Differential Effects of Emotion Focused Therapy and Psycho-education in Facilitating

Forgiveness and Letting Go of Emotional Injuries

Leslie S. Greenberg, Serine H. Warwar, Wanda M. Malcolm

York University, Toronto

Correspondence should be sent to the first author Leslie S. Greenberg, Dept. of Psychology York University 4700 Keele St. Toronto, ON, Canada M3J 1P3. Email: lgrnberg@yorku.ca

This study was supported by a grant ID# CRF 5202 from the Campaign for forgiveness research to the first author.

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Abstract

This study compared the effectiveness of Emotion-focused Therapy (EFT) involving gestalt

empty-chair dialogue in the treatment of individuals who were emotionally injured by a

significant other with a psycho-education group designed to deal with these injuries. In addition,

this study examined aspects of the emotional process of forgiveness in resolving interpersonal

injuries and investigated the relationship between letting go of distressing feelings and

forgiveness. A total of forty-six clients assessed as having unresolved, interpersonal, emotional

injuries were randomly assigned to an individual therapy treatment of EFT or a psycho-education

group. Clients were assessed pre-treatment, post-treatment, and at 3-month follow-up on

measures of forgiveness, letting go, depression, global symptoms, and key target complaints.

Results indicated that clients in EFT using empty chair dialogue showed significantly more

improvement than the psycho-education treatment on all measures of forgiveness and letting go,

as well as global symptoms and key target complaints.

Key words

Interpersonal injuries, Forgiveness, Letting go, Emotion-focused therapy, Psycho-education

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Differential Effects of Emotion Focused Therapy and Psycho-education in Facilitating

Forgiveness and Letting Go of Emotional Injuries

Forgiveness has recently been proposed as an important aspect of emotional recovery

following an interpersonal injury (Enright & Fitzgibbons, 2000; Worthington, 1998, 2001).

Although the debate continues as to whether forgiveness should be granted to injurers when they

will not take responsibility for their actions, or when they continue to perpetuate harmful acts

(Worthington, 2005), forgiveness has been shown to have a positive impact on physical,

relational, mental and spiritual health, whereas unforgiveness can be distressing and may leave

people ruminating about their injuries and feeling hostile towards those who injured them

(Witvliet, Ludwig, & Vander Laan, 2001). The majority of studies on the facilitation of

forgiveness (Al-Mabuk, Enright & Cardis, 1995; Hebl & Enright, 1993; McCullough &

Worthington, 1995; Ripley & Worthington, 2002; Worthington & Drinkard, 2000; Wade,

Worthington, & Meyer, 2005) have involved psycho-educational group programs designed to

promote the benefits of forgiveness to self and others, and these provide the knowledge and skills

associated with a particular model of forgiveness. To date only two studies have been published

that report on an investigation of the effectiveness of individual therapy in facilitating unilateral

forgiveness (Coyle and Enright, 1997; Freedman and Enright, 1996). The present study

examined the effectiveness of Emotion-focused Therapy (EFT) compared to a psycho-

educational group in facilitating emotional resolution and forgiveness.

Numerous investigators have proposed that both emotion work and empathy play

important roles in forgiveness (Davenport, 1991; Enright & Fitzgibbons, 2000; Fitzgibbons,

1986; Hope, 1987; Karen, 2001; Malcolm, Warwar, & Greenberg, 2005). One of the

assumptions of EFT is that the blocking of primary biologically adaptive emotions subverts

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healthy boundary setting, self-respectful anger and necessary grieving, and that adequate

processing of unresolved emotion leads to its transformation (Greenberg, 2002). Many clinicians

(Akhtar, 2002; Baures, 1996; Enright & Eastin, 1992) emphasize the value of facilitating in-

session expressions of adaptive anger at violation, and suggest that facilitating forgiveness

requires an acknowledgement of the legitimacy of emotions such as resentment and hatred

towards the offender. Baures (1996), Boss (1997), and Fincham (2000) consider resentment and

desires for revenge to be closely linked with self-respect, and Greenberg and Paivio (1997)

suggest that there may be times when it is therapeutic to encourage clients to talk about their

revenge fantasies. From these perspectives, the desire to retaliate is normalized as a sign of how

damaged the injured person feels. Encouraging such expressions in therapy is not the same thing

as promoting outer-directed blaming or hurling of insults. In encouraging clients to speak from

their inner experiences of violation, the therapist is promoting ownership of a client’s emotional

experience and is empowering clients to appropriately assign responsibility for harm done.

Ownership of emotion also helps clients focus on their own needs and concerns rather than

getting stuck in blaming the other or feeling victimized. The danger in short-circuiting

expressions of anger as might occur in some treatments is that the client may end up condoning

or excusing the injurer’s hurtful behavior, or inappropriately take too much responsibility for the

unfolding of events that surrounded the injury.

Therapists also need to facilitate the process of grieving the loss of, or damage to, a

significant relationship, as well as the shattering of the client’s view of self and the world that

may have been caused by the injury. Akhtar (2002) addresses the relationship between mourning

and forgiveness, and Greenberg and Paivio (1997) emphasize that work with betrayal and

abandonment often involves a process of facilitating normal grieving in which anger and sadness

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play central roles. Facilitating an imaginary dialogue with the injurer can help the client grieve

and say goodbye to what has been lost or irreparably damaged as a consequence of the injury

(Greenberg Rice & Elliott 1993; Elliott, Watson, Goldman & Greenberg 2004).

Emotion-focused Therapy (Greenberg 2002), which employs empty-chair dialogue for

the resolution of unfinished business as one of its major methods has been found to be an

effective intervention in the treatment of depression, interpersonal problems and trauma

(Greenberg & Watson, 1998, 2005, Paivio & Greenberg, 1995; Paivio & Niewenhaus, 2001).

Paivio and Greenberg’s (1995) comparative study of a psycho-educational group intervention

versus individual EFT using gestalt empty-chair dialogue in the resolution of unfinished

business, supported the efficacy of the empty-chair intervention. The results demonstrated a

significant reduction in symptomotology, target complaints, and interpersonal distress and more

resolution of unfinished business. The empty-chair method as it is employed in EFT is also a

particularly effective tool in promoting empathy felt toward the offender (Paivio, Hall,

Holowaty, Jellis, & Tran, 2001;Paivio & Nieuwenhuis 2001; Paivio & Greenberg, 1995). In

imaginatively bringing the injurer and injury alive, the client moves from a cognitive discussion

with the therapist, to an imaginal confrontation and dialogue with the injurer. In so doing, the

client is helped to move reified inner representations of self and other (injurer) into a transitional

space in conscious awareness where the representations can be re-examined, reworked, and

resolved.

Empirical evidence also is mounting in support of the importance of transforming

emotions by changing one emotion with another emotion (Frederickson, 1998; Greenberg 2002,

2004), and this suggests that a maladaptive emotion state can be effectively transformed by

undoing it with the presence of another more adaptive emotion. More specifically Frederickson,

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Marcuso, Branigun & Tugade (2002) have shown that positive emotion undoes the

cardiovascular after-effects of negative emotion. Greenberg (2002) has suggested that the key to

transforming maladaptive emotions is to access alternate healthy adaptive emotions to act as

resources in the self. Thus, in an emotion-focused treatment, feelings related to unforgiveness

such as anger, contempt and pain are eventually changed by accessing feelings of sadness,

compassion, empathy and concern.

