FORGIVENESS THERAPY REVIEW 2
Journal Article Review
Summary
Chronic illness continues to be a growing concern for Americans as knowledge and
comprehension of illnesses increase, so do the questions as to where the root cause is coming
from and how does one not only treat chronic illness but intervene before one’s health is in
detriment. The burden of chronic illness has fallen not only the bodies of those experiencing it,
but also on the individuals’ finances and the public health community as a whole. Elliot (2011)
identifies the following chronic health conditions as also having social and interpersonal
etiologies and consequences: addictions, obesity, mental health circumstances, COPD, and
cirrhosis. Although many chronic illnesses are fully developed and aware to the individual later
into adulthood, new understandings believe the origin of the illness stems from adverse early
childhood experiences rather than habits and behaviors experienced in adulthood. Instead of
viewing chronic illness from a purely medical model it is suggested that future research and
investigation be directed towards experiences and the bodies physical and biological response to
the repeated nature of said experiences.
Two hypotheses by Shonkoff et al. (2009) have been discussed, with one focusing on
chronic stress and the other on early childhood adversity. The chronic stress hypothesis revolves
around the concept that repeated or chronic exposure of adversity as a child produces greater
dysregulation and increased secretion of stress hormones. This heightened exposure is then
carried through into adulthood, resulting in “physiological ‘weathering’” (Geronimus, 1992) or
the overwork and exhaustion of one’s biology, lending way into an earlier death. The childhood
adversity hypothesis references a multitude of studies involving the survey of ACES (adverse
childhood experiences). Childhood is the primary time for growth and development while one’s
FORGIVENESS THERAPY REVIEW 3
body and biology is increasingly placid. While placidity offer a greater opportunity to learn,
grow, and develop it is also an immensely vulnerable time. The experience of adversity during
these developmentally sensitive times may result in unhealthy associations and regulations being
worked into the child’s brain and biology, rather than developing healthy functioning. This can
then affect the child into adulthood as maladaptive neuropathways are created and biology was
altered resulting in a weakened immune system.
Elliot (2011) presents the concept of forgiveness therapy as a means to manage and treat
chronic illness. It is addressed that forgiveness is not a new concept incorporated in therapy as it
is typically seen as a goal, however it is suggested in this study that forgiveness be used as an
intervention instead. Enright & Fitzgibbon (2000) highlight decisional and emotional as two
different types of forgiveness that are experienced. Decisional forgiveness is viewed as a
cognitive model, resulting in marginally effective improvement, whereas emotional forgiveness
is process-based and focuses on motivation and emotion, producing greater effectiveness.
Forgiveness therapy works to provide the client with a greater sense of personal knowledge and
acceptance of self, taking control away from someone/something external and giving it back to
the client, increasing personal independence.
Using forgiveness therapy as an intervention has been shown to produce physiological
benefits as well. Through implementation of forgiveness presenting through a client letting go
and taking on a positive outlook, research has been able to draw connections to the impact of
these interventions and physiological identifiers that have resulted from adverse experiences.
Physical and biological supportive evidence for forgiveness therapy can be seen through
hormonal patterns, changes in brain activity and brain anatomy when viewed on scans,
experience of diabetes and change in blood pressure, as well as life expectancy. An individual’s
FORGIVENESS THERAPY REVIEW 4
left frontal cortex is most active in forgiving and judgement (Elliot, 2011). When one’s body
holds onto unforgiveness through feelings of increased stress, there is a change in levels of
cortisol, production of adrenaline, and balance of cytokine (Worthington et al., 2005). Continued
disruption and alteration of hormonal patterns can result in being immunocompromised and
development of long-term chronic illnesses. In contrast, when forgiveness is implemented, it
works to balance out physiological markers resulting in a lower heart rate, blood pressure, and
cardiovascular recovery.
Interaction
Forgiveness is a word not uncommon to the field of therapy and counseling however, as
Elliot (2011) noted, forgiveness is typically the end result or goal that is worked towards rather
than an active participant and implantation in the work towards health and wholeness. This new
alternative perspective taken from a historical practice is what drew my attention towards this
article. The ability to be curious, critical, and forward thinking is what furthers research and
understanding in the world, and that is what I see being done with the exploration of forgiveness
therapy. Although interested, I was skeptical as I viewed forgiveness as emotional and
subjective. Therefore prior to reading the article I struggled to identify how scientific backing
would be seen through the research. Elliot’s (2011) reference to various research conducted by
others that focused on the mental/emotional aspect in addition to the psychological implications
sparked a connection between emotions and biology that I had not considered when thinking of
the word and action of forgiveness.
My initial response after reading the article was excitement and intrigue. Not only is
forgiveness therapy a new take on already established understandings of forgiveness but it also
presents an additional noninvasive method of intervention and treatment. This is an important
FORGIVENESS THERAPY REVIEW 5
consideration as although many may only think of invasive treatments being related to
physicality and medical procedures, there are also therapies that can be psychologically or
emotionally evasive (Marco et al., 2023). Another portion of the article I appreciated was the
brief discussion of how forgiveness therapy can be applied in practice. Application of this
therapy by psychologists as well as pastoral counselors was discussed. While the concept of
forgiveness is common to all, it can be tailored to a religious context as well, such as
Christianity. Research conducted by Toussain et al (2020) examined the outcomes of two
different forgiveness therapies, REACH forgiveness and forgive for good. Both of these methods
were researched on a Christian campus and produced results of increased forgiveness and
decreased unforgiveness. It was also noted that while both methods were used on students of a
Christian campus, the REACH forgiveness method has a greater focus towards Christianity.
