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Journal Article Review Assignment:
Forgiveness Therapy – A Clinical Intervention for Chronic Disease
The following essay is a review of the journal article authored by Barbara Elliot in 2011,
titled “Forgiveness therapy: A clinical intervention for chronic disease.” A summary of the main
concepts of the article is provided. An interaction with the article follows, which includes my
initial response to the article, insights that I gained from the article, and other though-enhancing
discussions. Lastly, a clinical scenario is described where the key concepts of the article are
applicable.
Summary
Several chronic illnesses have been identified to have social and interpersonal etiologies
and consequences (Elliot, 2011). There is a positive correlation between early adverse
experiences and later unfavorable health outcomes. In other words, one’s childhood adverse
experiences has lifelong effects on one’s biology and health consequences. There are two
hypotheses that attempt to explain the mechanism that connects experiences of adversity and
health outcomes. One hypothesis is that adversity is a stressor that builds up in the body over
time until the burden becomes toxic. The high levels of stress associated with childhood
adversity causes the body to be physiologically exhausted and results in shorter life spans (Elliot,
2011). The second hypothesis is that childhood adversity occurs at a critical developmental time,
which causes the adversity to become integrated into the individual’s brain and physiology. The
adversity becomes imprinted onto the individual’s brain and biological makeup and causes
diminished immune reactivity in adulthood (Elliot, 2011). Overall, the medical science indicates
that the adverse life experiences, especially those that occur in the earlier stages of development,
can result in physical and psychological complications later in life, to the extent that chronic
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illnesses develop, life spans are shortened, and physiology is permanently altered. However,
forgiveness therapy may be a viable clinical intervention to subvert these health complications
(Elliot, 2011).
Therapeutic forgiveness interventions have been used with clients that have
psychological and social dysfunctions resulting from destructive relationships (Elliot, 2011). It
has been shown to be an effective method in breaking cycles of hostility, anger, and hatred.
There are two different forgiveness experiences: decisional and emotional (Elliot, 2011).
Decisional forgiveness grants forgiveness without eliminating the emotion; thus, some
resentment may linger. Emotional forgiveness includes changes in emotion and in the attitude
towards the offender; it overcomes unforgiveness and offers healing. There are psychological
benefits to forgiving, such as letting go of unforgiveness and embracing a positive view on life
that isn’t controlled or tainted by the offender (Elliot, 2011). Additionally, there are
physiological benefits to forgiveness as well, such as lower heart rate, increased rate of
cardiovascular recovery, reduced resting blood pressure, less EMG tension, and reduced skin
conductance (Elliot, 2011). These physiological indicators are all neutralized by forgiveness.
This is promising since chronic illnesses are the leading causes of disability and death in the
United States. Overall, forgiveness therapy has a positive, healing role in helping individuals
who have chronic health disease and issues that stem from early adverse experiences, and
redirecting preventative health resources towards forgiveness therapy is likely to reduce
suffering and healthcare expenses (Elliot, 2011).
Interaction
Forgiveness is the process of confronting and releasing anger directed at someone who
has inflicted pain (Kim et al., 2021). Forgiveness is a two-part process, intrapersonal and
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interpersonal (Enright & Song, 2020). First is the intrapersonal; there must be an emotional
transformation whereby the negative emotions associated with the wrongdoing are released.
Second is the interpersonal; the victim must empathize with the wrongdoer and treat the
wrongdoer with compassion. There are four techniques in the forgiveness process, known as the
4 Ds of Forgiveness: deep diving, deciding, doing, and deepening (Enright & Song, 2020). Deep
diving refers to gaining insight into the wrongdoing, as well as its impact on the victim.
Deciding involves reflecting on what forgiveness means on a personal level and making an
empowered decision to forgive. Doing refers to empathizing with the offender and attempting to
understand their actions. Deepening refers to finding prospects for growth and meaning from the
incident.
As someone who has suffered multiple instances of wrongdoing from people that I
should have been able to trust, I can see where forgiveness therapy would offer a variety of
health benefits. I used to hold grudges, but I’ve learned that when I allow that anger and hurt to
linger, it consumes all of my energy. I literally feel pain in my stomach like knots being
kneaded. I also felt guilty for not extending forgiveness, because I knew it was my duty as a
Christian. I’ve had to forgive a lot of people who have hurt me for my own sanity. When you
hold onto unforgiveness, it eats away at your soul and diminishes your relationship with God.
Without forgiveness, it is impossible to heal from the trauma and move forward. I don’t forgive
people to absolve them of their wrongdoing; I forgive them for myself. Plus, when you hold
onto anger against someone, it gives them power over you. Forgiveness is the only way I can
take that power back and return to a healthy emotional state.
Each act of forgiveness is unique, which means some decisions to forgive are more
difficult than others. As would be expected, the more heinous the offense, the more difficult it is
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to forgive the offender. Violence against others and instances of interpersonal hurts are
prevalent within society, and they tend to be associated with a range of long-term psychological
problems. Forgiveness therapy is thought to improve different aspects of psychological health in
individuals who have suffered from various forms of hurt, violence, and trauma. Akhtar and
Barlow (2018) found strong evidence to imply that forgiving a variety of real-life interpersonal
offenses can be efficient in supporting multiple aspects of mental wellness. The results
suggested that forgiveness interventions not only promote positive affect, but are effective in
reducing depression, anxiety, anger, hostility, and stress.
