I meet the most incredible people in my work. Struggle as they might with various vices like substance abuse, serial monogamy, stormy relationships or keeping a job, the people I've worked with consistently have a surplus of one thing I highly value: empathy.

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It seems as if people who have suffered greatly often have the ability to understand other's pain at a deeper level than most people. Often they have a depth of insight that far exceeds their "normal" peers. When they offer support, it touches deeply and effectively. But they are much better at helping others than themselves. 

Most importantly, they are unique among those who suffer. They have asked for help facing and fixing their problems. Being willing to accept help gives them the willingness to look themselves squarely in the mirror and be willing to see what is really there. When they look at themselves, they feel a withering sense of shame about how responsible they with all that has gone wrong. With help, they see in exaggerated clarity all that they need to change. Shame has a way of discouraging any imagination of escape from the pattern of repeating mistakes. It often keeps people stuck or in denial for years. The willingness to walk through that process of sharing the darkest and most shameful events in their lives requires great courage.

Many times, all they really lack is a way to get beyond the shame of what they find inside themselves, make the changes and move on. Once they achieve that, they blossom before my eyes. And they are forever grateful.

Most days, I feel as if I've learned so much from them that I feel a little guilty getting paid to do this. Only a little... ;o)

This is the second in a series of articles on emotional intelligence for personal growth. The first part is here.

Mindfulness is a non-judgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted as it is. It is a skill that is learned by committed practice. The object is to focus one's attention on thoughts, feelings and events in the present moment while remaining curious, open, and accepting whatever occurs.

The idea is to take on the role of an observer of your own mind. Notice everything that happens without holding onto anything, having a "Teflon Mind". An important part of observing is putting words to the experience. The effect of naming the experience effectively separates you from it. Thoughts are just thoughts, feelings just feelings, all transient experiences that are not necessarily a part of or define who we are.

True mindfulness involves immersing yourself in your experiences so that you actually forget yourself. The idea here is to stop the conversation you have with yourself, or as Eastern traditions put it, letting go of ego. This internal dialogue, while an important skill in the right circumstances, can become a major distraction. Imagine yourself walking through a beautiful park muttering to yourself. Would you remember what you saw in the park? You'd probably remember more about what you were muttering to yourself!

One way to do this is to focus on what is at hand. "See the job, do the job." The idea is NOT to always stay busy, ut to invest all of yourself in everything you do. "Smell the roses." Another thing to watch while doing things judging if this should have happened or whether it's fair, just, or right or wrong. It IS, the only value in questioning why is avoiding a problem in the future. Anything more than that is a waste time and emotional energy. See what you are doing, but don't evaluate it. Focus on the facts without evaluating it. Count on your intuitive self to react appropriately, changing the harmful situation or changing your harmful reaction to the situation.

Another distraction to your experiences is multi-tasking. Doing more than one thing at a time spreads your skills thin so that your product becomes sub-optimal, perhaps even mediocre. If you multi-task regularly, you actually train yourself to be easily distracted. There is some research that suggests that this subtle distraction training contributes significantly to attention deficits that impair your concentration. Research also suggests that training persons with Attention Deficit Disorder with mindfulness techniques can be an effective treatment!

The idea is to keep your mind's eye on the objectives until the task is done having faith that you will do the best job your can and react appropriately should something go wrong. Think about it, if you are preoccupied with what might go wrong while doing something, will your focus be on the job or the fear of what might happen? If you are distracted by fear, how good a job can you do?

Most of us, when not structured and focused on a task at hand, are thinking about past and future events. We either review previous experiences looking for new learnings we might have missed or planning our reactions to anticipated events. We focus on the moment only when there is something immediately presenting that requires a response. Our focus is often divided between what is happening in the moment and the thoughts on which we are focused.

For those of us that have more than our share of regrets and/or worries, being focused on the past or the future becomes a nearly full time job! This is not good. Without your full participation in the moment you are in, you are distracted, your reactions are primed with the emotions of the worry or regret. That means your judgment and decision making ability is impaired by emotionally distorted judgments! Have you ever been startled by someone while preoccupied with regrets or worries? Did you react with an emotion not meant for the other person? Most people have had that experience. It is likely we have all experienced spilling our internal emotion on an unintended other. And if that person was paying attention, he or she probably noticed your emotion and wondered if you were upset with them!

