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Differential Effects of Emotion Focused Therapy and Psycho-education in Facilitating
Forgiveness and Letting Go of Emotional Injuries
Leslie S. Greenberg, Serine H. Warwar, Wanda M. Malcolm
York University, Toronto
Correspondence should be sent to the first author Leslie S. Greenberg, Dept. of Psychology York
University 4700 Keele St. Toronto, ON, Canada M3J 1P3. Email: lgrnberg@yorku.ca
This study was supported by a grant ID# CRF 5202 from the Campaign for forgiveness research
to the first author.
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Abstract
This study compared the effectiveness of Emotion-focused Therapy (EFT) involving gestalt
empty-chair dialogue in the treatment of individuals who were emotionally injured by a
significant other with a psycho-education group designed to deal with these injuries. In addition,
this study examined aspects of the emotional process of forgiveness in resolving interpersonal
injuries and investigated the relationship between letting go of distressing feelings and
forgiveness. A total of forty-six clients assessed as having unresolved, interpersonal, emotional
injuries were randomly assigned to an individual therapy treatment of EFT or a psycho-education
group. Clients were assessed pre-treatment, post-treatment, and at 3-month follow-up on
measures of forgiveness, letting go, depression, global symptoms, and key target complaints.
Results indicated that clients in EFT using empty chair dialogue showed significantly more
improvement than the psycho-education treatment on all measures of forgiveness and letting go,
as well as global symptoms and key target complaints.
Key words
Interpersonal injuries, Forgiveness, Letting go, Emotion-focused therapy, Psycho-education
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Differential Effects of Emotion Focused Therapy and Psycho-education in Facilitating
Forgiveness and Letting Go of Emotional Injuries
Forgiveness has recently been proposed as an important aspect of emotional recovery
following an interpersonal injury (Enright & Fitzgibbons, 2000; Worthington, 1998, 2001).
Although the debate continues as to whether forgiveness should be granted to injurers when they
will not take responsibility for their actions, or when they continue to perpetuate harmful acts
(Worthington, 2005), forgiveness has been shown to have a positive impact on physical,
relational, mental and spiritual health, whereas unforgiveness can be distressing and may leave
people ruminating about their injuries and feeling hostile towards those who injured them
(Witvliet, Ludwig, & Vander Laan, 2001). The majority of studies on the facilitation of
forgiveness (Al-Mabuk, Enright & Cardis, 1995; Hebl & Enright, 1993; McCullough &
Worthington, 1995; Ripley & Worthington, 2002; Worthington & Drinkard, 2000; Wade,
Worthington, & Meyer, 2005) have involved psycho-educational group programs designed to
promote the benefits of forgiveness to self and others, and these provide the knowledge and skills
associated with a particular model of forgiveness. To date only two studies have been published
that report on an investigation of the effectiveness of individual therapy in facilitating unilateral
forgiveness (Coyle and Enright, 1997; Freedman and Enright, 1996). The present study
examined the effectiveness of Emotion-focused Therapy (EFT) compared to a psychoeducational group in facilitating emotional resolution and forgiveness.
Numerous investigators have proposed that both emotion work and empathy play
important roles in forgiveness (Davenport, 1991; Enright & Fitzgibbons, 2000; Fitzgibbons,
1986; Hope, 1987; Karen, 2001; Malcolm, Warwar, & Greenberg, 2005). One of the
assumptions of EFT is that the blocking of primary biologically adaptive emotions subverts
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healthy boundary setting, self-respectful anger and necessary grieving, and that adequate
processing of unresolved emotion leads to its transformation (Greenberg, 2002). Many clinicians
(Akhtar, 2002; Baures, 1996; Enright & Eastin, 1992) emphasize the value of facilitating insession expressions of adaptive anger at violation, and suggest that facilitating forgiveness
requires an acknowledgement of the legitimacy of emotions such as resentment and hatred
towards the offender. Baures (1996), Boss (1997), and Fincham (2000) consider resentment and
desires for revenge to be closely linked with self-respect, and Greenberg and Paivio (1997)
suggest that there may be times when it is therapeutic to encourage clients to talk about their
revenge fantasies. From these perspectives, the desire to retaliate is normalized as a sign of how
damaged the injured person feels. Encouraging such expressions in therapy is not the same thing
as promoting outer-directed blaming or hurling of insults. In encouraging clients to speak from
their inner experiences of violation, the therapist is promoting ownership of a client’s emotional
experience and is empowering clients to appropriately assign responsibility for harm done.
Ownership of emotion also helps clients focus on their own needs and concerns rather than
getting stuck in blaming the other or feeling victimized. The danger in short-circuiting
expressions of anger as might occur in some treatments is that the client may end up condoning
or excusing the injurer’s hurtful behavior, or inappropriately take too much responsibility for the
unfolding of events that surrounded the injury.
