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Forgiveness Therapy

Topic Areas
Scientific Rating
Child Welfare Relevance
Anger Management Treatment (Adult)
3  — Promising Research Evidence
Medium

About This Program

Target Population: Adults who have been treated unjustly and have residual anger, anxiety, depression, and/or low self-esteem

Program Overview

When people forgive someone who has deeply hurt them, they let go of resentment and the urge to seek revenge, no matter how deserving of these things the wrongdoer may be. The forgiver gives the gifts of acceptance, generosity, and even love. Forgivers give these, not out of grim obligation. Rather, they are given because the forgiver has chosen to have a merciful heart. Forgiveness Therapy is designed to teach the participant how to forgive others through 4 distinct phases. It can be provided in individual or group sessions.

Program Goals

The goals of Forgiveness Therapy are:

  • Reduced anger
  • Reduced anxiety
  • Reduced depression
  • Increased hope for the future
  • Increased self-esteem
  • Less displacement of anger onto other people

Logic Model

The program representative did not provide information about a Logic Model for Forgiveness Therapy.

Essential Components

The essential components of Forgiveness Therapy include:

  • The 4 phases of the Process Model of Forgiveness:
    • Uncovering Phase:
      • During this phase, the individual is supposed to become aware of the emotional pain that has resulted from a deep, unjust injury.
      • Characteristic feelings of anger or even hatred may be present.
      • As these negative emotions are ideally confronted and the injury is honestly understood, individuals may become aware of considerable emotional distress.
      • Deciding on the appropriate amount of energy to process this pain while still functioning effectively is an important consideration during this phase.
      • However, as the anger and other negative emotions are brought out into the open, healing ideally begins to occur.
    • Decision Phase:
      • The individual ideally now realizes that to continue to focus on the injury and the injurer may cause more unnecessary suffering and begins to understand that a change must occur to go ahead in the healing process.
      • This person may then experience a “heart conversion” or, in other words, a life change in a positive direction.
      • The individual ideally entertains the idea of forgiveness as a healing strategy and then commits to forgiving the injurer who has caused such pain.
      • Complete forgiveness is not yet realized but the injured individual has decided to explore forgiveness and to take initial steps in the direction of full forgiveness.
      • An important first step at this point is to forego any thoughts, feelings, or intentions of revenge toward the injurer.
    • Work Phase:
      • Here the forgiving individual begins the active work of forgiving the injurer.
      • This phase may include new ways of thinking about the injurer.
      • The injured individual may strive to understand the injurer’s childhood or put the injurious event in context by understanding the pressures the injurer was under at the time of the offense.
      • This new way of thinking is undertaken not to excuse the injurer of responsibility for the offense, but rather to better understand the one who offended and to see the injurer as a member of the human community.
      • Often, this new understanding may be accompanied by a willingness to experience empathy and compassion toward the offender.
      • The work phase also includes the heart of forgiveness which is the acceptance of the pain that resulted from the actions of the injurer.
      • This must not be confused with any sense of deserving the pain but rather a bearing of pain that has been unjustly given.
      • As the individual bears the pain, the forgiver chooses not to pass it on to others, including the injurer.
      • This is often where the challenge of a “quest for the good” is most evident.
      • Indeed, the individual may now become ready to begin to offer goodwill toward the injurer in the form of merciful restraint, generosity, and moral love.
      • This may or may not include reconciliation.
      • The goodwill may be offered while at the same time taking into consideration current issues of trust and safety in the relationship between the individual and the injurer.
    • Outcome/Deepening Phase:
      • In this phase, the forgiving individuals ideally begin to realize that they are gaining emotional relief from the process of forgiving their injurers.
      • The forgiving individuals may find meaning in the suffering that they have faced.
      • The emotional relief and newfound meaning may lead to increased compassion for self and others.
      • The forgiving individuals may discover a new purpose in life and an active concern for their community.
      • Thus, the forgivers discover the paradox of forgiveness: as we give to others the gifts of mercy, generosity, and moral love, we ourselves are healed.
    • These four phases represent the program developer’s understanding of the general pathway that people follow when they forgive someone who has unjustly injured them. For more information, see the complete 20 Step Process Model for details.
    • Keep in mind that this process is not a rigid sequence and individuals may experience all or only some of the steps as they undertake the journey of forgiveness.

Program Delivery

Adult Services

Forgiveness Therapy directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Adults, who are treated unjustly by others, experience resentment, and heightened anxiety and depression and low self-esteem

Recommended Intensity:

Individual and group sessions last about one hour and usually occur once a week.