McCullough and his colleagues have shown that empathy for the perpetrator mediates

successful forgiveness (McCullough, Worthington, & Rachal, 1997; McCullough, Rachal,

Sandage, & Worthington, 1997). This proposition is consistent with clinical observation, theory,

and empirical evidence concerning forgiveness (Macaskill, Maltby, & Day, 2002; McCullough,

Worthington, & Rachal, 1997; McCullough, Rachal, Sandage, & Worthington, 1997;

Worthington & Wade, 1999). When accessed, empathy involves understanding another’s

feelings and is a complex cognitive/affective state that facilitates forgiveness of an interpersonal

injury. As Rowe et al. (1989) have pointed out, empathy towards the injurer involves being able

to see the other person as acting in a quintessentially human manner, which flows out of the

context of his or her own self-focused needs and perceptions. This includes (but does not require)

the possibility of recognizing that what the injurer did was similar to something one has done, or

could do under the same circumstances. In addition to assisting in the revision of how one sees

the injurer, cognitive perspective taking sometimes allows the injury itself to be recast within a

broader understanding of the context of the unfolding of events. However, cognitive perspective

taking of this nature does not have to involve warm benevolent feelings associated with

forgiveness. Something more is required for forgiveness and this appears to be compassion for

the injurer, or affective empathy.

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Affective empathy is best understood as a means of imaginative entry into the world of

the other, which generates a bodily felt sense of understanding what the other person may have

been feeling, without actually sharing the same experience (Greenberg & Rosenberg, 2003).

Berecz (2001) suggests that the task for the injured person is to imaginatively transpose himself

or herself into the other person’s place in an attempt to understand the unfolding of events from

the injurer’s perspective.

Unforgiveness has been defined as the combination of a complex set of negative feelings

towards an injurer, and it has been shown that people can decrease unforgiveness without

increasing forgiveness (Worthington, Sandage & Berry, 2000; Worthington & Wade, 1999).

Unforgiveness is regarded as being stuck in negative emotions and a hyperaroused stress

response through rumination (Harris, & Thoresen, 2005). It is noteworthy that reducing

unforgiveness is not the same as promoting forgiveness. Forgiveness seems to include the

reduction of unforgiveness, or letting go, through decreasing negative feelings and thoughts in

relation to the injurer. In addition to, and in contrast with letting go or reducing unforgiveness,

forgiveness is also comprised of the increase of positive emotions such as compassion, empathy

or understanding felt towards the injurer.

In our view, forgiveness thus appears to involve two important emotional processes:

resolving the hurt and anger involved in the injury; and the possible generation of positive

feelings of compassion, loving, kindness and empathic concern for the injurer. People thus may

be able to resolve emotional injuries, by reducing or letting go of their bad feelings, or by letting

go of bad feelings and increasing positive feelings ie: by forgiving.

The main purpose of the present study was to evaluate the effectiveness of Emotion-

focused Therapy (EFT) (Greenberg et al., 1993) involving empty-chair dialogue in the treatment

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of individuals who had been emotionally injured by a significant other. Empty-chair work was

used to facilitate emotional transformation by: both expressing and processing the anger and

sadness to the offender; facilitating empathy; and asking clients to play the role of the injurer,

thereby having them imagine what the injurer might feel if he or she were capable of

comprehending the consequences and impact of his or her actions on the client. The primary

hypothesis was that EFT, which used empty-chair dialogue to process unresolved emotion,

would produce better outcomes than a psycho-education group (PG) in the treatment of

interpersonal, emotional injuries on measures of forgiveness and letting go, and other indices of

outcome. It was assumed that an experiential treatment such as EFT that works by evoking,

processing and transforming emotion would address the emotional causes of the injury more

directly than a psycho-education group that was less emotion-activating.

This study also examined the emotional process of forgiveness in resolving interpersonal

injury and evaluated whether forgiveness was necessary to resolution of the injury. In the

present study, recovery from an emotional injury therefore was conceptualized as occurring in

one of the following two ways: 1) forgiving the injurer, which was defined as letting go of

unresolved bad feelings or reducing unforgiveness plus the development of empathy and

compassion for the other; or 2) letting go of the bad feelings which involves letting go of unmet

needs and negative feelings in relation to the injury or injurer and changing negative perceptions

of self in relation to the injury or injurer, without the development of empathy and compassion

for the other. The second hypothesis was that all people who forgave would let go of bad

feelings but that not all who let go would forgive. The third hypothesis was that reported

emotional arousal would be higher in the EFT, than in PG

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Treatment focused on facilitating the resolution of specific unresolved interpersonal,

emotional injuries that had occurred at least two years prior to the start of therapy and continued

to be distressing. The injuries that clients brought to treatment were both emotional and

interpersonal; they were emotional in that they involved intense lingering unresolved feelings of

hurt or anger and betrayal, and they were interpersonal in that the injurer was a significant other

in the injured person’s life. Injuries involved abandonment, betrayals or violations by significant

others, such a friends, bosses, family members, or intimate partners.

Method

Participants

The sample for the present study consisted of 46 clients who had an unresolved

interpersonal, emotional injury with a significant other that had occurred at least two years prior

to commencing treatment. The requirement that the injury not be more recent was to ensure that

the natural process of recovering from hurts had been given time to work and that the injured

person was not in the midst of coping with the immediate aftermath of the injury. Participants

were required to be 18 years of age or older. Exclusion criteria for the study, based on the

assumption a brief treatment program would be unsuitable for some people, were as follows:

victims of incest; individuals who had attempted suicide or had lost a significant other in the past

year; those currently in physically violent relationships; individuals currently abusing drugs or

alcohol; individuals diagnosed with antisocial, borderline or narcissistic personality disorder,

post-traumatic stress disorder, or a psychotic disorder. Individuals who were already in

psychotherapy elsewhere were also excluded.

The average age for clients in the EFT treatment was 43 years. The average age for the

PG treatment was 46. The overall population thus had a mean age of 44.5 and S.D = 8.3 (range

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22 - 67). There were seven males and 16 females in the EFT treatment and 13 males and 10

females in the PG treatment. In the EFT treatment, eight individuals had never been married, 13

were married, and two were separated or divorced. In the PG treatment, five had never been

married, nine were married, and nine were separated or divorced. In terms of their level of

education, in the EFT treatment one individual had completed high school, three had some

college or university training, 12 had graduated from college or university, and seven had

postgraduate experience. In the PG treatment, five individuals had completed high school, three

had some college or university training, six had graduated from college or university, and nine

had postgraduate experience. Ethnicity in both groups was predominantly Caucasian with 1

client of South Asian and one of East Asian origins in each treatment group.