Therapists also need to facilitate the process of grieving the loss of, or damage to, a
significant relationship, as well as the shattering of the client’s view of self and the world that
may have been caused by the injury. Akhtar (2002) addresses the relationship between mourning
and forgiveness, and Greenberg and Paivio (1997) emphasize that work with betrayal and
abandonment often involves a process of facilitating normal grieving in which anger and sadness
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play central roles. Facilitating an imaginary dialogue with the injurer can help the client grieve
and say goodbye to what has been lost or irreparably damaged as a consequence of the injury
(Greenberg Rice & Elliott 1993; Elliott, Watson, Goldman & Greenberg 2004).
Emotion-focused Therapy (Greenberg 2002), which employs empty-chair dialogue for
the resolution of unfinished business as one of its major methods has been found to be an
effective intervention in the treatment of depression, interpersonal problems and trauma
(Greenberg & Watson, 1998, 2005, Paivio & Greenberg, 1995; Paivio & Niewenhaus, 2001).
Paivio and Greenberg’s (1995) comparative study of a psycho-educational group intervention
versus individual EFT using gestalt empty-chair dialogue in the resolution of unfinished
business, supported the efficacy of the empty-chair intervention. The results demonstrated a
significant reduction in symptomotology, target complaints, and interpersonal distress and more
resolution of unfinished business. The empty-chair method as it is employed in EFT is also a
particularly effective tool in promoting empathy felt toward the offender (Paivio, Hall,
Holowaty, Jellis, & Tran, 2001;Paivio & Nieuwenhuis 2001; Paivio & Greenberg, 1995). In
imaginatively bringing the injurer and injury alive, the client moves from a cognitive discussion
with the therapist, to an imaginal confrontation and dialogue with the injurer. In so doing, the
client is helped to move reified inner representations of self and other (injurer) into a transitional
space in conscious awareness where the representations can be re-examined, reworked, and
resolved.
Empirical evidence also is mounting in support of the importance of transforming
emotions by changing one emotion with another emotion (Frederickson, 1998; Greenberg 2002,
2004), and this suggests that a maladaptive emotion state can be effectively transformed by
undoing it with the presence of another more adaptive emotion. More specifically Frederickson,
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Marcuso, Branigun & Tugade (2002) have shown that positive emotion undoes the
cardiovascular after-effects of negative emotion. Greenberg (2002) has suggested that the key to
transforming maladaptive emotions is to access alternate healthy adaptive emotions to act as
resources in the self. Thus, in an emotion-focused treatment, feelings related to unforgiveness
such as anger, contempt and pain are eventually changed by accessing feelings of sadness,
compassion, empathy and concern.
McCullough and his colleagues have shown that empathy for the perpetrator mediates
successful forgiveness (McCullough, Worthington, & Rachal, 1997; McCullough, Rachal,
Sandage, & Worthington, 1997). This proposition is consistent with clinical observation, theory,
and empirical evidence concerning forgiveness (Macaskill, Maltby, & Day, 2002; McCullough,
Worthington, & Rachal, 1997; McCullough, Rachal, Sandage, & Worthington, 1997;
Worthington & Wade, 1999). When accessed, empathy involves understanding another’s
feelings and is a complex cognitive/affective state that facilitates forgiveness of an interpersonal
injury. As Rowe et al. (1989) have pointed out, empathy towards the injurer involves being able
to see the other person as acting in a quintessentially human manner, which flows out of the
context of his or her own self-focused needs and perceptions. This includes (but does not require)
the possibility of recognizing that what the injurer did was similar to something one has done, or
could do under the same circumstances. In addition to assisting in the revision of how one sees
the injurer, cognitive perspective taking sometimes allows the injury itself to be recast within a
broader understanding of the context of the unfolding of events. However, cognitive perspective
taking of this nature does not have to involve warm benevolent feelings associated with
forgiveness. Something more is required for forgiveness and this appears to be compassion for
the injurer, or affective empathy.
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Affective empathy is best understood as a means of imaginative entry into the world of
the other, which generates a bodily felt sense of understanding what the other person may have
been feeling, without actually sharing the same experience (Greenberg & Rosenberg, 2003).
Berecz (2001) suggests that the task for the injured person is to imaginatively transpose himself
or herself into the other person’s place in an attempt to understand the unfolding of events from
the injurer’s perspective.
Unforgiveness has been defined as the combination of a complex set of negative feelings
towards an injurer, and it has been shown that people can decrease unforgiveness without
increasing forgiveness (Worthington, Sandage & Berry, 2000; Worthington & Wade, 1999).