Recommended Duration:

Up to 6 months, depending on how much the client knows about forgiveness and the depth of the hurt within the forgiver

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • Shelter (Domestic Violence, Homeless, etc.)

Homework

Forgiveness Therapy includes a homework component:

Forgivers often are given homework assignments about working on forgiveness outside of the therapeutic context.

Languages

Forgiveness Therapy has materials available in languages other than English:

Chinese, German, Italian, Japanese, Korean, Portuguese, Romanian, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Robert Enright’s self-help books (at least one of them) are necessary for adults who wish to forgive (see Manual section). Therapists characteristically retain a copy of the self-help book and give a copy to the client

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Therapists with a graduate degree and therapist credentials

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual Details:

Self-Help Books (at least one used in therapy sessions by client and therapist):

  • Enright, R. D. (2001). Forgiveness is a choice: A step-by-step process for resolving anger and restoring hope. APA LifeTools.
  • Enright, R. D. (2012). The forgiving life: A pathway to overcoming resentment and creating a legacy of love. APA LifeTools.
  • Enright, R. D. (2015). 8 keys to forgiveness. W. W. Norton & Company

All of the self-help books are available on Amazon.com.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training is obtained by watching two hour-and-a-half videos and then asking questions of Robert Enright.

Number of days/hours:

3 hours to view the training videos and several days to read one of the self-help books that will serve the client

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Forgiveness Therapy.

Formal Support for Implementation

There is formal support available for implementation of Forgiveness Therapy as listed below:

Optional; a site visit to speak with organizers or a Zoom meeting can be arranged.

Fidelity Measures

There are fidelity measures for Forgiveness Therapy as listed below:

For interveners, a person trained in the therapy, but not directly involved in the intervention, visits several of the sessions to give the intervener feedback.

Implementation Guides or Manuals

There are implementation guides or manuals for Forgiveness Therapy as listed below:

For adults, we have my three self-help books mentioned above. Therapists can easily see the goals within each chapter or these self-help books. Further, therapists can read the book Forgiveness Therapy for a more in-depth view of forgiveness.

Implementation Cost

There are no studies of the costs of Forgiveness Therapy.

Research on How to Implement the Program

Research has not been conducted on how to implement Forgiveness Therapy.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Coyle, C. T., & Enright, R. D. (1997). Forgiveness intervention with postabortion men. Journal of Consulting and Clinical Psychology, 65(6), 1042–1046. https://doi.org/10.1037/0022-006X.65.6.1042

Type of Study: Randomized controlled trial
Number of Participants: 10

Population:

  • Age — 21–43 years (Mean=28 years)
  • Race/Ethnicity — Not specified
  • Gender — 100% Male
  • Status — Participants were men who were hurt by the abortion decision of a partner.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of Forgiveness Therapy to promote emotional healing among postabortion men. Participants were randomly assigned to Forgiveness Therapy (FT) or to a waitlist control group. Measures utilized include the Enright Forgiveness Inventory (EFI), the State Anger Scale, the State Anxiety Scale, and the Perinatal Grief Scale. Results indicate that following treatment, the FT participants demonstrated a significant gain in forgiveness and significant reductions in anxiety, anger, and grief as compared with controls. Similar significant findings were evident among control participants after they participated in the FT treatment. Maintenance of psychological benefits among the first set of participants was demonstrated at a 3-month follow-up. Limitations include small sample size and lack of controlled postintervention follow-up.

Length of controlled postintervention follow-up: None.

Lin, W.-F., Mack, D., Enright, R. D., Krahn, D., & Baskin, T. W. (2004). Effects of Forgiveness Therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. Journal of Consulting and Clinical Psychology, 72(6), 1114–1121. https://doi.org/10.1037/0022-006X.72.6.1114

Type of Study: Randomized controlled trial
Number of Participants: 14

Population:

  • Age — 21–51 years (Mean=36.6 years)
  • Race/Ethnicity — 13 European American and 1 Not reported
  • Gender — 7 Female and 7 Male
  • Status — Participants were patients with substance dependence from a local residential treatment facility.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate anger and related emotions as triggers in substance use. Participants were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual Forgiveness Therapy (FT) or 12 approximately twice-weekly sessions of an alternative individual treatment based on routine drug and alcohol therapy topics. Measures utilized include the Enright Forgiveness Inventory (EFI), the Spielberger State-Trait Anger Expression Scale (SSTAEI), the Beck Depression Inventory II (BDI-II), the Coopersmith Self-Esteem Inventory (CSEI), the State-Trait Anxiety Inventory (STAI), and a modified version of the Adult Substance Use Survey. Results indicate that participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up. Limitations include small sample size, unclear the extent to which resentments in a client’s past are typical or are relatively rare, 14 of 40 clients completed their respective interventions, and length of follow-up.