In terms of pre-treatment diagnosis on DSM Axis I and II, there were nine clients (39%)

with a least one Axis I diagnosis in the EFT treatment, and seven clients (30%) with at least one

Axis I diagnosis in the PG treatment. In the EFT treatment there were six clients with at least one

Axis II diagnosis, and in the PG treatment there were at least four clients with an Axis II

diagnosis. The mean Global Assessment of Functioning was 77 for each treatment, with the

range being 65-95 for the EFT treatment and 60-90 for the PG treatment. There were no

statistically significant differences between treatment conditions on any of these variables.

Emotional Injuries

The types of emotional injuries clients presented in this study, and the nature of the

relationship with the significant other are summarized in Table 1. Each participant targetd one

injury. Parents were the main perpetrators of the injuries. In the EFT treatment, 18 (78%) of the

clients were dealing with an interpersonal injury in relation to at least one parent and two (8%)

with an ex-partner, while in the PG treatment, 13 (57%) of the participants were dealing with an

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injury regarding at least one parent and five (21%) with an ex-partner. The people in the “other”

category included a boss, a neighbor, and people in non-parental positions of power relative to

children.

Therapists

There were eight therapists in the EFT condition, two of whom were male and six female.

Two of the therapists were registered psychologists, one had a doctorate and five were advanced

doctoral students in clinical psychology. Prior to training for the treatment study, all therapists

were required to have at least one year of EFT therapy training including prior empathy training,

and one year of experience as a therapist. Therapists in the EFT treatment received an additional

30 hours of specialized training based on a treatment manual for resolving emotional injuries

developed for this project (Greenberg, Malcolm & Warwar, 2002). The group had two leaders.

One of the group leaders was a registered psychologist who had devised the PG treatment and

conducted it on a number of prior occasions. The co-leader was a doctoral student and was

trained by the first leader. The therapists in both treatment conditions received weekly

supervision throughout the study to promote adherence to treatment manuals.

Treatments

Both interventions involved 12 hours of treatment distributed over approximately 12

weeks.

Emotion Focused Therapy

The treatment manual for this study is based on the principles outlined for Emotion-

focused Therapy (EFT) (Greenberg et al., 1993; Greenberg, 2002), also known as Process-

experiential therapy. This therapy includes the implementation of the person-centered relational

attitudes of empathy, positive regard, and congruence, as well as marker-guided, process

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directive, experiential interventions. In EFT, the therapist uses the following interventions:

gestalt two-chair dialogues when clients present in-session self-evaluative conflicts; client-

centered systematic evocative unfolding for problematic reactions over which clients are

puzzling; and gestalt empty-chair dialogue for resolving currently felt unfinished business with a

significant other. Focusing (Gendlin, 1996) is also utilized in this approach to assist clients in

attending to their internal experience and to obtain a bodily felt sense of the issues they are

exploring and struggling with (Gendlin, 1996, Greenberg et al., 1993). The emphasis in EFT is

on accessing primary adaptive feelings and maladaptive emotion schemes in order to make them

amenable to change (Greenberg, 1993, Greenberg & Paivio, 1997).

A specialized EFT treatment manual (Greenberg, Malcolm, & Warwar, 2002) was

developed for this project to focus on facilitating the resolution of emotional interpersonal

injuries. The treatment protocol is summarized in the following four phases which overlap rather

than being purely sequentially.

Phase I: Creating an Alliance. The first phase of treatment involves creating a

therapeutic alliance with the client by empathically responding to and validating the client’s pain

and emotional experience of the interpersonal injury. This stage also entails helping clients to

identity the impact of the injury and articulate and clarify the most problematic aspects of the

injury for them.

Phase II: Evocation and Exploration. The second phase of treatment involves

acknowledging, experiencing, and expressing the anger, sadness, pain, and other distressing

feelings associated with the emotional injury. Empty chair work is utilized to help clients

process unresolved feelings towards the injurer. Therapists were advised to begin work on

Evocation and Exploration as early as the second session if the injury was clear and safety and

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the bond seemed to be sufficiently strong no later than the 3rd session if the client appeared ready,

and to continue up until the pen ultimate session if needed. Empty chair work however was not

to be done in every session but if suitable in at least half the sessions in the evocation phase. The

next two phases integrate within and overlap with phase 2.

Phase III: Self-Interruptive Work. The third phase of therapy involves interventions

facilitated by therapists at client markers of interruption such as emotional constriction,

resignation, or hopelessness. These interventions are aimed at turning the passive, automatic

process of interruption into an active one. This phase aims to heighten clients’ awareness of how

they interrupt themselves and to promote change in these interruptive processes so that emotions

preventing resolution can be accessed and processed.

Phase IV: Empowerment and Letting Go or Forgiving. This final phase entails accessing

previously unexpressed emotions, and mobilizing and promoting the entitlement of unmet needs.

The therapist promotes a change in the way the client views the injurer, facilitated by emotional

arousal and accessing of past unmet needs. This phase also involves helping clients grieve and

let go of unmet needs. Elaborating the world-view of the other aids empathy towards the injurer

and the therapist helps the client understand or hold the other accountable.

Homework. Clients were asked to complete homework throughout the course of

treatment. At the start, they were asked to keep a diary of their feelings and thoughts in relation

to their injuries and to note how the therapy sessions played a role in their change processes. At

session six, clients were given a handout which instructed them to write an unmailed letter to the

injurer accusing the injurer of knowing the impact of his or her hurtful behavior. The second

part of this homework exercise instructed clients to write a letter in response to themselves

denying the accusation from the perspective of the person who injured them. This was done to

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highlight that change was to come from the client, not the perpetrator, as the perpetrator may

never change. At session seven, clients were given some definitions of forgiveness and asked to

think about their understanding of forgiveness and to consider whether forgiveness was

important to them personally with respect to their emotional injuries. At session eight, clients

were given a handout which asked them to reflect on the bond that still held them to the injurer,

and to write down their difficulties in letting go of the emotional injury and what was sustaining

the painful feelings. These were discussed in the session

Psychoeducation Group

The psycho-education group manual (PG) was devised for this study (Malcolm, 2001)

and drew on various sources for content (Bolger, 1999; Klassen, 2001; Paivio & Greenberg,

1995; Smedes, 1984; Worthington and Drinkard, 2000). The six workshops were facilitated by

the two workshop leaders. The introductory session provided an overview of all the sessions,

along with a rationale for participating in the study and an explanation of the differences between

PG and group therapy. Sessions two through five included a discussion of the previous session’s

homework, a topic presentation by the facilitators, a coffee break with a personal reflection task

and then group discussion of the presentation and personal reflection. Each session ended with

the assignment of a homework task to be done between sessions and completion of session

measures. The content presentations covered the following topics: the nature and structure of an

emotional injury; understanding unfinished business and how it disrupts adaptive functioning;

aspects of forgiveness, including what it is and is not, and why one would be motivated to

forgive in the face of being hurt by another person; the role of pain and other strong emotions in

experiencing and recovering from interpersonal emotional injuries; the process of reconciliation

with the hurtful other and how it differs from forgiveness; and finally how to resolve an injury.