Unforgiveness is regarded as being stuck in negative emotions and a hyperaroused stress
response through rumination (Harris, & Thoresen, 2005). It is noteworthy that reducing
unforgiveness is not the same as promoting forgiveness. Forgiveness seems to include the
reduction of unforgiveness, or letting go, through decreasing negative feelings and thoughts in
relation to the injurer. In addition to, and in contrast with letting go or reducing unforgiveness,
forgiveness is also comprised of the increase of positive emotions such as compassion, empathy
or understanding felt towards the injurer.
In our view, forgiveness thus appears to involve two important emotional processes:
resolving the hurt and anger involved in the injury; and the possible generation of positive
feelings of compassion, loving, kindness and empathic concern for the injurer. People thus may
be able to resolve emotional injuries, by reducing or letting go of their bad feelings, or by letting
go of bad feelings and increasing positive feelings ie: by forgiving.
The main purpose of the present study was to evaluate the effectiveness of Emotionfocused Therapy (EFT) (Greenberg et al., 1993) involving empty-chair dialogue in the treatment
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of individuals who had been emotionally injured by a significant other. Empty-chair work was
used to facilitate emotional transformation by: both expressing and processing the anger and
sadness to the offender; facilitating empathy; and asking clients to play the role of the injurer,
thereby having them imagine what the injurer might feel if he or she were capable of
comprehending the consequences and impact of his or her actions on the client. The primary
hypothesis was that EFT, which used empty-chair dialogue to process unresolved emotion,
would produce better outcomes than a psycho-education group (PG) in the treatment of
interpersonal, emotional injuries on measures of forgiveness and letting go, and other indices of
outcome. It was assumed that an experiential treatment such as EFT that works by evoking,
processing and transforming emotion would address the emotional causes of the injury more
directly than a psycho-education group that was less emotion-activating.
This study also examined the emotional process of forgiveness in resolving interpersonal
injury and evaluated whether forgiveness was necessary to resolution of the injury. In the
present study, recovery from an emotional injury therefore was conceptualized as occurring in
one of the following two ways: 1) forgiving the injurer, which was defined as letting go of
unresolved bad feelings or reducing unforgiveness plus the development of empathy and
compassion for the other; or 2) letting go of the bad feelings which involves letting go of unmet
needs and negative feelings in relation to the injury or injurer and changing negative perceptions
of self in relation to the injury or injurer, without the development of empathy and compassion
for the other. The second hypothesis was that all people who forgave would let go of bad
feelings but that not all who let go would forgive. The third hypothesis was that reported
emotional arousal would be higher in the EFT, than in PG
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Treatment focused on facilitating the resolution of specific unresolved interpersonal,
emotional injuries that had occurred at least two years prior to the start of therapy and continued
to be distressing. The injuries that clients brought to treatment were both emotional and
interpersonal; they were emotional in that they involved intense lingering unresolved feelings of
hurt or anger and betrayal, and they were interpersonal in that the injurer was a significant other
in the injured person’s life. Injuries involved abandonment, betrayals or violations by significant
others, such a friends, bosses, family members, or intimate partners.
Method
Participants
The sample for the present study consisted of 46 clients who had an unresolved
interpersonal, emotional injury with a significant other that had occurred at least two years prior
to commencing treatment. The requirement that the injury not be more recent was to ensure that
the natural process of recovering from hurts had been given time to work and that the injured
person was not in the midst of coping with the immediate aftermath of the injury. Participants
were required to be 18 years of age or older. Exclusion criteria for the study, based on the
assumption a brief treatment program would be unsuitable for some people, were as follows:
victims of incest; individuals who had attempted suicide or had lost a significant other in the past
year; those currently in physically violent relationships; individuals currently abusing drugs or
alcohol; individuals diagnosed with antisocial, borderline or narcissistic personality disorder,
post-traumatic stress disorder, or a psychotic disorder. Individuals who were already in
psychotherapy elsewhere were also excluded.
The average age for clients in the EFT treatment was 43 years. The average age for the
PG treatment was 46. The overall population thus had a mean age of 44.5 and S.D = 8.3 (range
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22 - 67). There were seven males and 16 females in the EFT treatment and 13 males and 10
females in the PG treatment. In the EFT treatment, eight individuals had never been married, 13
were married, and two were separated or divorced. In the PG treatment, five had never been
married, nine were married, and nine were separated or divorced. In terms of their level of
education, in the EFT treatment one individual had completed high school, three had some
college or university training, 12 had graduated from college or university, and seven had
postgraduate experience. In the PG treatment, five individuals had completed high school, three
had some college or university training, six had graduated from college or university, and nine
had postgraduate experience. Ethnicity in both groups was predominantly Caucasian with 1
client of South Asian and one of East Asian origins in each treatment group.