Few of us have the ability to be focused on the moment at will. It is a skill that takes a lot practice and a commitment to follow through. The eventual reward is an incredible feeling of peacefulness, acceptance, and centeredness combined with heightened concentration. You see, a mind uncluttered by regrets or worries has only the moment to focus on. Self-consciousness dissolves into the experience of the moment. Instead our focus is on our senses, our perceptions, punctuated by the thoughts and feelings flowing through our minds. The ultimate state of mindfulness is what is called flow.

Flow is the state in which the person is fully immersed in what he or she is doing with a feeling of energized focus, full involvement, and an expectation of success. Flow could be conceived of as being completely focused and motivated in a single-minded immersion. Emotions and thoughts are synchronized in the service of performing and learning. In flow, the emotions are not just contained and channeled, but positive, energized, and aligned with the task at hand. While in flow, we feel a clear sense of direction, confidence, intense concentration, and personal control. We feel a natural and continuous intrinsic reward. Time seems altered, slowed or moving quickly. Feedback for one's actions and focused redirection come easily and painlessly so that action and awareness seem to merge.

One does not have to reach the ultimate form of mindfulness to benefit. With each strengthening of the skill comes with incredible benefits in quality of life. There are many tools available to us that will help us learn. Check out the resources here.

Continued here.

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I caught this article at Psychcentral.com, Positive Thoughts Make Things Worse for Poor Self-Esteem . It struck me as a counter-intuitive finding for a research study. I've been helping clients build self-esteem for over 30 years and while positive thoughts is not a short road to better self-esteem, it certainly does work over the long run. I'd estimate that at least six months is required to make significant progress with self-esteem from solely refocusing on the positive, and some people require much more time. Several things jumped at me as I read the article. First of all, Dr. Grohol quoted an article from the The Economist of all places. Both articles stated the research was published in this month's Psychology Research and authored by Wood et al (2009). A review of the past three months of that journal produced no article.

So I went to the old reliable, I googled the lead author, Joanne Wood. I came up with several mentions of her at academic institutions and emailed the author for a reprint. I also found another review of the same article by Ed Yong writer for the Science Blog Not Exactly Rocket Science dated May 15th.

The next day, the article arrived in my email with a short note from the author saying it hadn't been published yet! Apparently, there have been some pre-publication prints floating about likely for publicity purposes. This is one of my pet peeves. Articles submitted to peer reviewed journals are intended to inform the academic community and allow scholarly review and comment. The object of repeated review is to ensure the research is sound and is appropriately interpreted. When it appears first in lay publications, the writers who are not scientists often inadvertently distort the interpretation of the research, as I've noted before. That really didn't happen this time. Both the Psychcentral.com and The Economist got the research mostly right. But Ed Yong did a much better job of explaining the fine points.

This time, it's the researchers that make a subtle but major error in an assumption involving an interpretation of a key measurement. Its subtle because it's endemic in our culture. It seems like everyone assumes that negative feelings are harmful. In this case, Wood et al (2009) found that their subjects who had low self-esteem, immediately reported a lower mood and self-esteem after telling themselves sixteen times they are a "lovable person." Interestingly, persons with high self-esteem report only slight, non-significant improvement in self-esteem.

I decided to do an anecdotal demonstration of the "intervention" for my own understanding. After saying to my self 16 times "I am a loveable person", I felt annoyed, a little silly, embarrassed, and was reminded of quite a few traits which make me not always so lovable. But I can't imagine how this would have any long term effect on my self-esteem either way.

An even bigger problem is one that I talked about before and called it Dust Bowl Empiricism. Researchers are so enamored with their professional activities, they demonstrate their preference for inductive research. Wood et al. reviewed all the relevant research on their topic quite satisfactorily, but then failed to do a sufficient review of related theory. In previous post, I quoted Michael Schermer, a columnist with Scientific American, who eloquently asserted that the really valuable research, the kind of research that can fairly readily be used to educate the public, "higher-order works of science that synthesize and coalesce primary sources into a unifying whole toward the purpose of testing a general theory or answering a grand question." To be fair, few researchers venture into grand theory, perhaps because of the dearth of recent reviews, and perhaps because of the few notable exceptions have been eviscerated by their colleagues for their efforts. Sigmund Freud comes to mind. I have sometimes wondered if psychology's love-hate relationship with Freud resulted in an over-emphasis on induction and de-emphasis of deduction and construct validity.

