reduced motivations to avoid their transgressor, and (c) increased in benevolence or good will for their transgressor.

Forgiveness as a Construct

Though the term “forgiveness” is widely used, there is no universally accepted definition of what constitutes “forgiveness” (Enright & Coyle, 1998).

All definitions point to the commonality that forgiveness involves a change in cognitions, emotions and behaviors toward another individual.

More recently two models of forgiveness have emerge, Robert Enright’s (Enright & the Human Development Study Group, 1996) “Process Model of Forgiveness,” and Everett Worthington’s (1998) “Empathy Based Model of Forgiveness.”

Two ways of defining forgiveness: What forgiveness is What forgiveness is not

Forgiveness: Construct

Enright and his colleague defined forgiveness as:

A willingness to abandon one’s right to resentment, negative judgment, and indifferent behavior toward one who unjustly hurt us, while fostering the undeserved qualities of compassion, generosity, and even love toward him or her.

Literature Review

Process Model of Forgiveness:Enright and the Human Development Study Group (1991, 1996). Forgiveness as an interpersonal process. Describe units and model.Enright & Coyle (1998). Described the psychological model of forgiveness.Enright, Freedman, & Rique (1998). Emphasized forgiveness as a flexible process.Al-Mabuk & Downs (1996). Study of forgiveness with parents survivors of adolescents suicide.

Forgiveness Theory and Intervention

Al-Mabuk, Enright & Cardis (1995). Study # 1. The participants were 48 parentally love-deprived college students. Findings, Students in the experimental group increased in the areas of hope and willingness to forgive. This study only included the first phases of the model.

Study # 2. Participants were 45 college students. Reported positive attitudes toward parents, increased self-esteem, hope and forgiveness, and decreased anxiety. (The whole process model.)

Coyle & Enright (1997). Results suggests that participants experienced a reduction in anxiety, anger and grief, along with an increase in forgiveness.

Forgiveness Theory and Intervention

Freedman & Enright (1996). Participants were 12 adult females sexual abuse survivors. Participants increased forgiveness and self-esteem and decreased anxiety and depression.

Hebl & Enright (1993). Participants 24 elderly females. Decreased in negative feelings and hostile thoughts, and a willingness to offer love and support to the one who hurt them.

The Process Model of Forgivenees

This process models consists of 20 psychological variables that are organized into four distinct phases.

The model incorporates the affective, behavioral and cognitive aspects of forgiveness.

Teaches the client that forgiveness is an ongoing process rather than a single event.

Forgiveness is multidimensional in its comprising cognitive processes, emotions and overt behaviors.

Phases

Uncovering Phase- client gains insight into whether and how the injustice and subsequent injury have compromised his or her life.

Decision- client gains an accurate understanding of the nature of forgiveness and makes a decision to commit to forgiving on the basis of this understanding.

Work- client gains a cognitive understanding of the offender and begins to view the offender in a new light, resulting in positive change in affect about the offender, about the self, and about the relationship.

Deepening- client finds increasing meaning in the suffering, feels more connected with others, and experiences decreased negative affect and, at times, renewed purpose in life.

Phases and Units of Forgiving

Uncovering Phase:

1.Examination of psychological defenses and the issues involved (Kiel, 1986).

2.Confrontation of anger; the point is to release, not harbor, the anger (Trainer, 1981/1984).

3.Admittance of shame, when this is appropriate (Patton, 1985).

4.Awareness of depleted emotional energy (Droll, 1984/1985).

5.Awareness of cognitive rehearsal of the offense (Droll, 1984/1985).

6.Insight that he injured party may be comparing self with the injurer (Kiel, 1986).

7.Realization that oneself may be permanently and adversely changed by the injury (Close, 1970)

8.Insight into a possibly altered “just world” view (Flanigan, 1987).

Phases and Units of Forgiving, cont.

Decision Phase-

9.A change of heart/conversion/new insights that old resolution strategies are not working (North, 1987).

10.Willingness to consider forgiveness as an option (Enright, Freedman & Rique, 1998).

11.Commitment to forgive the offender (Neblett, 1974).

Work Phase-

12.Reframing, through role-taking, who the wrongdoer is by viewing him or her in context (M. Smith, 1981).

13.Empathy and compassion toward the offender (Cunningham, 1985).

14.Bearing/accepting the pain (Bergin, 1988).

15.Giving a moral gift to the offender (North, 1987)

Phases and Units of Forgiving, cont.

Deepening Phase-

16.Finding meaning for self and others in the suffering and in the forgiveness process (Frankl, 1959).

17.Realization that self has needed others’ forgiveness in the past (Cunningham, 1985).

18.Insight that one is not alone (universal, support) (Enright et al., 1998).

19.Realization that self may have a new purpose in life because of the injury (Enright et al., 1998).

20.Awareness of decreased negative affect and, perhaps, increased positive affect, if this begins to emerge, toward the injurer; awareness of internal, emotional release (Smedes, 1984).

Substance Use Disorders

Levels of anger and violence among alcohol and other substance abuser. (Clancy, 1997)

State Trait Anger Expression Inventory and substance abusers (Aharonovich, Nguyen,& Nunes, 2001)

Anger and Resentment (Nowinski, Baker & Carol, 1999)Anger and Frustration (Marllat, 1985)Anger management vs Forgiveness Therapy (Lin, Mack,

Enright, Krahn & Baskin, 2004)

Role of Trauma in SUD

Illinois- 42 % of women in a shelter receiving services for substance abuse revealed hx of domestic violence (Bennett & Lawson, 1994).

90 % of women in substance abuse tx has experience domestic violence from a partner in their life time. (Miller, 1994)

74 % of women in substance abuse tx have experience sexual abuse (Kubbs, 2000).

Forgiveness Phases for SUD

Uncovering PhaseDecision PhaseWork PhaseDeepening Phase