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The content presentation of the first session was short and group discussion intentionally

structured to create safety and assure group members that their participation in the group

discussions was voluntary and at their discretion. The final session reviewed the material

presented in the first five sessions and instead of a homework assignment, a bibliography was

provided for those interested in further reading on the topics covered in the workshops.

The PG group members received the same homework as those in individual therapy, in

the same order and at approximately the same time intervals. They also received additional

journaling and reflection exercises in order to provide homework assignments after each of the

first five workshops. It was assumed that any change experienced in the PG group would be the

result of discussion of and reflection on the information provided, which would produce change

in attitude(s). It was further assumed that attitude change would in turn change the feelings

participants had toward the injurer and injury.

Measures

A battery of self-report measures was administered before and after treatment to assess

changes in specific domains. All clients were assessed approximately one week prior to

treatment and one week following treatment. Clients were also assessed at a three-month follow-

up on measures of letting go, forgiveness, level of depression, global symptoms, and target

complaints.

Forgiveness Measures

The Enright Forgiveness Inventory (Enright, Rique & Coyle, 2000). The Enright

Forgiveness Inventory is a measure of the degree to which one person forgives another who has

hurt him or her deeply or unfairly. The first part of the inventory instructs individuals to visualize

the emotional injury, focus on the offending person, and imagine what happened. The

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participant is asked to write a description of the injury in his or her own words. The second part

of the inventory is comprised of 60 items from three 20-item subscales measuring affect,

behavior and cognition in relation to forgiveness. Participants are asked to rate each item on a 1

to six-point Likert scale from Strongly Disagree to Strongly Agree. The authors report a stability

coefficient in a community sample for total EFI scores of .86 during a four week test-retest

reliability study. The subscale test-retest coefficients ranged from .67 to .91. With respect to

concurrent validity, the EFI has been positively associated with other measures of forgiveness.

There is also support for the EFI’s divergent validity (Enright et al., 2000). The Cronbachs alpha

for the scale as a whole in this sample was .81.

Forgiveness Measure (Enright et al., 2000). This single item scale for assessing degree

of forgiveness derives from the EFI and directly asks clients to what extent they have forgiven

the person who injured them. Responses are indicated on a five-point Likert scale (1 = not at all,

3 = in progress, 5 = completely). The authors of the EFI did not use the term “forgiveness” in

any other item of the EFI measure to avoid creating conceptual biases. For this reason the EFI is

referred to as the Attitude Scale during its administration. The forgiveness measure is thus used

to directly assess degree of forgiveness. In classifying peoples degree of forgiveness a score of 4

or above, i.e.: rating that they had forgiven, either “a lot” or “completely” was used to indicate

that forgiveness had been attained

Unfinished Business Empathy and Acceptance Scale (UFB EA). Singh (1994) developed

the Unfinished Business Scale to measure resolution of unfinished business with a significant

other. For the present study, items were extracted from this scale and adapted to create the

empathy and acceptance subscale (UFB EA). The UFB EA Scale is comprised of six items and

measures the extent to which clients feel acceptance and empathy towards the individual who

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injured them. Clients were asked to indicate their agreement with the statements of empathy or

acceptance on a five-point Likert scale (ranging from 1 = not at all, to 5 = very much). For

example, empathy items consisted of statements such as ‘I feel compassionately understanding

of the other person’, or ‘I have a real appreciation of this person’s own personal difficulties.’

Acceptance items included statements such as: ‘I feel accepting toward this person’ and reverse-

scored items like ‘I see this person negatively.’ The items on this subscale have been found to

inter-correlate highly in a sample of clients in treatment for unfinished business (Paivio &

Greenberg 1995) and a sample of university students (Singh 1994) and the overall scale has been

found to correlate with other outcome measures (Watson & Greenberg 1996; Paivio &

Greenberg 1995). The Cronbachs alpha for the subscale in this sample was .87.

Letting Go Measures

Unfinished Business Feelings and Needs Scale (UFB FN). This scale was

adapted from Singh’s (1994) Unfinished Business Scale. It measures the resolution of feelings

and needs as they relate to the injurer, and positive changes in the perception of self. This

measure is comprised of eight items on a five-point Likert scale (ranging from 1 = not at all, to 5

= very much). The UFB FN Scale contains three sets of items that refer to feelings, needs, and

the self. The feelings subscale contains items such as ‘I feel unable to let go of my unresolved

feelings in relation to this person.’ The needs subscale includes items like ‘I feel frustrated about

not having my needs met by this person.’ Finally, self items included statements such as, ‘This

person’s negative view or treatment of me has made me feel badly about my self ’, or ‘I feel

worthwhile in relation to this person.’ This subscale of the UFB has shown inter-item reliability

in a sample of clients in treatment and a sample of university students and has been found to

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correlate with other outcome measures a sample of clients in treatment. The Cronbachs alpha for

the subscale in this sample was .79.

Letting Go Measure. This measure was constructed for this study to parallel the single

item forgiveness measure. It is a single item self-report measure that asks clients to what extent

they have let go of their hurt and angry feelings in relation to the injurer. Responses are

indicated on a five-point Likert scale (1 = not at all, 3 = in progress, 5 = completely).

Other Outcome Measures

Target Complaints (TC) Discomfort and Change Scale (Battle, Inber, Hoehn-Saric,

Stone, Nash, & Frank, 1968). The Target Complaints Discomfort Scale asks clients to specify

three problems they would like to see change as a result of treatment. Clients were asked to rate

each problem at three points in time (pre-treatment, post-treatment and three-month follow-up)

in terms of how distressed they are by it. In addition, at two points in time (post-treatment and

three-month follow-up) clients were asked to rate how much they felt it had changed since the

beginning of treatment. Battle et al. (1968) reported high correlations with other outcome

measures and test-retest reliability (r = .68) between pre- and post-psychiatric interviews.

Global Symptom Index (GSI) of the Symptom Checklist 90 Revised (SCL-90-R). The

SCL-90-R (Derogatis, 1983) is a well known instrument that measures general symptom distress,

with high internal consistency (.77 to .90) and test-retest reliability (.80-.90) over a one-week

interval with people with a variety of disorders (Derogatis, Rickels, & Roch, 1976). Calculations

of change on the Global Symptom Index(GSI) was used as an outcome measure at three points in

time (pre-treatment, post-treatment and three-month follow-up). Cronbachs alpha for GSI in this

sample was .82

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Beck Depression Inventory. This 21-item inventory is widely used to assess depression

(Beck, Ward, Mendelson, Mock, Erbaugh, 1961). It has high internal consistency and correlates

highly with other self-report measures of depression and with clinician’s ratings of depression

(r = .60 to .90; Beck et al., 1988). Cronbachs alpha for BDI in this sample was .87

Process Measures

Working Alliance Inventory (WAI; Horvath & Greenberg, 1989). The WAI is a 36-item

scale rated on a seven-point Likert scale. The WAI is made up of three alliance subscales that

assess the therapist-client bond and agreement on therapy tasks and goals. Internal consistency is

high for the whole scale (.87 to .93) as well as the subscales (.89 to .92) (Horvath & Greenberg,

1989). Cronbachs alpha for WAI was .89

Emotional Arousal Session Report Measure (Warwar & Greenberg, 2002). The EA

Session Report Measure was developed in order to evaluate the intensity of emotional arousal

experienced during therapy. This measure consists of 18 emotions items, which the client rates

on a seven-point Likert scale (1= not at all, 5 = moderately, 7 = very much). Clients are

instructed to indicate the degree to which they felt each of the 18 emotions during their session.