Wood et al. appears to be testing a specific intervention using Cognitive Behavior Therapy (CBT). CBT purports to change feelings by changing thoughts.

While I prefer more psychodynamic conceptualizations, lets approach this issue of negative feelings from cognitive-behavioral point of view for purposes of demonstrating how relevent theory would aide in the interpretation of research. There is conceivable explanation of low self-esteem and associated negative emotion in the concept of "conditioned emotional response" or CER. A person may learn they are not valuable or important by, for example, an invalidating experience. That invalidating experience is remembered in at least two ways, by the facts of the event and by the associated emotions. According to current understanding of neurophysiology, memories of facts and emotions are kept in different part of the brain, presumably by different methods of storage with different processes of recall. The hippocampus and medial temporal lobe are involved in verbalized memories. Emotional memories involve the amygdala.

Sufficient invalidating experiences may lead to low self-esteem. Whenever a sufferer of low self-esteem remembers an invalidating experience or experiences a new one, she is likely to remember the event and feel the emotion associated with the experience.

In the Wood et al. experiment, the lowered mood and self-esteem are experienced after a validating experience. The subject feels the emotions associated with the original invalidating experience of invalidation perhaps because the positive self-talk controdicts the perception of the subject. Wood et al. makes that point. However, what she misses is that the subject is under going extinction of the conditioned emotional response. The subject is experiencing the emotion without the triggering invalidating experience. According to the theory of Classical Conditioning, repeated exposures to the emotion without the associated invalidation will eventually weaken the conditioning. Perhaps this process is complicated by the fact that the alternative experience, validation, is a close opposite to the conditioning stimulus, triggering a strong emotional response.

In my experience, this triggering of a strong negative emotional response associated with past destructive learning without the presence of the negative stimulus actually quickens the de-conditioning. What this experience amounts to is an abreaction, an emotional re-experiencing of the past event in a supportive and nurturing environment.

One point of the research is well taken. A person with an abysmal self-esteem reading a self-help book will find herself ruminating about how wrong it is that she could be so lovable. Such a person, supported only by herself, is not receiving the necessary nurturing due to her low self-esteem. She is likely re-conditioning the CER with more invalidating self-talk.

The reviews of this article did a fair job of presenting the study. However, there is risk in presenting research to a lay audience. The well written review by Yong had unintended consequences. The comments below the article contained some anquished and angry responses:

"As a person with very low self-esteem who has been encouraged to think positively and love myself throughout my life, I can only thank Joanne Wood for publishing this study. Packaged one-size-fits-all programs promoting the personal pep talk only serve to make those people already in touch with their mediocre side more acutely aware of their non-value within society."

"And when I feel unloved by one person even i feel like no one at all loves me or values me. How can I value myself when i feel like that. and after going thru a marriage where my ex always devalued me and everything i did if he did not approve of it. being abusive, verbally, mentally, emotionally, and physically... and even tho i have come a long way past this experience, it haunts me and i feel lower then dirt. no positive self talk makes me feel better, only makes me feel worse, cuz i figure if i don't actually believe what i am saying or thinking how can it possibly be true?"

Unfortunately, some people with very low self-esteem have been reinforced in their belief that positive thinking can't help. Self-help is best read by the worried well. People with long standing issues with low self-esteem need psychotherapy. Both the authors, Wood et al., and reviewer, Yong, stated this clearly, the other two articles did not. Even so, this knowledge proved harmful to a few. I certainly do not fault the authors for this problem. Yong especially did a great job. One can't ensure everyone reads the entire article or even correctly understands it.

I believe we as professionals who write about mental health have a duty to be as clear and thorough as possible in an attempt to avoid confusion and inadvertant harm. But knowledge is powerful. Sometimes, knowledge mishandled can lead to worsening of symptoms that hopefully brings those in need to help.

Reference: Wood, J., Perunovic, W. Elaine, & Lee, J. (2009). Positive Self-Statements: Power for Some, Peril for Others Psychological Science DOI: 10.1111/j.1467-9280.2009.02370.x

Update 7/15/09: Joanne V. Wood, PhD responds to all the media hype about her research.

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Recently, I exchanged messages with Michele Rosenthal, author of the blog, Parasites of the Mind. She asked me a very good question, one that is so much a part of my everyday work, a good long contemplation was needed just to tease out a good answer.

