Our Gratitude. Steven J. Sandage, PhD, LP, Beverly Long, PsyD, LP & RichelleMoen, PhD, LP

Transcription

1 Forgiveness in Psychotherapy: New Steven J. Sandage, PhD, LP Boston University & The Danielsen Institute Beverly Long, University of Minnesota Medical School 1 Our Gratitude The research described in this presentation has been supported by grants from the FetzerInstitute (#2266, 2512), the John Templeton Foundation (#10987), the Lilly Endowment, Inc. (#2078). 2 Forgiveness: Mental Health Counselors Survey (Konstam et al, N=381 Mental Health Counselors 2. Positive attitude toward topic overall % Forgiveness in their practice % Appropriate to raise the issue 5. 51% Thought counselor s responsibility. 6. Lack of knowledge of the Interpersonal quality of forgiveness. 3 PracticeGround-October 29 th,

2 Number of PsychINFO articles with keywords forgive, forgiving, or forgiveness Templeton Forgiveness RFP Forgiveness Empirical Studies Available 1997 = 58 articles 2012 = peer-reviewed studies since : Around 450 psychological psychological dissertations on forgiveness 54 studies of forgiveness interventions (N=2,323) (Wade et al., 2014) 5 Psychological Research on Forgiveness Forgiving Others* Seeking Forgiveness Self-Forgiveness Receiving Forgiveness Inter-Group Forgiveness 6 PracticeGround-October 29 th,

3 Defining the F word Forgiveness: a process of soothing one s demand for revenge and internal avoidance and moving toward an attitude of goodwill toward one s offender (McCullough et al., 2007; Sandage, 2005; Shults & Sandage, 2003). 7 Forgiveness (Definition Cont.) An alternative to seeking revenge and requires managing the anxiety that arises when someone hurt or offends us. An inner process by which the person who has been injured releases him/herself: the anger, resentment & fear A multifaceted and a process overtime. 8 Differentiating Forgiveness Authentic Forgiveness is not: 1. Forgetting or dissociation 2. Exoneration or condoning an offense 3. Reaction formation 4. A means for taking a one-up position 5. Reconciliation 9 PracticeGround-October 29 th,

4 Slide 8 1 Richelle Moen-Moore, 10/19/ Richelle Moen-Moore, 10/19/2014

5 Benefits to holding an Attitude of Forgiveness: 1. Communicates a non-judgmental stance and an openness to the humanity of the other person 2. Others are more likely to be receptive to our feedback following conflicts 3. Working on our own internal forgivenes can help us avoid resentment and bitterness Worthington, E. (2010) 10 Memories vs. Unforgiveness: When you see the person who hurt you and feel the negative feelings (anger, fear, sadness) pop up again Having memories of past harms is our way of protecting ourselves from doing something dangerous again. 11 Science of Forgiveness 12 PracticeGround-October 29 th,

6 Science of Forgiveness Brain Scan: (Farrow, Pietrini), EEG (Harmon-Jones) Stress Cortisol: (Berry, Newman, Temoshock, McCullough) Oxytocin: (McCullough) Peripheral Physiology (HR, BP, Skin conduct, EMG, HRV) (Witvliet, Row) Behavior Forgiveness as self-control Reaction time (remember + words, IATs) Prisoners Dilemma Violence and aggression literatures Priming manipulations *Generally, forgiveness of others is positively correlated with mental and physical health (Hannon ea2011; Toussaint ea2012; Worthington ea, 2007). 13 Forgiveness & Health Forgiving Personality has been associated with reduced (Worthington et al., 2007): Depression Muscle Tension Systolic and Diastolic Blood Pressure Mean Arterial Pressure & Lower Cardiovascular Reactivity Self-Reported Illness Sensory Pain among those with Chronic Back Pain 14 Forgiveness & Health Forgiving Personality has been associated with increased(webb ea, 2013; Worthington ea, 2007): Well-Being Social Support Healthy Behaviors Substance Recovery Successful Aging Neural Activation of Anterior Cingulate Cortex (Natural pain killer, cf. Hypnosis) 15 PracticeGround-October 29 th,

7 Psychological Factors & Interpersonal Forgiveness Negative Correlates Insecure Attachment Rumination Narcissism Intercultural Defensiveness Shame-proneness Positive Correlates Secure Attachment Differentiation of Self Empathy Gratitude Hope 16 ThichNhatHanhon Forgiveness & Compassion People are not the enemy, anger is the enemy the other is the victim of violence, injustice, and hate. When you begin to understand, Compassion is born in your heart Now it is possible to forgive and not before. 17 bell hooks on Forgiveness & Compassion For me, forgiveness and compassion are always linked: how do we hold people accountable for wrongdoing and yet at the same time remain in touch with their humanity enough to believe in their capacity to be transformed? 18 PracticeGround-October 29 th,