In terms of pre-treatment diagnosis on DSM Axis I and II, there were nine clients (39%)
with a least one Axis I diagnosis in the EFT treatment, and seven clients (30%) with at least one
Axis I diagnosis in the PG treatment. In the EFT treatment there were six clients with at least one
Axis II diagnosis, and in the PG treatment there were at least four clients with an Axis II
diagnosis. The mean Global Assessment of Functioning was 77 for each treatment, with the
range being 65-95 for the EFT treatment and 60-90 for the PG treatment. There were no
statistically significant differences between treatment conditions on any of these variables.
Emotional Injuries
The types of emotional injuries clients presented in this study, and the nature of the
relationship with the significant other are summarized in Table 1. Each participant targetd one
injury. Parents were the main perpetrators of the injuries. In the EFT treatment, 18 (78%) of the
clients were dealing with an interpersonal injury in relation to at least one parent and two (8%)
with an ex-partner, while in the PG treatment, 13 (57%) of the participants were dealing with an
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injury regarding at least one parent and five (21%) with an ex-partner. The people in the “other”
category included a boss, a neighbor, and people in non-parental positions of power relative to
children.
Therapists
There were eight therapists in the EFT condition, two of whom were male and six female.
Two of the therapists were registered psychologists, one had a doctorate and five were advanced
doctoral students in clinical psychology. Prior to training for the treatment study, all therapists
were required to have at least one year of EFT therapy training including prior empathy training,
and one year of experience as a therapist. Therapists in the EFT treatment received an additional
30 hours of specialized training based on a treatment manual for resolving emotional injuries
developed for this project (Greenberg, Malcolm & Warwar, 2002). The group had two leaders.
One of the group leaders was a registered psychologist who had devised the PG treatment and
conducted it on a number of prior occasions. The co-leader was a doctoral student and was
trained by the first leader. The therapists in both treatment conditions received weekly
supervision throughout the study to promote adherence to treatment manuals.
Treatments
Both interventions involved 12 hours of treatment distributed over approximately 12
weeks.
Emotion Focused Therapy
The treatment manual for this study is based on the principles outlined for Emotionfocused Therapy (EFT) (Greenberg et al., 1993; Greenberg, 2002), also known as Processexperiential therapy. This therapy includes the implementation of the person-centered relational
attitudes of empathy, positive regard, and congruence, as well as marker-guided, process
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directive, experiential interventions. In EFT, the therapist uses the following interventions:
gestalt two-chair dialogues when clients present in-session self-evaluative conflicts; clientcentered systematic evocative unfolding for problematic reactions over which clients are
puzzling; and gestalt empty-chair dialogue for resolving currently felt unfinished business with a
significant other. Focusing (Gendlin, 1996) is also utilized in this approach to assist clients in
attending to their internal experience and to obtain a bodily felt sense of the issues they are
exploring and struggling with (Gendlin, 1996, Greenberg et al., 1993). The emphasis in EFT is
on accessing primary adaptive feelings and maladaptive emotion schemes in order to make them
amenable to change (Greenberg, 1993, Greenberg & Paivio, 1997).
A specialized EFT treatment manual (Greenberg, Malcolm, & Warwar, 2002) was
developed for this project to focus on facilitating the resolution of emotional interpersonal
injuries. The treatment protocol is summarized in the following four phases which overlap rather
than being purely sequentially.
Phase I: Creating an Alliance. The first phase of treatment involves creating a
therapeutic alliance with the client by empathically responding to and validating the client’s pain
and emotional experience of the interpersonal injury. This stage also entails helping clients to
identity the impact of the injury and articulate and clarify the most problematic aspects of the
injury for them.
Phase II: Evocation and Exploration. The second phase of treatment involves
acknowledging, experiencing, and expressing the anger, sadness, pain, and other distressing
feelings associated with the emotional injury. Empty chair work is utilized to help clients
process unresolved feelings towards the injurer. Therapists were advised to begin work on
Evocation and Exploration as early as the second session if the injury was clear and safety and
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the bond seemed to be sufficiently strong no later than the 3rd session if the client appeared
ready, and to continue up until the pen ultimate session if needed. Empty chair work however
was not to be done in every session but if suitable in at least half the sessions in the evocation
phase. The next two phases integrate within and overlap with phase 2.
Phase III: Self-Interruptive Work. The third phase of therapy involves interventions
facilitated by therapists at client markers of interruption such as emotional constriction,
resignation, or hopelessness. These interventions are aimed at turning the passive, automatic
process of interruption into an active one. This phase aims to heighten clients’ awareness of how
they interrupt themselves and to promote change in these interruptive processes so that emotions
preventing resolution can be accessed and processed.