"Speaking of inspiring, how do you inspire a client to believe in what he/she is doing? It's so difficult to believe in anything when PTSD has settled its big black cloud on your head.

Any general rules of the game for (self) empowering belief?"

Another therapist, Mary Redoutey, joined our discussion and attempted to answer this question. She took the conventional route.

"All therapy in essence is self empowered therapy.... The therapist is the partner in the process. I can sit in the chair in my office, can make suggestions, can teach, can do anything as much as I want... and nothing different will happen unless of course the client is present, listens somewhat attentively, suspends negativity long enough to experience a shift in feeling state and/or thoughts or actions.... And the work in the session does not transfer into the client's life unless the client chooses to make the necessary changes. "

Essentially, Mary says that therapists don't change people, people can only change themselves. I have commented on a release for a new book that made this point as well. While it is true that what a client brings to therapy may account for much of the effectiveness of therapy, I don't think this is the core of Michelle's question. As I understand her question, she wants to know what the therapist brings to the therapy room.

My first attempt at replying was rooted in my daily routine. I'm always helping people understand how their past experience impinges on their current symptoms.

"Consider what happens between mother and child. A child develops their self-concept initially based on how they are treated by their mother. In therapy, the therapist communicates his belief in the client. And if the connection already exists, a seed is planted. But as an adult, only the client can nurture the seed to germination and growth. The therapist can only teach them how."

Generally, when I take this tact, which is common with the childhood trauma survivors I see, I am helping them see the importance of exploring their childhood history and their relationships with their caregivers as a way to understand the origins of their symptoms. This is a much more specific answer that still only partly answers Michelle's question.

I think Michelle wants to know what is the therapists role in motivating a client in each and every step through therapy. In other words, what is the client getting from paid expert advice they can't get from a book? From Michelle's point of view, perceptions of her options are clouded by the rollercoaster existence that accompanies PTSD.

There has been extensive research on this topic. Most recently, much of this research has taken on a ideological fervor endorsing Cognitive Behavior Therapy (CBT). I've written often about my opinion CBT. Suffice it to say, CBT may be the core methodology in helping a client manage their thoughts and building treatment plans, but there is much more to behavior change than changing thoughts. One of CBT's central assumptions is patently false. Not all feelings are produced by or changable by thoughts. Much of our earliest learning occurs before thoughts begin to play a major role in our learning around the age of 8.

Patterson (1989) identified common specific factors recognized by virtually all schools of psychotherapy. He included therapist acceptance, permissiveness, warmth, respect, nonjudgmentalism, honesty, genuineness, and empathy or empathic understanding. Three of these, warmth, empathy, and genuineness have considerable research backing. In a previous article, Patterson (1984) points out:

"There are few things in the field of psychology for which the evidence is so strong. The evidence for the necessity, if not the sufficiency, of the therapist conditions of accurate empathy, respect, or warmth, and therapeutic genuineness in incontrovertible.... The fact that specific change occurs in a therapeutic relationship without the addition of so-called specific techniques, such as interpretation, suggestion, instruction, etc., is also evidence of the sufficiency of the relationship by itself. "

More recent research has found the competence of the therapist is critical. Verhofstadt et al. 2008, in their article about the value of emotional similarity and empathic accuracy in support giving with couples. They cite:

"...mounting evidence that unskilled support can be ineffective or even harmful to the support recipient.... In summary, whereas matching the partner's emotion during a support-seeking interaction may provide a sufficient basis for understanding the partner's current affective state(s) and responding with appropriate emotional support and consolation, understanding the partner's specific thoughts and feelings during a support-seeking interaction may provide a sufficient basis for understanding what kind(s) of help the partner desires and how to provide such help in an acceptable way."

Successful therapists must be able to adapt to their clients' emotional uniqueness and to accurately perceive their thoughts and feelings to provide appropriate support in an acceptable way. Perhaps even more important, therapists must be perceptive and adaptive enough to understand the clients complaint that brought them to therapy and the nature of their quandary beyond the clients' own understanding, or the underlying problems. And having discovered what must be done, therapists must be able to provide the clients insight into their dilemma, provide a rationale for a course of action, and persuade their clients to make changes they are unlikely to find easy or achieve without significant discomfort. Initially, clients are often unable to understand the significance of their problems or nature and potential benefit of the required changes. If they did they wouldn't need therapy!