To account for the possibility that the 18 emotion categories omitted an emotion the client

believed to be vital in describing their emotional experience, an additional item (question 19)

gives the client an opportunity to rate the intensity of any other emotion they may have felt. The

EA Session Report Measure was completed by clients after each session. This measure was

constructed as a self-report form of the observer Emotional Arousal Scale (Warwar &

Greenberg, 1999) which has been show to predict outcome.

Procedure

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Clients were recruited through advertisements in local community newspapers and flyers

distributed to the university and general community. The advertisements announced that a

treatment study was being conducted at the York University Psychotherapy Clinic and that

individuals over the age of 18 who had been emotionally injured by a significant other in the past

who were interested in participating in a treatment study should call for more information. The

advertisements for the study also indicated that the injury should have occurred at least two years

prior to responding to the advertisement, and that respondents should still be experiencing some

lingering feelings of hurt or anger towards the other in relation to the injury.

Eighty six participants who called were first briefly interviewed over the telephone to

assess initial suitability regarding general inclusion and exclusion criteria, and to determine

whether they were presenting with a specified unresolved target injury from at least 2 years prior

and were willing to participate in a videotaped research treatment. Fifty nine suitable potential

participants were invited to undergo a further assessment process to ensure that the proposed

treatment program could meet their treatment needs. The initial two hour assessment interview

was designed to obtain consent for assessment and treatment and assess clients in terms of Axis I

and Axis II disorders using the Semi-structured Clinical Interview and Diagnosis protocol

(SCID; Spitzer, Williams, Gibbon, & First, 1990). Clients also completed the Beck Depression

Inventory and the SCL-90-R at the first assessment appointment. If this initial assessment

supported the appropriateness of the proposed treatment for the client, he or she was invited to

participate in the treatment study, and asked to come in to complete the rest of the pre-treatment

measures. Forty six clients were successfully assigned to treatment.

Participants were randomly assigned to either the PG or EFT treatment. Clients in the

individual EFT treatment were seen for 12 one-hour weekly individual therapy sessions. Clients

20

in the PG group were seen for six two-hour sessions that were held bi-weekly for 12 weeks.

Three PG groups (of n=9, n=8 and n=6) were run for a total of 23 participants. In the EFT

treatment one therapist saw five clients, one saw four, two saw three and four saw two each.

Sessions in the PG group were audiotaped only, whereas sessions in the EFT treatment were both

audiotaped and videotaped. Clients in both groups completed questionnaires following each

treatment session and were assigned homework at approximately the same time intervals

throughout the course of treatment. Clients completed outcome measures at pre-treatment,

termination of treatment, during a post-therapy interview, and at a three-month follow-up

interview. A short form of the Working Alliance Inventory was given to the PG clients

following session one, and to the individual EFT clients after session three. Therapists completed

a post-session questionnaire after each session.

Results

Adherence to the therapy treatment manual in the EFT treatment was monitored by

therapist and supervisor reports. Adherence to the PG group manual was monitored only by the

therapists. Therapists reported on a 5 point scale ranging from “not at all” to “completely”, the

degree to which they judged themselves to have adhered to the treatment protocol and in the

individual therapy condition reported whether they had used chair dialogues during the session.

The supervisor using the same five point scale, reported an adherence judgment from supervising

a video tape of at least four of the individual therapy sessions. Means and standard deviations of

therapist reports for the individual treatment over the sessions were 4.23 (1.11) and supervisor

ratings were 4.14 (.52) indicating good adherence. The therapists reported a mean of 5.13 chair

dialogues per treatment with a range of 4 – 7 per client. The PG treatment leader reported

successful implementation of the group manual for each session.

21

Given that clients were grouped within treatment with 9, 8 and 6 respectively in the 3

PG groups, and a different number of clients were seen by each therapist, there was a non-

independence in the data and this could introduce a statistical bias in the analyses (Kenny, 1995).

Treatment outcome scores thus were investigated for bias by looking at intra class correlation to

measure homogeneity within groups in relation to variation between groups and the F statistics

used in the analyses of variance were adjusted if the correlation was larger than 0.1. For the

analyses that did not compare treatments, effects, the importance of ignoring statistical

dependencies among observations, are likely to be relatively minor, and so in these cases

dependence was ignored.

Correlations were conducted between all pretreatment variables1. The pre-treatment BDI

did not correlate with any of the other symptom measures at pretreatment. However, there were

positive correlations between the Enright Forgiveness Inventory (EFI) and the Forgiveness

Measure (r=.35, p<.05), and between the EFI and the Unfinished Business Empathy and

Acceptance Scale (r=.56, p<.001). There were no significant differences at the .05 level between

treatments on any of the pretreatment, demographic or other assessment variables assessed by

means of one-way ANOVAs. A t-test conducted to evaluate whether therapeutic alliances were

different in the two treatments showed that clients’ early working alliances were not significantly

different at the .05 level (EFT individual therapy, M=5.89, SD=0.84; PG group, M=5.75,

SD=0.78).

Outcome

In order to test the hypothesis that EFT would be more effective than PG repeated

measures analyses of covariance were performed. Pre test scores of the dependent measure was

used as the covariate with post treatment and follow up as the repeated measures and type of

22

therapy received (either PG or individual EFT) as the between groups factor. Target complaint

change which does not have a measure at pre treatment was analyzed by a repeated measure

analysis of variance with post and follow-up as the two occasions. The means for each of the

measures for pre-therapy, post-therapy, and follow-up are provided in Table 2. There were no

significant group by time interactions on any of the measures. The groups were significantly

different on almost all measures such that the EFT groups exhibited the highest levels of

forgiveness-related gains (i.e. Enright Forgiveness, Forgiveness, Empathy and Acceptance,

Feelings and Needs, and Letting Go) as well as the greatest levels of symptom reduction (i.e.

Target Complaints Discomfort, Target Complaints Change, and GSI) 2. However, the differences

for the BDI were not statistically significant.