Phase IV: Empowerment and Letting Go or Forgiving. This final phase entails accessing
previously unexpressed emotions, and mobilizing and promoting the entitlement of unmet needs.
The therapist promotes a change in the way the client views the injurer, facilitated by emotional
arousal and accessing of past unmet needs. This phase also involves helping clients grieve and
let go of unmet needs. Elaborating the world-view of the other aids empathy towards the injurer
and the therapist helps the client understand or hold the other accountable.
Homework. Clients were asked to complete homework throughout the course of
treatment. At the start, they were asked to keep a diary of their feelings and thoughts in relation
to their injuries and to note how the therapy sessions played a role in their change processes. At
session six, clients were given a handout which instructed them to write an unmailed letter to the
injurer accusing the injurer of knowing the impact of his or her hurtful behavior. The second
part of this homework exercise instructed clients to write a letter in response to themselves
denying the accusation from the perspective of the person who injured them. This was done to
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highlight that change was to come from the client, not the perpetrator, as the perpetrator may
never change. At session seven, clients were given some definitions of forgiveness and asked to
think about their understanding of forgiveness and to consider whether forgiveness was
important to them personally with respect to their emotional injuries. At session eight, clients
were given a handout which asked them to reflect on the bond that still held them to the injurer,
and to write down their difficulties in letting go of the emotional injury and what was sustaining
the painful feelings. These were discussed in the session
Psychoeducation Group
The psycho-education group manual (PG) was devised for this study (Malcolm, 2001)
and drew on various sources for content (Bolger, 1999; Klassen, 2001; Paivio & Greenberg,
1995; Smedes, 1984; Worthington and Drinkard, 2000). The six workshops were facilitated by
the two workshop leaders. The introductory session provided an overview of all the sessions,
along with a rationale for participating in the study and an explanation of the differences between
PG and group therapy. Sessions two through five included a discussion of the previous session’s
homework, a topic presentation by the facilitators, a coffee break with a personal reflection task
and then group discussion of the presentation and personal reflection. Each session ended with
the assignment of a homework task to be done between sessions and completion of session
measures. The content presentations covered the following topics: the nature and structure of an
emotional injury; understanding unfinished business and how it disrupts adaptive functioning;
aspects of forgiveness, including what it is and is not, and why one would be motivated to
forgive in the face of being hurt by another person; the role of pain and other strong emotions in
experiencing and recovering from interpersonal emotional injuries; the process of reconciliation
with the hurtful other and how it differs from forgiveness; and finally how to resolve an injury.
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The content presentation of the first session was short and group discussion intentionally
structured to create safety and assure group members that their participation in the group
discussions was voluntary and at their discretion. The final session reviewed the material
presented in the first five sessions and instead of a homework assignment, a bibliography was
provided for those interested in further reading on the topics covered in the workshops.
The PG group members received the same homework as those in individual therapy, in
the same order and at approximately the same time intervals. They also received additional
journaling and reflection exercises in order to provide homework assignments after each of the
first five workshops. It was assumed that any change experienced in the PG group would be the
result of discussion of and reflection on the information provided, which would produce change
in attitude(s). It was further assumed that attitude change would in turn change the feelings
participants had toward the injurer and injury.
Measures
A battery of self-report measures was administered before and after treatment to assess
changes in specific domains. All clients were assessed approximately one week prior to
treatment and one week following treatment. Clients were also assessed at a three-month followup on measures of letting go, forgiveness, level of depression, global symptoms, and target
complaints.
Forgiveness Measures
The Enright Forgiveness Inventory (Enright, Rique & Coyle, 2000). The Enright
Forgiveness Inventory is a measure of the degree to which one person forgives another who has
hurt him or her deeply or unfairly. The first part of the inventory instructs individuals to visualize
the emotional injury, focus on the offending person, and imagine what happened. The
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participant is asked to write a description of the injury in his or her own words. The second part
of the inventory is comprised of 60 items from three 20-item subscales measuring affect,
behavior and cognition in relation to forgiveness. Participants are asked to rate each item on a 1
to six-point Likert scale from Strongly Disagree to Strongly Agree. The authors report a stability
coefficient in a community sample for total EFI scores of .86 during a four week test-retest
reliability study. The subscale test-retest coefficients ranged from .67 to .91. With respect to
concurrent validity, the EFI has been positively associated with other measures of forgiveness.
There is also support for the EFI’s divergent validity (Enright et al., 2000). The Cronbachs alpha
for the scale as a whole in this sample was .81.