There is only one experience that I find cuts through virtually any dark cloud, and that is the touch of human empathy. When people who are overwhelmed by pain suddenly find someone who seems to understand how they feel, they no longer feel alone and abandoned by the world. A skilled therapist can provide more than the usual kind of empathy. After years of exploring the human condition, the therapist reaches within the client's experience that at least begins to provide some meaning to explain and place in context her experience.

Preston and de Waal (2002) describes the nature of human interaction as involving an exchange of complementary emotional and thought messages. These shared representations allow people to adjust their responses based on the communicated states of others suited to relieve each others' distress. (Cited in Gruhn et al., 2008)

Grillion et al. (2008) describe the emotional exchange between client and therapist and the unique skills required of the therapist.

"When the context becomes safe enough for the client to lower his or her defenses, the alteration of regulatory structures becomes possible. The therapist's own self-regulatory movements reveal his or her inner states to the client. Much like the "good enough mother", the therapist's efforts to regulate his or her own inner states show the client that he or she is in contact with the client. Personal therapy for therapists helps to extend the range of experience that they can draw upon in their work with clients (Schore, 2006, cited in Grillion et al. (2008). According to Amini et al. (1996) the most effective interventions are based on the therapist's awareness of his or her own physical, emotional, and ideational responses to the client's veiled messages.

Accordingly, when the therapist has increasingly expanded self-integration and awareness in regard to his or her state of mind with respect to attachment, then he or she has a larger capacity for assisting clients to achieve integration and awareness. This understanding derives from the primary attachment relationship within the developmental psychobiological perspective in which parents who have secure or "earned" secure states of mind with respect to attachment function in certain ways (including attunement and sensitivity) with their infants that result in attachment security in their children. Therefore, from an attachment point of view, the more secure the therapist is, the greater the likelihood is that he or she can assist clients with achieving greater security (Beebe, 1998, cited in Grillion et al. (2008). Therapist self-awareness broadens "clinical intuition", which is referred to as the art of psychotherapy (Bugental, 1987; Schore, 2006; cited in Grillion et al. (2008). "

Thus the relationship of between therapist and client is perhaps the second most important aspect therapy, right behind client characteristics and motivation. So it is critically important that the client has a good relationship with the therapist. Clients must be willing to shop around to make sure there is a good match. Cooper (2008, quoted in Croft, 2008) makes research based recommendations for finding the right therapist.

"Think about choosing a therapist who can help you build on your strengths - for instance, if you are good at understanding why you do the things you do, a therapist who can help you develop these reflective skills may be more use to you than a therapist who wants to focus mainly on your behaviour or emotions. Ask potential therapists what thoughts they might have on why you are facing the difficulties you are and what they think might help. If these are radically different from your own understandings, it may be more difficult to establish a good working relationship. Ask yourself whether you like your therapist and feel respected by them - the quality of your relationship, early on in therapy, will be one of the best indicators of eventual outcomes, so don't put up with a bad relationship. Remember that probably the best predictor of the outcomes of therapy will be the extent to which you actively involve yourself in the process."

References

Croft, Alison. (2008, October 17). Clients, Not Practitioners, Make Therapy Work. Press release by the British Association For Counselling & Psychotherapy on a new book Cooper, Mick (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. In Medical News Today. Retrieved May 1, 2009, from http://www.medicalnewstoday.com/articles/125815.php.

Grillon, C., Pine, D., Lissek, S., Rabin, S., & Vythilingam, M. (2009). Increased Anxiety During Anticipation of Unpredictable Aversive Stimuli in Posttraumatic Stress Disorder but not in Generalized Anxiety Disorder Biological Psychiatry DOI: 10.1016/j.biopsych.2008.12.028

Grühn, D., Rebucal, K., Diehl, M., Lumley, M., & Labouvie-Vief, G. (2008). Empathy across the adult lifespan: Longitudinal and experience-sampling findings. Emotion, 8 (6), 753-765 DOI: 10.1037/a0014123

Patterson, C. H. (1984). Empathy Warmth And Genuiness In Psychotherapy: A Review Of Reviews. Psychotherapy, 21, 431-438

Patterson, C. H. (1986). Foundations For A Systematic Eclectic Psychotherapy. Psychotherapy, 29, 427-435

Verhofstadt, L., Buysse, A., Ickes, W., Davis, M., & Devoldre, I. (2008). Support provision in marriage: The role of emotional similarity and empathic accuracy. Emotion, 8 (6), 792-802 DOI: 10.1037/a0013976

Since I heard of all the excitement in the therapy literature about forgiveness therapy, I've been a skeptic. I've worked with a lot of people who have experienced unforgivable abuse. Often they are tortured by their feelings of anger, resentment, helplessness, violation, and shame for allowing themselves to be a victim. They also feel guilt about their anger with the perpetrator so much so they feel morally obligated to forgive the perpetrator. When they do, they seem to feel no personal relief from forgiveness except for less anger and guilt and a better relationship with the perpetrator. But they seem no closer to recovery than before.