Length of controlled postintervention follow-up: 1 month.

Magnuson, C. M., Enright, R. D., Fulmer, B., & Magnuson, K. A. (2009). Waging peace through forgiveness in Belfast, Northern Ireland IV: A parent and child forgiveness program. Journal of Research in Education, 19, 57–65.

Type of Study: Randomized controlled trial
Number of Participants: 10 parent-child dyads

Population:

  • Age — Adults: 26–40 years (Mean=33.0 years); Children: 8–9 years (Mean=8.3 years)
  • Race/Ethnicity — Not specified
  • Gender — Adults: Not specified; Children: 7 Female, 3 Male
  • Status — Participants were families recruited from schools that participated in ongoing research and service projects.

Location/Institution: Belfast, Northern Ireland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to appraise the effects of a parent-led forgiveness intervention on forgiveness for parents and their third-grade children (ages 8–9) in Belfast, Northern Ireland. Participants were randomly assigned to either the Forgiveness Therapy (FT) experimental group, or the Family Art Program (FAP) control group. Measures utilized include the Enright Forgiveness Inventory Short Form (EFI-30). Results indicate that there was a significant increase in interpersonal forgiveness of an offender for parents who taught forgiveness (FT) to their child compared with the control group parents. The control group showed no significant changes on any of the seven dependent variables. Limitations include small sample size and length of follow-up.

Length of controlled postintervention follow-up: Approximately 1 month.

Waltman, M. A., Russell, D. C., Coyle, C. T., Enright, R. D., Holter, A. C., & Swoboda, C. M. (2009). The effects of a forgiveness intervention on patients with coronary artery disease. Psychology & Health, 24(1), 11–27 https://doi.org/10.1080/08870440801975127

Type of Study: Randomized controlled trial
Number of Participants: 32

Population:

  • Age — 21-79 years
  • Race/Ethnicity — Not reported
  • Gender — 100% Male
  • Status — Participants were United States veterans with documented reversible myocardial ischemia.

Location/Institution: A veteran’s hospital in a Midwestern city

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effects of a psychology of forgiveness pilot study on anger-recall stress induced changes in myocardial perfusion, forgiveness, and related variables. Participants were randomly assigned to a series of 10 weekly Forgiveness Therapy (FT) or control therapy sessions with a trained psychologist and underwent additional anger-recall stress myocardial perfusion nuclear imaging studies post-test and at 10-week follow-up. Measures utilized include the Enright Forgiveness Inventory (EFI), the Spielberger State-Trait Anger Expression Scale (SSTAEI), and Myocardial perfusion imaging that assessed anger-recall. Results indicate that patients assigned to the FT group showed significantly fewer anger-recall induced myocardial perfusion defects from pre-test to the 10-week follow-up as well as significantly greater gains in forgiveness from pre-test to post-test and from pre-test to follow-up compared to the control group. Limitations include small sample size, the risk of generalizing findings from a select group of veteran patients to all patients with coronary artery disease (CAD), the laboratory setting of the study may have influenced the efficacy of the anger-recall task, and lack of postintervention follow-up.

Length of controlled postintervention follow-up: None.

Osterndorf, C., Enright, R., Holter, A., & Klatt, J. (2011). Treating adult children of alcoholics through Forgiveness Therapy. Alcoholism Treatment Quarterly, 29(3), 274–292. https://doi.org/10.1080/07347324.2011.586285

Type of Study: Randomized controlled trial
Number of Participants: 12

Population:

  • Age — 22–49 years (Mean=38.55 years)
  • Race/Ethnicity — 11 White and 1 Native American
  • Gender — 11 Female and 1 Male
  • Status — Participants were adult children of alcoholics who responded to local advertisements and flyers.