8 Differentiation of Self Differentiation of Self (DoS) represents the capacity to balance: (a) cognitive and emotional functioning, and (b) intimacy and autonomy in relationships (Skowron & Schmitt, 2003). Solid, flexible self (Schnarch, 2009). Limited need for interpersonal fusion or cutoff. Skills in self-regulation or self-soothing. 19 E1 E2 R 2 =.34 Differentiation of Self.35*** Humility R 2 =.48.63*** Forgivingness.20*** *** -1.68* R 2 =.29 Depression Symptoms E3 (Jankowski, Sandage, & Hill, 2013; N=213): Multiple mediation model predicting depression symptoms. Note: Unstandardized coefficients are presented. Overall model:f(3, 209) = 27.90, p=.00, R 2 =.29. Specific indirect effect between forgivingness and depression symptoms through DoS: B= -1.62, SE=.34, BC 95% CI (-2.34, -1.03). Specific indirect effect between forgivingness and depression symptoms through humility: B= -.33, SE=.19, BC 95% CI (-.80, -.04). Specific indirect effect through DoSand then through humility: B= -.37, SE=.21, BC 95% CI (-.89, -.02). *p <.05, **p <.01, ***p < Can People Be Helped to Forgive? Wade, N. G., Hoyt, W. T., Kidwell, J. E. M., & Worthington, E. L., Jr. (2014). Efficacy of psychotherapeutic interventions to promote forgiveness: A meta-analysis. Journal of Consulting and Clinical Psychology, 82(1), studies (N=2,323) Avgeffect size +.56 cf. no tx; + cf. alternative tx Forgiveness in psychoeducational groups: Hour for hour, all forgiveness treatments that have been investigated have been found to be equal. Efficacy is proportional to time in treatment. 21 PracticeGround-October 29 th,

9 Other Outcomes from Forgiveness Interventions Wade et al Depression (k = 10), ES = 0.34, 95% CI [0.17, 0.52]. Compare forgiveness in this same group of studies, ES = 0.60, 95% CI [0.26, 0.94] (p =.09). Anxiety (k = 7), the aggregate effect size for anxiety was 0.63, 95% CI [0.0003, 1.26]. Compare forgiveness ES= 1.34, 95% CI [0.55, 2.12] (p =.21). Hope (k = 6), the aggregate effect size for hope was 1.00, 95% CI [0.38, 1.62]. Compare forgiveness ES = 0.94, 95% CI [0.16, 1.73] (p.96). Conclusion When people participate in forgiveness interventions, their depression and anxiety get better but at a reduced rate relative to the forgiveness experienced (about half the effect size), but hope gets better about the same rate (equal effect size). 22 Forgiveness & Diversity Considerations 23 Forgiveness in Cultural Context (Sandage& Williamson, 2005) Forgiveness theorists often ignore the context in which forgiveness occurs. (Lamb & Murphy, 2002) There is a great need for indigenous psychologies of virtues like forgiveness (Sandage, Hill, & Vang, 2003). 24 PracticeGround-October 29 th,

10 Collectivistic Forgiveness I don t want them to be criminal. I want them to have peace. Cambodian-American Buddhist participant in study explaining his reason for forgiving someone (Cook, Sandage, Hill, & Strawn, 2009) 25 Hmong Filial Piety & Forgiveness (Sandage, Hill, & Vang, 2003) We have always said, After a family argues, they still sleep in the same bed. For brothers, even after an argument, it is them who prepare your funeral and you who prepares theirs. Male (age 47) 26 Sharon Lamb, Before Forgiving Concerning women, and particularly women who have been abused, the idea of offering forgiveness toward unrepentant perpetrators in an effort to help a woman free herself from anger is dangerous and plays into deep stereotypes of women s essential nature. 27 PracticeGround-October 29 th,

11 Balancing Forgiveness & Justice Dialectics Forgiveness and justice are related in this way. To claim forgiveness while perpetuating injustice is to live a fiction; to fight for justice without also being prepared to offer forgiveness is to render your struggle null and void. Kenneth Kaunda 28 Relational Spirituality Relational Spirituality(Shults & Sandage, 2006): ways of relating to God and the sacred. Images of God and the sacred are shaped by neurobiological relational templates. Spiritual health & pathology 29 Spirituality/Religious Factors & Forgiveness Negative Correlates Spiritual Instability Spiritual Disappointment Insecure Attachment w/ God Spiritual Grandiosity Positive Correlates Positive Religious Coping Intrinsic Religiosity Secure Attachment w/ God Meditative Prayer 30 PracticeGround-October 29 th,