Clinical Significance and Effect Size

Cohen's d’s (1988), the standardized mean difference, which provide an index of the

practical, as well as statistical significance of the differences between treatments and between pre

and post treatment were calculated. The effect size for differences between treatments on the

EFI was moderate d = .41, while pre-post effect sizes were large for both treatments, with d = 1

for EFT and .71 for PG treatment. This demonstrates that both treatments led practically to a

large amount of change and that there was a meaningful difference between groups on the major

measure of forgiveness. Pre- post effect on the GSI were d = .62, for the EFT treatment and was

negligible for the PG treatment. The between treatment effect size was d = .66, again showing

large effects for EFT over PG. The pre-post effects on empathy and acceptance were 1.73

and .74 for EFT and PG respectively and the between treatment effect size was .98. For feeling

and needs the pre-post effects were 3.22 and 1.62 respectively with between treatment effects

size of 1.62. The pre-post effects on TC discomfort were 3.84 and 2.27 for EFT and PG

23

respectively and the between treatment effect was 1.56. All these effects are very large. The

between treatment effects on BDI was very small d =.06 and the pre- post effects of .47 and .69

although large were much smaller than on other measures.

Forgiving and Letting Go

Cut off Scores were used on the relevant outcome measures to classify clients according

to whether they forgave their injurers and/or let go of their negative feelings towards the injurer

(level 4 or above on each measure). The classification of clients on this dichotomous

classification is shown in Table 4. Dichotimization on these single item measures however are

suggestive rather than definitive because the dividing lines between forgiving and not forgiving

and letting go and not letting go may not be that sharp.

All of the nine clients in EFT who forgave the injurer also let go, as did the four people in

the PG treatment who forgave the injurer. However, five people in the EFT treatment and three

in the PG treatment let go but did not forgive. A Chi square analysis of the distribution

comparing forgivers and those who let go was significant, X = 21.5 p<.001showing that 100%

who forgave let go, while 38% who let go did not forgive. This suggests that letting go may be a

necessary requirement of forgiveness (i.e., everyone who forgave also let go), but is not by itself

sufficient for, nor the same thing as, forgiveness, since clients who met the criteria for letting go

did not always consider themselves to have forgiven the injurer. It is important to note that in

both groups a large proportion of those people who were classified as not forgiving or letting go

rated themselves as in progress (level 3) on these tasks so it was not the case that they did not

benefit from treatment. They simply had not yet reached as full a resolution according to our

cutoff criteria as those who indicated they had more fully forgiven or let go.

Test of emotional arousal in groups

24

Clients in each of the treatment modalities were compared on the intensity of self-

reported emotional arousal (EA) experienced in the session to test for the hypothesized

difference between treatment in reported emotional arousal. The EA measure was divided into

positive and negative or unpleasant emotion clusters for the following periods: total duration of

treatment and three phases of therapy (early, middle and late). The positive emotion cluster

included happy and content, while the negative cluster included sad, angry, afraid, and pain.

Changes in reported intensity of negative/unpleasant and pleasant in-session emotional

arousal across three phases of each treatment were examined. For treatment comparisons the

EFT sessions were grouped to form early (3 sessions), middle (5 sessions) and late phases (last 2

sessions). This structure was thought to best reflect the phase structure of the treatment. The six

group sessions were broken into three sets of two sessions each. A 2x3x2 repeated measures

ANOVA compared reported in-session intensity of positive and negative emotions in the two

treatment conditions overall and by each phase of therapy. Means and standard deviations are

shown in Table 4 and the graph over phases is given in figure1.

There was a significant emotion by time interaction F (2, 43) =12.853, p<0.001, a

significant emotion by group interaction F (1,44) = 24.6, p<0.001, and a significant three way

emotion by time by group interaction F(2,43) = 3.29, p < .05. Post hoc analyses using a

Bonferonni adjustment for multiple comparisons found the groups differed significantly (p

< .001) on the amount of reported negative affect arousal overall in the treatment but that there

were no significant differences at the .05 level between the treatment in self-reports of overall

positive emotion experienced in-session over all. This acted as a form of implementation check

showing that the individual EFT treatment was effective in arousing more unpleasant emotion.

The clients in the EFT treatment reported significantly higher levels of negative/unpleasant

25

emotional arousal than the PG treatment, in the initial phase of treatment (p<.01) and in the

middle phase of therapy, (p < .01). The clients in the PG treatment reported significantly higher

levels of positive emotional arousal than the EFT treatment, in the middle phase of therapy (p

< .01). Finally, during the late phase of therapy there was no significant difference at the .05

level between the groups in reported intensity of negative/unpleasant or positive emotional

arousal.

The EFT clients’ reports of in-session negative/unpleasant emotional arousal were found

to be relatively stable over the first two phases, demonstrating no significant differences at

the .05 level between early and middle phases. However, the EFT clients reported significantly

less in-session negative/unpleasant emotional arousal in the final phase of therapy as compared

to the middle phase (p< .05). Analysis of the PG clients’ reports followed a similar pattern.

Differences between early and middle phases of treatment were not significant at the .05 level.

However, a significant decline in reported negative emotional arousal from the middle to the late

phase of therapy was present (p< .05).

In an examination of the pattern of reported positive in-session emotional arousal, EFT

clients reported a significant increase in the intensity of positive emotional arousal from the

middle phase to the final phase of treatment (p<.001). In the PG group, a trend of increasing

positive emotional arousal from the early to late phases of therapy was found. The PG clients’

ratings of positive emotions increased significantly from the early to middle treatment phase, p

< .01 and from the middle to late phase, p< .05. Degree of reported in-session intensity of

emotional arousal averaged over the whole treatment, or averaged of any of the phases of

treatment, did not correlate significantly with change on any of the outcome measures for the

combined sample or for either treatment.

26

Correlational Analyses

Correlations calculated between residual gains in the forgiveness and letting go related

variables, and symptom variables are displayed in Table 5. Pre-post changes were calculated as

the standardized residuals by regressing initial scores onto final scores for all the symptom and

outcome measures (Cronbach & Furby, 1970). As can be seen in the table, an increase in

forgiveness and empathy and acceptance, and of feelings and needs all were related to a decrease

in overall symptom distress

Discussion

The results of this study showed that clients in the individual EFT treatment showed

significantly more improvement than those in the PG treatment on all measures of forgiveness,

on measures assessing the degree to which clients had let go of distressing feelings and unmet

needs in relation to the injurer and on target complaints at termination and follow-up. The two

groups however were found to not differ significantly on the change in feelings and needs at

termination, when possible dependence in the PG group was taken into account. Greater

improvement also was reported in the EFT condition on the Global Symptom Index of the SCL-

90-R. There however was no difference between groups on the BDI, but given clients in this

study were not depressed this is not surprising. The significant change in general psychological

symptoms on the SCL 90-R in EFT, with no change in PG on symptoms, is notable, suggesting

that an individual emotion-focused treatment in addition to enhancing forgiveness and letting go

of the emotional injury, has positive effects on a person’s general level of well being that exceed

that of a psycho-education group. Taken as a whole, this study provides support for the

differential effectiveness of an EFT approach for promoting forgiveness, resolving emotional

injuries and reducing general symptoms over a PG treatment intervention of the same duration.