Location/Institution: A Midwestern city

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine two forms of group therapy for adult children of alcoholics; a Forgiveness Therapy (FT) was compared to a conflict resolution intervention. Participants were randomly assigned to FT or to a conflict resolution intervention. At the end of 12 weeks, the conflict resolution group received the forgiveness intervention, whereas the original forgiveness group received no further treatment. Measures utilized include the Children of Alcoholics Screening Test (CAST), the Spielberger State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI-II), the Enright Forgiveness Inventory (EFI), the Spielberger State-Trait Anger Expression Inventory (STAXI), the Coopersmith Self Esteem Inventory (CSEI), and the Positive Relations with Others Scale (PRO). Results indicate that the FT group improved on five of the six dependent measures from pretest to posttest: forgiveness, self-esteem, depression, anger, and positive relations with others. The conflict resolution group improved on two of the six measures during this same period: anger and positive relations with others. Although the mean scores for the other measures were moving in a positive direction, the changes were not significant. No statistical differences were found between the two groups on any of the variables after the initial 12-week intervention. Limitations include an almost entirely female sample, the similarity of the interventions, and one interviewer conducting both groups.

Length of controlled postintervention follow-up: None.

Lee, Y-R & Enright, R.D. (2014). A forgiveness intervention for women with fibromyalgia who were abused in childhood: A pilot study. Spirituality in Clinical Practice, 1(3), 203–217 https://doi.org/10.1037/scp0000025

Type of Study: Randomized controlled trial
Number of Participants: 11

Population:

  • Age — 21–68 years (Mean=43.55 years)
  • Race/Ethnicity — 100% Caucasian
  • Gender — 100% Female
  • Status — Participants were women diagnosed with fibromyalgia who experienced abuse by their parents.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of a forgiveness intervention with a fibromyalgia (FM) health intervention [now called Forgiveness Therapy (FT)] on women with FM who have experienced emotional, physical, or sexual abuse, and emotional or physical neglect in childhood by one of their parents. Participants were randomly assigned to FT or the FM health intervention and completed the once-weekly individualized program for 24 weeks. Measures utilized include the Enright Forgiveness Inventory (EFI), the Beck Depression Inventory-II (BDI-II), the Fibromyalgia Impact Questionnaire, the Childhood Trauma Questionnaire (CTQ), the State Trait Anger Expression Inventory-II (STAXI-II), the State Trait Anxiety Inventory (STAI), Coopersmith Self-Esteem Inventory Adult Form (CSEI), the Coping Strategies Questionnaire (CSQ) and the Forgiveness Intervention Final Test. Results indicate that the FT intervention participants had greater improvements in forgiveness and overall FM health from the pretest to the posttest, and in forgiveness and state anger from the pretest to the follow-up test than the FM health intervention participants. Moreover, the FT intervention participants scored higher on the forgiveness final test than the FM health intervention participants, and the FM health intervention participants scored higher on the FM health final test than the FT participants. Limitations include small sample size, reliance on self-reported measures, the results cannot be generalized beyond the participants with FM in this pilot study, and attrition.

Length of controlled postintervention follow-up: None.

Zhao, C., Enright, R.D., & Klatt, J. (2017). Forgiveness education in the workplace: A new strategy for the management of anger. London Journal of Research in Humanities and Social Sciences, 17(1), 11–24. https://journalspress.com/LJRHSS_Volume17/77_Forgiveness-Education-in-the-Workplace-A-New-Strategy-for-the-Management-of-Anger.pdf

Type of Study: Randomized controlled trial
Number of Participants: 41

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — 30 Female and 11 Male
  • Status — Participants were white-collar workers who had experienced or were experiencing injustice in the workplace.

Location/Institution: Wales and West Midlands in the United Kingdom

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effects of a forgiveness education program to a relaxation training program in the workplace for reducing anger and increasing well-being in workers. Participants were randomly assigned to either the Forgiveness Therapy (FT) education group or the relaxation training program. At the end of 12 weeks, the conflict resolution group received the forgiveness intervention whereas the original forgiveness group received no further treatment. Measures utilized include the Electronically Altered Version of the Enright Forgiveness Inventory (EFI) and the State-Trait Personality Inventory Form Y (STPI). Results indicate that participants across the two groups changed on all outcome measures and that the FT education group had greater changes than the relaxation training group on trait anxiety and state anger. Within group t tests revealed the FT group demonstrated significant change on more outcome variables than the relaxation training group. Limitations include small sample size, results cannot be generalized across occupations and industries in the UK, and reliance on self-reported measures.

Length of controlled postintervention follow-up: None.

Haroon, Z., Iftikhar, R., Kim, J. J., Volk, F., & Enright, R. D. (2021). A randomized controlled trial of a forgiveness intervention program with female acid attack survivors in Pakistan. Clinical Psychology & Psychotherapy, 28(4), 917–928. https://doi.org/10.1002/cpp.2545

Type of Study: Randomized controlled trial
Number of Participants: 16

Population:

  • Age — 23–years (Mean-28.8 years)
  • Race/Ethnicity — 100% Pakistani
  • Gender — 100% Female
  • Status — Participants were female acid attack victims in Pakistan.