Forgiveness Measure (Enright et al., 2000). This single item scale for assessing degree
of forgiveness derives from the EFI and directly asks clients to what extent they have forgiven
the person who injured them. Responses are indicated on a five-point Likert scale (1 = not at all,
3 = in progress, 5 = completely). The authors of the EFI did not use the term “forgiveness” in
any other item of the EFI measure to avoid creating conceptual biases. For this reason the EFI is
referred to as the Attitude Scale during its administration. The forgiveness measure is thus used
to directly assess degree of forgiveness. In classifying peoples degree of forgiveness a score of 4
or above, i.e.: rating that they had forgiven, either “a lot” or “completely” was used to indicate
that forgiveness had been attained
Unfinished Business Empathy and Acceptance Scale (UFB EA). Singh (1994) developed
the Unfinished Business Scale to measure resolution of unfinished business with a significant
other. For the present study, items were extracted from this scale and adapted to create the
empathy and acceptance subscale (UFB EA). The UFB EA Scale is comprised of six items and
measures the extent to which clients feel acceptance and empathy towards the individual who
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injured them. Clients were asked to indicate their agreement with the statements of empathy or
acceptance on a five-point Likert scale (ranging from 1 = not at all, to 5 = very much). For
example, empathy items consisted of statements such as ‘I feel compassionately understanding
of the other person’, or ‘I have a real appreciation of this person’s own personal difficulties.’
Acceptance items included statements such as: ‘I feel accepting toward this person’ and reversescored items like ‘I see this person negatively.’ The items on this subscale have been found to
inter-correlate highly in a sample of clients in treatment for unfinished business (Paivio &
Greenberg 1995) and a sample of university students (Singh 1994) and the overall scale has been
found to correlate with other outcome measures (Watson & Greenberg 1996; Paivio &
Greenberg 1995). The Cronbachs alpha for the subscale in this sample was .87.
Letting Go Measures
Unfinished Business Feelings and Needs Scale (UFB FN). This scale was
adapted from Singh’s (1994) Unfinished Business Scale. It measures the resolution of feelings
and needs as they relate to the injurer, and positive changes in the perception of self. This
measure is comprised of eight items on a five-point Likert scale (ranging from 1 = not at all, to 5
= very much). The UFB FN Scale contains three sets of items that refer to feelings, needs, and
the self.
The feelings subscale contains items such as ‘I feel unable to let go of my unresolved
feelings in relation to this person.’ The needs subscale includes items like ‘I feel frustrated about
not having my needs met by this person.’ Finally, self items included statements such as, ‘This
person’s negative view or treatment of me has made me feel badly about my self ’, or ‘I feel
worthwhile in relation to this person.’ This subscale of the UFB has shown inter-item reliability
in a sample of clients in treatment and a sample of university students and has been found to
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correlate with other outcome measures a sample of clients in treatment. The Cronbachs alpha for
the subscale in this sample was .79.
Letting Go Measure. This measure was constructed for this study to parallel the single
item forgiveness measure. It is a single item self-report measure that asks clients to what extent
they have let go of their hurt and angry feelings in relation to the injurer. Responses are
indicated on a five-point Likert scale (1 = not at all, 3 = in progress, 5 = completely).
Other Outcome Measures
Target Complaints (TC) Discomfort and Change Scale (Battle, Inber, Hoehn-Saric,
Stone, Nash, & Frank, 1968). The Target Complaints Discomfort Scale asks clients to specify
three problems they would like to see change as a result of treatment. Clients were asked to rate
each problem at three points in time (pre-treatment, post-treatment and three-month follow-up)
in terms of how distressed they are by it. In addition, at two points in time (post-treatment and
three-month follow-up) clients were asked to rate how much they felt it had changed since the
beginning of treatment. Battle et al. (1968) reported high correlations with other outcome
measures and test-retest reliability (r = .68) between pre- and post-psychiatric interviews.
Global Symptom Index (GSI) of the Symptom Checklist 90 Revised (SCL-90-R). The
SCL-90-R (Derogatis, 1983) is a well known instrument that measures general symptom distress,
with high internal consistency (.77 to .90) and test-retest reliability (.80-.90) over a one-week
interval with people with a variety of disorders (Derogatis, Rickels, & Roch, 1976). Calculations
of change on the Global Symptom Index(GSI) was used as an outcome measure at three points in
time (pre-treatment, post-treatment and three-month follow-up). Cronbachs alpha for GSI in this
sample was .82
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Beck Depression Inventory. This 21-item inventory is widely used to assess depression
(Beck, Ward, Mendelson, Mock, Erbaugh, 1961). It has high internal consistency and correlates
highly with other self-report measures of depression and with clinician’s ratings of depression
(r = .60 to .90; Beck et al., 1988). Cronbachs alpha for BDI in this sample was .87
Process Measures
Working Alliance Inventory (WAI; Horvath & Greenberg, 1989). The WAI is a 36-item
scale rated on a seven-point Likert scale. The WAI is made up of three alliance subscales that
assess the therapist-client bond and agreement on therapy tasks and goals. Internal consistency is
high for the whole scale (.87 to .93) as well as the subscales (.89 to .92) (Horvath & Greenberg,
1989). Cronbachs alpha for WAI was .89
Emotional Arousal Session Report Measure (Warwar & Greenberg, 2002). The EA
Session Report Measure was developed in order to evaluate the intensity of emotional arousal
experienced during therapy. This measure consists of 18 emotions items, which the client rates
on a seven-point Likert scale (1= not at all, 5 = moderately, 7 = very much). Clients are
instructed to indicate the degree to which they felt each of the 18 emotions during their session.