27

In addition all those clients who reported that they forgave the injurer, regardless of

group, also indicated that they had let go of the distressing feelings and unmet needs previously

associated with the injury. In contrast, there were some individuals who indicated that they had

let go of the distressing feelings and unmet needs associated with the injury, but had not forgiven

the injurer. This suggests that letting go of persisting unresolved feelings such as anger, grief,

sadness and/or hurt may be a necessary step in resolving past interpersonal hurtfulness, but may

not be sufficient nor equivalent to forgiveness. Further research on this question is needed but

seeing that the process of reducing un-forgiveness or letting go of bad feelings is distinct from

the process of generating positive feelings, such as loving kindness, may be useful ones when

examining the process of forgiveness and the possibility of the resolution of an emotional injury

in the absence of forgiveness.

Contrary to what the forgiveness literature suggests (McCullough & Witvliet, 2001,

Orcutt 2006), forgiveness was not initially correlated with the pre-treatment variables measuring

emotional health such as the BDI and particularly the Global Symptom Index (GSI) of the SCL-

90R. Thus clients at the start of treatment who were more forgiving were not psychologically

healthier. This however may have been due to lack of range on both the forgiveness measure and

the GSI and BDI and because participants were seeking help for presenting problems involving a

lack of letting go and forgiveness. In our study pre-post increases in forgiveness and letting go

variables however were related to a decrease in GSI. Thus, it seems that increases over treatment

in forgiveness, in empathy and acceptance, toward the injurer, and being able to resolve feelings

and needs, were related to improved health as measured by the GSI suggesting health benefits to

resolving injuries both by forgiveness and letting go. Recently Orcutt (2006) found that offence-

specific forgiveness at initial assessment correlated significantly with symptom distress

28

approximately 9 months later controlling for symptoms distress at initial assessment, and that

time since offence mediated the relationship between forgiveness and symptom distress,

suggesting a complex relationship between forgiveness and symptoms. Data on our treatment

seeking population does not support that forgiveness correlates with distress at initial assessment

but does show that increase in forgiveness certainly correlates with reduction in distress.

In addition to showing better outcomes, the EFT group was found to involve more client-

reported emotional arousal, especially of negative emotions in the mid-phase of treatment,

confirming that the EFT treatment was more emotion- arousing than the PG treatment. The

finding that there was more negative emotional arousal in the early phase of therapy for the EFT

treatment than for the PG treatment was probably because EFT clients were more likely to access

negative emotions right from the start as a function of therapy, rather than because they entered

treatment with more negative emotions than clients in the PG treatment. This finding also

suggests than the emotional change processes in therapy are not necessarily simply ones of

replacing bad feelings with good feelings in a linear process but that at times feeling bad can in

fact lead to feeling good. Thus working through bad feelings by facing them, allowing and

accepting them, can lead to change (Greenberg 2002). It should be noted however that reported

in-session emotional arousal did not relate to outcome in either group. This is likely because not

all arousal of emotion is the same. For example some arousal may be a sign of distress rather

than a sign of working through distress (Greenberg & Watson, 2006). Recently Greenberg,

Auzra and Hermann (2007) showed that arousal alone is not necessarily a measure of productive

emotional processing and that it is productive processing of arousal emotion that best

discriminates good from poor outcome cases. In other studies the intensity of observed expressed

emotional arousal however has been shown to predict outcome in the working phase of the EFT

29

treatment of depression (Missirilian, Toukmanian, Warwar & Greenberg, 2005; Warwar, 2003).

The difference in the finding on the relationship between emotional arousal and outcome in this

study to the finding in the studies on depression, if they are not because of differences in a

depressed and an emotional injury population, may be explained by the differences between the

nature of the experience of emotion, as measured by post session self-reports of emotional

arousal in the session, and the expression of emotions, captured by observational measures of

arousal. In the present study we observed that the session in which some clients reported high

emotional intensity in the session (experienced emotion) showed few visible signs of the

reported arousal (expression) and in fact often the clients were quite constricted in their

expression of emotion in the session. They appeared to have felt a lot of anger or sadness but not

necessarily expressed it, so although the self reports were indicative of emotion experienced,

they were not indices of how much emotion was allowed and expressed in the session and made

accessible for further processing. As Greenberg (2007) has suggested emotion awareness and

expression are different emotion change processes and the latter, by revealing the self to the

other, overcoming constriction and altering physiology and neurochemistry may be what is most

therapeutic when dealing with unresolved painful emotions.

Limitations

The clients in this study were volunteers who responded to advertisements, and

therefore may not be representative of the general population seeking help for emotional injuries.

Furthermore, equivalence of type and intensity of injuries was not taken into consideration in

assigning clients to groups, based on the assumption that this would be handled by

randomization, but in small samples such as this, this may not be the case. In addition,

resolution or forgiveness was not assessed in relation to whether the injured person still had an

30

ongoing relationship with the injurer, (as in the case with a living parent versus a deceased

parent) or not. It also would have been preferable to insure a balance of men and women in both

groups. To the extent that there were more women in EFT, this may have introduced a confound.

Taking all these factors into consideration will require further research with a larger sample of

clients.

Because therapist and researcher allegiance to treatment model (and their possible ability

to persuade clients of the relevance of the treatment process to their presenting problems) is a

common factor known to improve outcomes, regardless of specific treatment models employed,

one might attribute observed differences in this study to therapist training/allegiance, or

researcher allegiance, rather than differences in specific treatment techniques. The EFT

therapists had at least 1 year of experience with EFT, and received an additional 30 hr of training

in this specific intervention prior to participation in the study. Similar training did not occur for

the PG treatment leaders although the one leader was the developer of the group Psycho-

education treatment. Investigators were proponents of EFT and this too could influence results.

In addition differences between factors operating in group and individual therapy

modalities could account for the differences in effectiveness of treatment. Clients receiving

individual therapy receive a treatment tailored to their needs, whereas in groups there is less

flexibility and individualization. Spacing of sessions also was different in the two treatments.

Individual therapy met weekly whereas the group sessions were twice the length of individual

sessions, but met only once every two weeks. This could provide more continuity of treatment

and support in the individual therapy. On the other hand group participants benefit from other

factors in groups that promote change that are not available to the individual participants, such as

group support and a sense of the universality of their problems and having two therapists.

31

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39

Authors Footnotes

1. Readers can request a complete matrix of intercorrelations between all variables by writing to

the first author at lgrnberg@yorku.ca.

2. In order to test for possible dependence in the data Intra Class correlations (ICC) were

computed on the output from two separate one-way ANOVAs on the effect of the therapists in

the EFT condition and of the 3 groups in the Psycho-Ed condition. ICC measures the relative

homogeneity within groups in comparison to the between group variation. ICC is large and

positive when there is no variation within the groups, but group means differ. It will be at its

largest negative value when group means are the same but there is great variation within groups.

A negative ICC occurs when between-group variation is less than within-group variation. In this

situation, checking for independence, we would want the ICC to be close to 0 or negative,

indicating that group mean differences are negligible relative to individual differences i.e., the

grouping doesn’t matter. ICC recently is used in the context of hierarchical linear modeling

(HLM) to measure the extent to which data clustering (i.e., non-independence of observations) is

present. If the ICC is near 0, then HLM will give very similar results to a traditional ANOVA or

regression that assumes independence (Raudenbush & Bryk, 2002, Shrout, & Fleiss1979).