I work with persons with depression and anxiety, as well as long standing serious problems with relationships (personality disorder) due to growing up in a chaotic environment. So it is conceivable that forgiveness therapy may have been designed for a healthier population. Seeking to try to better understand this dilemma, I attended a great conference recently taught by Mary Hayes Grieco and colleagues on forgiveness therapy. From the conference flyer:

"This day-long course is intended to introduce the counseling professional to a model of wholistic psychological health and an effective method for accomplishing forgiveness that is one of the most useful tools for therapy available today.

You will:

• review current research linking forgiveness with stress reduction


• learn the Psychosynthesis Model of psychological health and wholeness


• learn The Eight Steps of forgiving another and the steps of self forgiveness


• understand how forgiveness brings healing into a family system


• learn how forgiveness brings integration and closure to trauma survivors


• develop strategies for applying the eight steps of forgiveness in a clinical practice

The course material reflects the connection between spirituality and emotional healing but the content is inclusive and non-denominational. We will discuss how to incorporate these concepts appropriately in a secular setting."

It was a small class of 17. Mary and her three assistants seemed to thrive in a small group setting. The atmosphere was most comfortable for listening and it allowed Mary to shine with her skill of personal connection. I got a sense of her therapeutic leadership skills, her gentle and humorous style, and her amazing ability to instill hope with her gentle encouragement. Her eyes positively sparkle with warmth, confidence and belief in her method. She succeeds as well as anyone I've seen providing a secular foundation for spirituality even though her foundations are clearly religious.

She defines forgiveness functionally, rather than semantically. To forgive is to release an expectation that is causing one to suffer, to cancel a debt of demands and expectations that one is holding on to, and to dissolve an attachment that blocks one's flow of love and energy. This is not the moralistic obligatory forgiveness that seems to have locked many of my clients in place.

The core of her method follows:

"The Eight Steps of Forgiveness of Another

1. State your will to make a change in attitude
2. Express your emotions about what happened
3. Cancel the expectation(s) you are holding in your mind
   • Shift expectation to positive preference
   • Acknowledge reality
   • Re-state your will to move on; open up to getting your needs met in a different way
   • Release the expectation with words and inner letting go
4. Open up to the Universe to receive exactly what you need
5. Sort out the boundaries: give them responsibility for their actions and take yours; visualize your personal space like a sphere of light around you
6. Send unconditional love to the person
7. See the good in them or in the situation
8. See the good

Notice the physical change and take time to gently integrate it."

Other authors have a bit more elaborate definition of forgiveness. Enright and Fitzgibbons (2000, p. 29), in their book Helping Clients Forgive, defines forgiveness as, after validating the person had been unfairly treated, a person chooses to forgive by willfully abandoning resentment (to which they have a right) and endeavor to respond to the wrongdoer based on the moral principal of beneficence (providing aid without thought of reciprocity or restitution), which may include compassion, unconditional worth (because he is human), generosity (in receiving more than what he deserves), and moral love (concern and respect to which the wrongdoer, by nature of the hurtful act or acts, has no right).

They also define what forgiveness is not: pardon, legal mercy, leniency, condoning, excusing, reconciliation, conciliation, justification, forgetting, restitution, forgiveness for self only. It is not the same as incomplete synonyms of letting time heal, abandoning resentment, possessing positive feelings, saying "i forgive you", making a decision to forgive. They also note confusing similar concepts. Forgiveness is not a quick fix for most. Acceptance and moving on doesn't involve how one feels about the offender. Nor is it in any way cloaked revenge.