To account for the possibility that the 18 emotion categories omitted an emotion the client
believed to be vital in describing their emotional experience, an additional item (question 19)
gives the client an opportunity to rate the intensity of any other emotion they may have felt. The
EA Session Report Measure was completed by clients after each session. This measure was
constructed as a self-report form of the observer Emotional Arousal Scale (Warwar &
Greenberg, 1999) which has been show to predict outcome.
Procedure
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Clients were recruited through advertisements in local community newspapers and flyers
distributed to the university and general community. The advertisements announced that a
treatment study was being conducted at the York University Psychotherapy Clinic and that
individuals over the age of 18 who had been emotionally injured by a significant other in the past
who were interested in participating in a treatment study should call for more information. The
advertisements for the study also indicated that the injury should have occurred at least two years
prior to responding to the advertisement, and that respondents should still be experiencing some
lingering feelings of hurt or anger towards the other in relation to the injury.
Eighty six participants who called were first briefly interviewed over the telephone to
assess initial suitability regarding general inclusion and exclusion criteria, and to determine
whether they were presenting with a specified unresolved target injury from at least 2 years prior
and were willing to participate in a videotaped research treatment. Fifty nine suitable potential
participants were invited to undergo a further assessment process to ensure that the proposed
treatment program could meet their treatment needs. The initial two hour assessment interview
was designed to obtain consent for assessment and treatment and assess clients in terms of Axis I
and Axis II disorders using the Semi-structured Clinical Interview and Diagnosis protocol
(SCID; Spitzer, Williams, Gibbon, & First, 1990). Clients also completed the Beck Depression
Inventory and the SCL-90-R at the first assessment appointment. If this initial assessment
supported the appropriateness of the proposed treatment for the client, he or she was invited to
participate in the treatment study, and asked to come in to complete the rest of the pre-treatment
measures. Forty six clients were successfully assigned to treatment.
Participants were randomly assigned to either the PG or EFT treatment. Clients in the
individual EFT treatment were seen for 12 one-hour weekly individual therapy sessions. Clients
21
in the PG group were seen for six two-hour sessions that were held bi-weekly for 12 weeks.
Three PG groups (of n=9, n=8 and n=6) were run for a total of 23 participants. In the EFT
treatment one therapist saw five clients, one saw four, two saw three and four saw two each.
Sessions in the PG group were audiotaped only, whereas sessions in the EFT treatment were both
audiotaped and videotaped. Clients in both groups completed questionnaires following each
treatment session and were assigned homework at approximately the same time intervals
throughout the course of treatment. Clients completed outcome measures at pre-treatment,
termination of treatment, during a post-therapy interview, and at a three-month follow-up
interview. A short form of the Working Alliance Inventory was given to the PG clients
following session one, and to the individual EFT clients after session three. Therapists completed
a post-session questionnaire after each session.
Results
Adherence to the therapy treatment manual in the EFT treatment was monitored by
therapist and supervisor reports. Adherence to the PG group manual was monitored only by the
therapists. Therapists reported on a 5 point scale ranging from “not at all” to “completely”, the
degree to which they judged themselves to have adhered to the treatment protocol and in the
individual therapy condition reported whether they had used chair dialogues during the session.
The supervisor using the same five point scale, reported an adherence judgment from supervising
a video tape of at least four of the individual therapy sessions. Means and standard deviations of
therapist reports for the individual treatment over the sessions were 4.23 (1.11) and supervisor
ratings were 4.14 (.52) indicating good adherence. The therapists reported a mean of 5.13 chair
dialogues per treatment with a range of 4 – 7 per client. The PG treatment leader reported
successful implementation of the group manual for each session.
22
Given that clients were grouped within treatment with 9, 8 and 6 respectively in the 3
PG groups, and a different number of clients were seen by each therapist, there was a nonindependence in the data and this could introduce a statistical bias in the analyses (Kenny, 1995).