ICCs on post test were found to be low, below .08 or negative for both treatment

conditions for all of the dependent variables except for Feelings and Needs (ICC=.15), in the PG

group. This provides evidence that the grouping of clients within therapists and within groups

was not a strong factor influencing the findings on the majority of measures in the study except

possibly for the Feelings and need scale. Fs were adjusted according to the design effect, which

is a function of ICC and sample size (Skinner, Holt, & Smith, 1989) for post test scores on the

Feelings and need scale and no significant difference between groups was found at post

40

F(1,43)=2.65, p=.112 thereby altering the conclusion of difference on this measure. There was

no difference in the between group comparisons on the other measures in which ICC had been

lower than .08

41

Table 1

Interpersonal Emotional Injuries Reported by Client Sample___________________________________________________________________ EFT PG ___________________________________________________________________Issue

Betrayal 5 8

Criticism 6 4

Neglect 4 3

Abandonment 5 4

Physical abuse 2 3

Sexual abuse 1 1

Total 23 23

Significant other

Both Parents 5 5

Mother 8 4

Father 5 4

Ex-partner 2 5

Sibling 2 2

Child 0 1

Other 1 2

Total 23 23

____________________________________________________________Note. Each participant targeted 1 injury only

42

Table 2

Pre, Post and Follow-up Means and Standard Deviations of Outcome Measures

Measure Pre Post Follow-up Ancova

EFT

(n = 23)

PG

(n = 23)

EFT

(n = 23)

PG

(n = 23)

EFT

(n = 23)

PG

(n = 23)

F(1,43)

M SD M SD M SD M SD M SD M SD

Enright

Forgiveness

Inventory

199.22

60.58

197.09

58.14

261.13

47.24

237.30

51.28

277.52

51.41

243.43

55.01

4.98*

Forgiveness

Measure

2.18

.72

2.39

.78

3.74

.81

2.87

1.06

3.83

.75

3.43

1.01

7.91**

UFB Empathy

and Acceptance

14.04

4.43

14.26

4.97

22.17

5.42

17.78

5.48

22.13

4.38

18.87

4.78

9.28**

UFB Feelings

and Needs1

14.87

5.06

17.48

4.63

30.95

6.0

25.58

8.35.

31.32

6.56

28.05

7.15

4.32*

Letting Go 2.00

.71

2.17

.94

4.09**

.79

2.17

.98

4.06

.71

3.42

.76

437.69**

1 See footnote 2

43

Table 2 (continued)

Measure Pre Post Follow-up Ancova

M SD M SD M SD M SD M SD M SD

TC Discomfort

10.48

1.53

10.07

1.64

4.40

2.25

6.48

3.03

4.61

2.41

6.22

2.56

7.03*

TC Change

--

--

--

--

7.16

1.64

5.39

1.99

7.70

1.29

6.3

1.91

12.67**

GSI

.70

.43

.58

.36

.46*

.47

.60

.45

.35

.31

.45

.32

6.73*

BDI

12.18

10.32

10.79

6.34

7.26

7.59

6.39

5.88

6.79

7.13

5.47

5.43

1.1

Note. Pretreatment scores used as covariates

*p < .05, **p < .01

44

Table 3: Frequency of Forgiveness and Letting Go*

Let Go

EFT PG % of Total

Yes No Yes No Yes No Yes 9 0 4 0 28.26% 0Forgive

No 5 9 3 16 17.39% 54.34%

Total 30.43% 19.56% 15.21% 34.78% 45.65% 54.34%

Note: A Chi square analysis of the distribution comparing forgivers and those who let go was

significant, X = 21.5 p<.001.

45

Table 4

In Session Emotion Clusters by Phase of Therapy: PG and EFT________________________________________________________________________

Phase of Therapy

Emotion Early Middle Late

PG EFT PG EFT PG EFT (N=23) (N=23) (N=23) (N=23) (N=23) (N=23)________________________________________________________________________

PositiveEmotions

M 3.03 2.97 3.62** 2.73 4.17 3.82

SD 1.17 1.16 1.26 1.23 1.53 1.44

NegativeEmotions

M 2.82 3.58* 2.67 3.50** 2.11 2.60

SD 1.40 0.91 1.12 0.98 1.04 1.09________________________________________________________________________

Asterisks indicate between group differences* p<.05**p<.01

46

Table 5: Correlations between Pre-Post Residual Gain Scores On Forgiveness, Letting go and

Symptom Variables(n=46):

GSI BDI Enright Forgiveness Inventory -.41** -.08

Forgiveness Measure -.36* -.22

UFB Empathy & Acceptance -.37* .05

UFB Feelings & Needs -.38** -.29

Letting Go Measure -.23 -.17

Target Complaints (Discomfort)

.27 .14

* p < .05, ** p <.01

47

Table 2

Pre, Post and Follow-up Means and Standard Deviations of Outcome Measures

Measure Pre Post Follow-up Ancova

EFT

(n = 23)

PG

(n = 23)

EFT

(n = 23)

PG

(n = 23)

EFT

(n = 23)

PG

(n = 23)

F(1,43)

M SD M SD M SD M SD M SD M SD

Enright

Forgiveness

Inventory

199.22

60.58

197.09

58.14

261.13*

47.24

237.30

51.28

277.52

51.41

243.43

55.01

4.98

Forgiveness

Measure

2.18

.72

2.39

.78

3.74**

.81

2.87

1.06

3.83

.75

3.43

1.01

7.91

UFB Empathy

and Acceptance

14.04

4.43

14.26

4.97

22.17**

5.42

17.78

5.48

22.13

4.38

18.87

4.78

9.28

UFB Feelings

and Needs2

14.87

5.06

17.48

4.63

30.95*

6.0

25.58

8.35.

31.32

6.56

28.05

7.15

4.32

Letting Go 2.00

.71

2.17

.94

4.09**

.79

2.17

.98

4.06

.71

3.42

.76

437.69

2 See footnote 2

48

Table 2 (continued)

Measure Pre Post Follow-up Ancova

M SD M SD M SD M SD M SD M SD

TC Discomfort

10.48

1.53

10.07

1.64

4.40

2.25

6.48

3.03

4.61*

2.41

6.22

2.56

7.03

TC Change

--

--

--

--

7.16

1.64

5.39

1.99

7.70**

1.29

6.3

1.91 12.67

GSI

.70

.43

.58

.36

.46*

.47

.60

.45

.35

.31

.45

.32

6.73

BDI

12.18

10.32

10.79

6.34

7.26

7.59

6.39

5.88

6.79

7.13

5.47

5.43

1.1

Note. Pretreatment scores used as covariates

*p < .05, **p < .01

49

Figure 1. Emotional Arousal Across Phases

4.5

◦4.0

□

◦ □

3.5 □

○ 3.0 □ ○

□

◦ 2.5

2.0 ◦ Early Middle

Late

Phase of Therapy

◦ PG□ EFT

50

Mea

ns

Negative EmotionPositive Emotion