Clearly, the forgiveness I had in mind is not what is described here. I had in mind the moralistic obligation to "turn the other cheek", something I've never understood. Mary confidently asserts in her brochure:

"Recent research on the relationship of forgiveness to health and happiness demonstrates empirically what religions and philosophers have suggested throughout history: that forgiveness is necessary in order to find peace from life's hurts, losses and disappointments. The ability to move on is critical to completing the emotional healing process. "

I think at this point I agree with everything but the use of the word "necessary". The literature review in the presentation gives a compelling argument for the value of forgiveness. But I don't believe I've seen a proof that it is necessary. What the method does contain seems to be a bit broader concept of change. Franz Alexander et al. (1946) defined "the corrective emotional experience:

"In all forms of etiological psychotherapy, the basic therapeutic principle is the same: to re-expose the patient, under more favorable circumstances, to emotional situations which he could not handle in the past. The patient, in order to be helped, must undergo a corrective emotional experience suitable to repair the traumatic influence of previous experiences. It is of secondary importance whether this corrective experience takes place during treatment in the transference relationship, or parallel with the treatment in the daily life of the patient."

In my clinical experience, there are two major obstacles to the effectiveness of forgiveness. Reed and Enright (2006) describes them well:

"Women who have experienced spousal emotional abuse present at least two unique challenges for recovery. First, learned helplessness (Sackett & Saunders, 1999) develops as a pattern of self-blame in response to the criticism and ridicule by the abusive spouse and often remains well beyond the end of the abusive relationship (Dutton & Painter, 1993). "If only I had done this to please him" quickly deteriorates in the ongoing, unpredictable stress of the abusive relationship to "I am trying to prevent this, but nothing is working" and remains in a residual "Maybe I am worthless and none of my decisions are valid." Therefore, any treatment for these women should demonstrate outcomes in practical decision making and moral decision making....

Second, Seagull and Seagull (1991) described an obstacle to recovery for emotionally abused women labeled accusatory suffering, which entails maintaining resentment and victim status. The assumption in accusatory suffering is that healing the wounds of the abuse will somehow let the perpetrator off the hook. At a deeper level, accusatory suffering may be seen as a defense against the fear that the woman is somehow responsible for her own victimization, a fear that is often inculcated by the victimizer (Sackett & Saunders, 1999). Seagull and Seagull (1991) argued that although accusatory suffering (resentment and victim status) may function as a temporary strategy to help the woman adapt to the extreme experience of spousal emotional abuse, it seriously hinders substantial post-relationship, post-crisis recovery. Therefore, any treatment for these women should demonstrate a change in victim status."

Each of these two obstacles represent major challenges to clients from highly traumatic and abusive environments. The risk of attempting forgiveness prematurely potentially could lock in place both a sense of helplessness and personal responsibility. In that case, forgiveness removes the resentment and improves the broken relationship, it leaves in place the client's vulnerability to recurrence. Reed and Enright (2006) continues:

"The FT client is encouraged to tell her own unique story of the abuse experience, with the purpose of working through this story to a healthy resolution that includes forgiveness. During the forgiveness process, the client does the hard work of uncovering anger and shame, grieving the undeserved pain from the abuse, and reframing the former partner (personal history, fallibility, and culpability, yet inherent human worth), with the purpose of relinquishing debilitating resentment."

Key here is the clients' ability to uncover and own their anger and, in particular, the underlying shame. The anger and resentment serves to both motivate the client to face her fears and change their circumstances, while protecting her sense of self from her underlying feeling of responsibility for having allowed the abuse and her own aggressive impulses to avenge their mistreatment. If the resentment is released prematurely, before the shame has been recognized and resolved, the client may be left will little emotional energy to move beyond self-loathing. From Greenberg and Pascual-Leone (2006):

"maladaptive shame can be transformed into self-acceptance by accessing anger at violation, self-soothing, compassion, and pride. Thus, the action tendency to shrink into the ground in shame or to flee in fear is transformed by the tendency to thrust forward as part of newly accessed anger at violation or pride at accomplishment. This sequentially ordered pattern is what actually creates confidence."

Thus the negative emotion actually combines with natural positive emotions to trigger a transformation.

Consider this clinical description of a woman with possible borderline personality from Bridges (2006) who failed to respond with an emotional transformation.