Future research and consideration may be directed to the co-use of another therapy in
addition to forgiveness therapy. Those who may be seeking or would benefit from forgiveness
therapy may also be individuals who have experienced crises that resulted into long lasting
trauma. Applying forgiveness therapy in addition to another noninvasive therapy such as
neurofeedback therapy (NFT) could be a beneficial combination when working with those who
have experienced trauma and are burdened by feelings of unforgiveness. NFT offers the ability
to stabilize the brain before working to process through the trauma. This is a critical component
and what sets NFT apart as many other treatments do not first work to get the brain to a calm and
relaxed state and unfortunately end up retraumatizing clients (Gerge, 2020). NFT focuses on the
neuroplasticity of the brain and the ability to address arousal regulation without traumatization
and rather in a more controlled manner (Kirk & Dahl, 2022). Acknowledging the play of
neuroplasticity in NFT we can also see a connection with forgiveness therapy as Elliot (2011)
FORGIVENESS THERAPY REVIEW 6
also discussed the placidity of the brain specifically in childhood and adverse experiences
reshaping the brain in a negative way. Using forgiveness therapy and NFT may offer a more
comprehensive way to utilize neuroplasticity while addressing emotions and regaining a sense of
personal control.
Application
In the presenting scenario, a client approached this author explaining they were
struggling with the loss of their mother after an extended battle with cancer. The client presented
with substantial depressed symptoms, including frequent crying spells, an inability to perform
daily tasks and hygiene practices, and a persistent negative emotional state. The client reported
experiencing anger towards God for her mother’s cancer diagnosis and eventual death.
When approached by this client, this author drew upon the clinical intervention described
in Elliott (2011) in an effort to assist the client in their grieving process. As suggested in Elliott
(2011), forgiveness was identified as a therapeutic goal rather than a therapeutic intervention.
With that, additional in-depth goals were created including reducing negative emotions and
increasing positive emotions. Through the four stages of forgiveness explained by Enright &
Fitzgibbons (2000), this author encouraged the client to uncover the origin of their anger, decide
whether forgiveness was an ultimate goal, work through and process their emotions, and deepen
their emotional understanding.
This author met with the client weekly with sessions lasting one hour long. The focus
each week would be directed towards on one of the four stages of forgiveness, working through a
new stage each week. By breaking each stage of forgiveness into smaller, manageable pieces,
this author was able to discover the intricacies of the client’s presenting problem and unearth the
innermost struggles the client was facing. Allowing the client to explore their anger towards God
FORGIVENESS THERAPY REVIEW 7
without prejudice provided the client with the opportunity to be vulnerable in their emotional
curiosity and expression. Ultimately, the emotional reactivity the client initially presented with
was able to be better understood and accepted by the client. Therefore, the client’s willingness to
explore their relationship with and the anger they felt towards God following their mother’s
death was increased and emotions became more stabilized and manageable.
FORGIVENESS THERAPY REVIEW 8
References
Elliott, B. A. (2011). Forgiveness Therapy: A Clinical Intervention for Chronic Disease. Journal
of Religion and Health, 50(2), 240-247.
Enright, R. D., & Fitzgibbons, R. P. (2000).IHelping clients forgive: An empirical guide for
resolving anger and restoring hope.IAmerican Psychological
Association.Ihttps://doi.org/10.1037/10381-000
De Marco, G., Simons, J., Forsberg, L., & Douglas, T. (2024). What makes a medical
intervention invasive?IJournal of Medical Ethics,I50(4), 226–233.
https://doi.org/10.1136/jme-2023-109301I
Gerge, A. (2020). What neuroscience and neurofeedback can teach psychotherapists in the fieid
of complex trauma: Interoception, neuroception and the embodiment of unspeakable
events in treatment of complex PTSD, dissociative disorders and childhood
traumatization.European Journal of Trauma & Dissociation = Revue Europâeenne Du
Trauma Et De La Dissociation,4(3), 100164.Ihttps://doi.org/10.1016/j.ejtd.2020.100164
Geronimus, A. T. (1992). The weather hypothesis and the health of African-American women
and infants: Evidence and speculations. Ethnicity and Disease, 2(3), 207-221.
Kirk, H. W., & Dahl, M. G. (2022). Infra low frequency neurofeedback training for trauma
recovery: A case report.Frontiers in Human
Neuroscience,16https://doi.org/10.3389/fnhum.2022.905823
Shonkoff, J. P., Boyce, W. T., & McEwen, В. S. (2009). Neuroscience, molecular biology, and
the child- hood roots of health disparities: Building a new framework for health
promotion and disease prevention. Journal of the American Medical Association, 301
(21), 2252-2.
FORGIVENESS THERAPY REVIEW 9
Toussaint, L. L., Griffin, B. J., Worthington, E. L., Zoelzer, M., & Luskin, F. (2020). Promoting
Forgiveness at a Christian College: A Comparison of the REACH Forgiveness and
Forgive for Good Methods. Journal of Psychology and Theology, 48(2), 154-165.
https://doi.org/10.1177/0091647120911109
Worthington, E. L., Witvliet, С. V. O., Lerner, A. J., & Sherer, M. (2005). Forgiveness in health
research and medical practice. Psychology and Health, 7(3), 169-176.
Powered by TCPDF (www.tcpdf.org)