12 Jon Kabat-Zinnon Forgiveness Dialectics: Joy & Sorrow We do a lovingkindness meditation to give people a taste of the power a concentrated and calm mind can generate when evoking feelings of kindness, generosity, goodwill, love, and forgiveness. The response is invariably moving; a great many tears are shed, both in joy and in sorrow. 31 Forgiveness, Spirituality, & Religion Varieties of S/R orientations and experiences Ethical norms & obligations? Currently in S/R transition? Relational templates S/R sources of healthy practices and motivations? Sources of pathology or dysregulation? 32 Forgiveness, Trauma, & Clinical Applications 33 PracticeGround-October 29 th,

13 Trauma, Forgiveness, and Spirituality Trauma involves threats to survival or other extreme danger Psychologically, trauma can activate overwhelming levels of attachment anxiety, which leads to contrasting response patterns of hyperarousaland dissociation, intrusive re-experiencing and emotional numbing (Shore, 2012). At a spiritual or existential level, trauma can sometimes shift a person s basic trust in benevolence or justice in the universe (Bryant-Davis & Wong, 2013) Traumatized Brain & Forgiveness The traumatized brain is poised for battle (Cozolino, 2006), but fear-based arousal can promote fight, flight, or freeze responses. In trauma survivors, unforgiveness can often be understood as anxiety-based, selfprotective responses to perceptions that danger is ongoing. In some cases, danger may actually be ongoing, but in other cases the chronic mobilization of defenses reflects a re-experiencing of trauma and activation of the autonomic nervous system. (Worthington & Sandage, 2014) Trauma & Attachment It is particularly tragic when trauma templates formed in relation to past perpetrators activate symptoms of generalized unforgiveness, which rupture or erode new relationships. Those with fearful/disorganized styles of attachment are particularly at risk to eventually live in a kind of angry, defensive fortress with a shrinking set of attachments due to conflicts and cutoffs. PracticeGround-October 29 th,

14 A Pilot Study Forgiveness in the Txof BPD We developed a curriculum for four weeks, using the REACH model adapted for DBT. We designed it to be psychoeducational in nature. We had participants, before starting the module, pick a situation of moderate intensity to practice the REACH model We had them pick something that occurred once, not repeatedly They reviewed it with their individual DBT therapist and had the therapist sign off that it was something appropriate to the stage of treatment We reminded them repeatedly to stick to the one situation, rather than bringing in others Worthington s REACH Model Recall the Hurt (in helpful ways) Empathize Altruistic Gift Commit Hold onto Forgiveness h/ 38 Forgiveness Groups We ran the groups like DBT Skills groups, and repeatedly reminded participants of the structure to avoid getting into a process group style, and to help with emotional containment. We kept the structure of Beginning with mindfulness exercise Review of diary cards (skills) and homework Presentation of new material Assignment of homework Wind-down exercise (Observe and Describe) PracticeGround-October 29 th,

15 The Forgiveness module came immediately after the Distress Tolerance module. We had contemplated doing it after the Interpersonal Effectiveness module, since BPD individuals lack of forgiveness can impact their relationships, but chose to have it after Radical Acceptance. Measures were done at four points: At the beginning of Distress Tolerance At the end of DT/beginning of Forgiveness At the end of Forgiveness Six weeks after the end of the Forgiveness module (which would have been during the Interpersonal Effectiveness module for those that had not graduated) Some Observations Participants were anxious at the first session P s seemed to be visibly relieved that they were doing this for themselves, not for the offender P s expressed surprise that forgiveness did not mean they had to talk to the offender P s were surprised that they did not need to know all the reasons the offense happened Forgiveness did not involve forgetting or even reestablishing a relationship with the offender More Observations One P noted that she now had a blue print with the steps for forgiving something if she wanted to P s felt it was helpful to define forgiveness and justice, and to know the differences (and similarities) P s liked the emphasis on empathy PracticeGround-October 29 th,

16 Future Directions P s felt they would like more information on applying it to themselves they noted it was much harder to forgive themselves than others Forgiveness in Couples & Family Therapy Form attachment with couple Assess trauma, safety & diversity factors Cultivate emotion regulation & validation skills (but not dependence on other-validation) Normalize reality of difference Process disappointment & grief Facilitate differentiation of self & empathy, particularly through modeling/alliance Explore anxiety-provoking dilemmas & choices related to forgiveness and collaboration 44 PracticeGround-October 29 th,