Gracia and Heng (2019) also found a positive correlation between psychological
wellbeing and forgiveness. In spite of the data in support of forgiveness having a positive effect
on wellbeing, many individuals still find it difficult to forgive offenders. There are three
dimensions of forgiveness: avoidance motivations, revenge motivations, and benevolence
motivations (Gracia & Heng, 2019). Avoidance motivations consists of the desire to avoid the
offender. Revenge motivations refers to the desire for danger directed at the offender.
Benevolence motivations involve the impulses to be kind to the offender. When an individual
forgives, benevolence motivations have increased, while avoidance and revenge motivations
have typically decreased. There are four categories of factors that affect forgiveness: personality
determinant, offense-related determinant, relational determinant, and social cognitive
determinant (Gracia & Heng, 2019). One’s personality is a determinant it influences how an
individual will respond to an act of wrongdoing. The offense is a determinant, because the more
egregious the offense, the more difficult the offense is to forgive. The relationship between the
victim and offender is a determinant, because the more intimate or high-quality the relationship,
the more likely the offense is to be forgiven. Lastly, the social cognitive aspect is a determinant
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because it takes into account empathy, blame, intentionality, severity, judgment of responsibility,
and religiosity. Each of these determining factors will have an influence on whether or not
forgiveness will be implemented (Gracia & Heng, 2019).
Forgiveness is a vital tenet associated with Christianity. Forgiveness is an important
practice because it restores relationships with others, as well as with God. Ephesians 4:32 states
“Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you,”
(NIV, 2011). As Christians, we are compelled by the Holy Spirit to forgive those who are guilty
of wrongdoing. Jesus warns us in Luke 6:37, “Do not judge, and you will not be judged. Do not
condemn, and you will not be condemned. Forgive and you will be forgiven,” (NIV, 2011).
Forgiveness therapy may help clients who struggle with letting go of resentments that keep them
ensnared by the wrongdoing committed against them. Refusing to forgive has consequences that
are spiritual, emotional, and physical. Forgiving involves more than simply making a conscious
decision to forgive. It must involve an emotional change of heart.
Application
Forgiveness therapy could be used in a variety of counseling scenarios. There are many
types and varying degrees of adversity that may have been experienced by individuals during
their early years that could be undermining one’s health. For instance, suppose a young woman
comes to a counselor’s office seeking help for chronic depression and anxiety with periodic
panic attacks. She is a twenty-five-year-old student working on her master’s degree. She has a
part-time job working as an armed security guard. Furthermore, she is a single mother of three
children. Her anxiety causes her to have high blood pressure and a high resting heart rate. She
has weekly panic attacks, causing her to not want to leave the house any more than necessary.
Her depression makes her irritable and apathetic. Upon interviewing the client, it is learned that
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she was constantly bullied throughout her childhood years by her school mates. Furthermore,
she was molested by her uncle, but no one in her family ever believed her. Lastly, she was raped
as a teenager by a peer and was never able to fully process the trauma.
This client has suffered from multiple forms of adversity throughout her childhood and
adolescence. She has negative chronic health problems stemming from these adverse
experiences. During her session, she speaks about her hatred for the people that mistreated her.
She is resentful towards her family for not believing her accusations against her uncle. She also
regrets not taking legal action against the man who raped her, and now it is too late, as the statute
of limitations has passed. This client is clearly clinging to unforgiveness, and this could be
detrimental to her current health. Forgiveness therapy could therefore be a vital element to
include in her treatment process. As indicated by Elliot (2011), her resting heart rate and blood
pressure could be reduced, as well as her depression, anxiety, and frequency of panic attacks.
Not only could forgiveness therapy cause her current symptoms to be mitigated, but the
progression of any chronic, life-shortening diseases could be prevented.
Conclusion
In conclusion, forgiveness is not an arbitrary act meant to keep the peace within a family
or civilized society, but it is a carefully considered choice that has monumental effects on one’s
overall health and wellbeing. We know that as Christians, it is our duty to forgive others, even
when we can’t forget the wrongdoing that has been done. Forgiveness is a process that involves
multiple steps, and it is frequently easier said than done. However, when incorporated into the
therapeutic treatment of an individual, chronic health issues, both psychological and
physiological can be abated and prevented.
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References
Akhtar, S., & Barlow, J. (2018). Forgiveness therapy for the promotion of mental well-being: A
systematic review and meta-analysis.GTrauma, Violence, & Abuse,G19(1), 107-122.
Elliott, B. A. (2011). Forgiveness therapy: A clinical intervention for chronic disease.GJournal of
Religion and Health,G50, 240-247.
Enright, R. D., & Song, J. Y. (2020). The development of forgiveness.GThe Oxford handbook of
moral development: An interdisciplinary perspective, 402-418.
Gracia, D., & Heng, P. H. (2020). Forgiveness and Its Relation to Psychological Well-Being in
Christians of Protestant Churches in Jakarta. Advances in Social Science, Education and
Humanities Research, 478, 422-430.
Kim, J. J., Volk, F., & Enright, R. D. (2021). Validating the Enright Self-Forgiveness Inventory
(ESFI).GCurrent Psychology, 1-14.
New International Version. (2011).GBibleGateway.com.
http://www.biblegateway.com/versions/New-International-Version-NIV-Bible/#booklist
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