Location/Institution: The Depilex Smileagain Foundation and the Jinnah Burn Unit and Reconstructive Surgery Center in Pakistan

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of a forgiveness intervention with female survivors of acid attack violence in Pakistan. Participants were randomly assigned to either Forgiveness Therapy (FT) or a treatment-as-usual (TAU) control group. The FT group received twice-a-week forgiveness sessions for 4 months, whereas the TAU group either received typical psychological treatment sessions for acid attack victims or no treatment. Measures utilized include the Enright Forgiveness Inventory (EFI), the Herth Hope Index (HHI), the 5-item PROMIS Anger Short Form, the 7-item PROMIS Anxiety Short Form, and 8-item PROMIS Depression Short Form from the Patient Reported Outcomes Measurement Information System. Results indicate that posttreatment, the FT intervention group showed greater improvement in hope, anger, anxiety, and depression when compared with the TAU group. Upon further examinations, both groups improved on forgiveness from pretreatment to posttreatment, but the FT group had a higher baseline. From pretreatment to the 12-month follow-up, the FT group, when compared with the TAU group, showed greater improvement in all areas except for depression. Limitations include small sample size, and the combination of the two TAU groups to make a comparison between those who received FT sessions and those who did not and to make sure that there was sufficient statistical power to make group comparisons between the experimental and control groups.

Length of controlled postintervention follow-up: 1 year.

Yu, L., Gambaro, M., Song, J. Y., Teslik, M., Song, M., Komoski, M. C., Wollner, B., & Enright, R. D. (2021). Forgiveness Therapy in a maximum‐security correctional institution: A randomized clinical trial. Clinical Psychology & Psychotherapy, 28(6), 1457–1471 https://doi.org/10.1002/cpp.2583

Type of Study: Randomized controlled trial
Number of Participants: 24

Population:

  • Age — 21–over 60 years
  • Race/Ethnicity — Experimental Group: 33% African American/Black, 17% Caucasian/White, 8% Hispanic/Mexico, 33% Biracial/Multiracial, and 8% Not specified; Control Group: 42% African American/Black, 25% Caucasian/White, 17% Hispanic/Mexico, 8% Asian, and 8% Native American
  • Gender — 100% Male
  • Status — Participants were men in a correctional institution.

Location/Institution: United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to propose Forgiveness Therapy (FT) as a novel approach to rehabilitation for men in a maximum-security correctional institution to alleviate psychological compromises. Participants were randomly assigned to either the FT experimental group or an alternative treatment (Carey Guides) control group. Measures utilized include the Enright Forgiveness Inventory Short Form (EFI-30), the Herth Hope Index (HHI), the 5-item PROMIS Anger Short Form, the 7-item PROMIS Anxiety Short Form, the 8-item PROMIS Depression Short Form, the Coopersmith Self-Esteem Inventory Form B (adult version), the Toronto Empathy Questionnaire (TEQ), the Marlowe-Crowne Social Desirability Scale, a questionnaire on personal and criminal history, and open-ended questions about unfair treatment. Results indicate that there was an inverse relationship between forgiveness and anger, anxiety, and depression. For the first period of treatment, when comparing the pretest scores and posttest scores, the experimental group showed significant decreases in anger, self-esteem, and empathy. The control group showed no significant changes on any of the seven dependent variables. Limitations include lack of controlled follow-up as both groups had received the FT intervention at the follow-up, anger did not show a strong negative association with EFI-30 and its three subscales at the initial assessment, the relatively small sample size in the intervention, and researchers cannot control confounding variables and unexpected security requirements in a prison.

Length of controlled postintervention follow-up: None.

Additional References

Akhtar, S., & Barlow, J. (2018). Forgiveness Therapy for the promotion of mental well-being: A systematic review and meta-analysis. Trauma, Violence, & Abuse, 19(1), 107–122. https://doi.org/10.1177/1524838016637079

Contact Information

Robert Enright, PhD
Agency/Affiliation: University of Wisconsin-Madison
Website: internationalforgiveness.com/product/forgiveness-therapy
Email:
Phone: (608) 262-0835

Date Research Evidence Last Reviewed by CEBC: July 2024

Date Program Content Last Reviewed by Program Staff: November 2024

Date Program Originally Loaded onto CEBC: November 2024