"Her general tone is one of blame, complaint, and resentment toward her husband for being away and enjoying himself while she is left to deal with the dog's illness. Yet, at no point does she mention that she is angry or even irritated. Her inability to put her anger into words and its relationship to her later waking with a "pain in the neck" almost cries out for interpretation. When she does mention her feelings, it is in regard to the puzzling, perhaps existential statement of feeling "nervous about living a lie." When the therapist makes an explicit attempt to inquire about her feelings related to the recent incident when she had started crying, she responds not by referring to her emotions but by instead focusing on legal details. The overall impression is one of the patient's skipping over the surface of her emotional life via her pressured, externally focused speech as a stone skips over the surface of water.

To summarize, this patient with a "venting" style displayed a pattern characterized by (1) high initial heart rate (HR) with little variability that gradually decreased from beginning to end of session; (2) rapid, incessant speech involving low-intensity expression of negative emotions, primarily complaint, resentment, and externalized blame of others; (3) very low levels of emotional processing (e.g., EXP < 2) characterized by an external focus on frustrating others and events with few references to their personal relevance or meaning or her immediate in-session experience; and (4) self-reports of experiencing intense negative emotions during sessions that were incongruent with her observable emotional behavior. One of the most surprising and interesting findings was that, on a purely physiological level, venting works! This patient showed an average decrease in heart rate from the beginning to end of each session of at least 18 beats per minute (bpm) for 9 of 12 sessions. If one were using progressive relaxation or desensitization and focusing only on decreased arousal as a measure, treatment would appear to be going very well indeed. Although this is obviously not the case, at least for this patient the opportunity to go to a session each week and "get out feelings" while experiencing a very real sense of physiological relief appeared to be very reinforcing in the short term but resulted in little if any long-term change."

So it's not as simple as venting one's anger about mistreatment, but venting reinforces the self-righteous anger by providing temporary emotional relief. To make a long lasting change, it is necessary to ferret out all underlying feelings as well. Resentment often defensively covers shame. The positive aspects of anger can be a strong motivator to transform shame into behavior change. Until this emotional transformation is complete, forgiveness is premature. It's most important to note, that adaptive negative emotions are at the core of movement in transformational therapy. Here anger serves as the energy to transform the shame into pride and confidence. The "debilitating resentment" Reed and Enright (2006) speaks of is not the core of being stuck. It's the shame of an often irrational sense of personal responsibility for ones own trauma and about aggressive impulses for revenge that is covered by the resentment and prevents recovery. Thus forgiveness of the other is not the primary ingredient, but forgiveness of one's self comes first.

Is forgiveness of the offender necessary? That I think depends more on the value system of the client. I believe an emotional transformation from maladaptive anger and shame to angry determination to make changes through self-encouragement and self-nurturance is the primary driver of recovery from trauma. Many of my clients seem to readily make the transformation from resentment to angry determination. Forgiveness, if it comes at all, comes as a consequence of the primary change, effortlessly, later on, as if part of a unforced natural process. Others feel an obligation to forgive and do so as a part of recovery. Unfortunately, too many go through a forgiveness process before they have made an emotional transformation. I find myself trying to encourage them to back track to their anger, which they thought they got over, so they can finally forgive themselves.

To be sure I'm pleased to have another important tool in the therapeutic tool box. However, given the acutity of the population I work with in a short term intensive program, there is probably little utility for full blown group forgiveness therapy. But at the very least I will be much more comfortable with a clients request that they wish to learn to forgive their victimizer.

References

Alexander, F. et al. (1946). Psychoanalytic Therapy: Principles and Application. New York: Ronald Press. Retrieved April 19, 2009, from http://www.psychomedia.it/pm/modther/probpsiter/alexan-2.htm.

Bridges, M. (2006). Activating the corrective emotional experience Journal of Clinical Psychology, 62 (5), 551-568 DOI: 10.1002/jclp.20248

Enright, Robert D. and Fitzgibbons, Richard P. (2000). Helping Clients Forgive - An Empirical Guide for Resolving Anger and Restoring Hope Washington DC: American Psychological Association IBSN: 1-55798-689-4

Greenberg, L., & Pascual-Leone, A. (2006). Emotion in psychotherapy: A practice-friendly research review Journal of Clinical Psychology, 62 (5), 611-630 DOI: 10.1002/jclp.20252

Reed, G., & Enright, R. (2006). The effects of forgiveness therapy on depression, anxiety, and posttraumatic stress for women after spousal emotional abuse. Journal of Consulting and Clinical Psychology, 74 (5), 920-929 DOI: 10.1037/0022-006X.74.5.920