Treatment outcome scores thus were investigated for bias by looking at intra class correlation to
measure homogeneity within groups in relation to variation between groups and the F statistics
used in the analyses of variance were adjusted if the correlation was larger than 0.1. For the
analyses that did not compare treatments, effects, the importance of ignoring statistical
dependencies among observations, are likely to be relatively minor, and so in these cases
dependence was ignored.
Correlations were conducted between all pretreatment variables1. The pre-treatment BDI
did not correlate with any of the other symptom measures at pretreatment. However, there were
positive correlations between the Enright Forgiveness Inventory (EFI) and the Forgiveness
Measure (r=.35, p<.05), and between the EFI and the Unfinished Business Empathy and
Acceptance Scale (r=.56, p<.001). There were no significant differences at the .05 level between
treatments on any of the pretreatment, demographic or other assessment variables assessed by
means of one-way ANOVAs. A t-test conducted to evaluate whether therapeutic alliances were
different in the two treatments showed that clients’ early working alliances were not significantly
different at the .05 level (EFT individual therapy, M=5.89, SD=0.84; PG group, M=5.75,
SD=0.78).
Outcome
In order to test the hypothesis that EFT would be more effective than PG repeated
measures analyses of covariance were performed. Pre test scores of the dependent measure was
used as the covariate with post treatment and follow up as the repeated measures and type of
23
therapy received (either PG or individual EFT) as the between groups factor. Target complaint
change which does not have a measure at pre treatment was analyzed by a repeated measure
analysis of variance with post and follow-up as the two occasions. The means for each of the
measures for pre-therapy, post-therapy, and follow-up are provided in Table 2. There were no
significant group by time interactions on any of the measures. The groups were significantly
different on almost all measures such that the EFT groups exhibited the highest levels of
forgiveness-related gains (i.e. Enright Forgiveness, Forgiveness, Empathy and Acceptance,
Feelings and Needs, and Letting Go) as well as the greatest levels of symptom reduction (i.e.
Target Complaints Discomfort, Target Complaints Change, and GSI) 2. However, the differences
for the BDI were not statistically significant.
Clinical Significance and Effect Size
Cohen's d’s (1988), the standardized mean difference, which provide an index of the
practical, as well as statistical significance of the differences between treatments and between pre
and post treatment were calculated. The effect size for differences between treatments on the
EFI was moderate d = .41, while pre-post effect sizes were large for both treatments, with d = 1
for EFT and .71 for PG treatment. This demonstrates that both treatments led practically to a
large amount of change and that there was a meaningful difference between groups on the major
measure of forgiveness. Pre- post effect on the GSI were d = .62, for the EFT treatment and was
negligible for the PG treatment. The between treatment effect size was d = .66, again showing
large effects for EFT over PG. The pre-post effects on empathy and acceptance were 1.73 and
.74 for EFT and PG respectively and the between treatment effect size was .98. For feeling and
needs the pre-post effects were 3.22 and 1.62 respectively with between treatment effects size of
1.62. The pre-post effects on TC discomfort were 3.84 and 2.27 for EFT and PG respectively
24
and the between treatment effect was 1.56. All these effects are very large. The between
treatment effects on BDI was very small d =.06 and the pre- post effects of .47 and .69 although
large were much smaller than on other measures.
Forgiving and Letting Go
Cut off Scores were used on the relevant outcome measures to classify clients according
to whether they forgave their injurers and/or let go of their negative feelings towards the injurer
(level 4 or above on each measure). The classification of clients on this dichotomous
classification is shown in Table 4. Dichotimization on these single item measures however are
suggestive rather than definitive because the dividing lines between forgiving and not forgiving
and letting go and not letting go may not be that sharp.
All of the nine clients in EFT who forgave the injurer also let go, as did the four people in
the PG treatment who forgave the injurer. However, five people in the EFT treatment and three
in the PG treatment let go but did not forgive. A Chi square analysis of the distribution
comparing forgivers and those who let go was significant, X = 21.5 p<.001showing that 100%
who forgave let go, while 38% who let go did not forgive. This suggests that letting go may be a
necessary requirement of forgiveness (i.e., everyone who forgave also let go), but is not by itself
sufficient for, nor the same thing as, forgiveness, since clients who met the criteria for letting go
did not always consider themselves to have forgiven the injurer. It is important to note that in
both groups a large proportion of those people who were classified as not forgiving or letting go
rated themselves as in progress (level 3) on these tasks so it was not the case that they did not
benefit from treatment. They simply had not yet reached as full a resolution according to our
cutoff criteria as those who indicated they had more fully forgiven or let go.
Test of emotional arousal in groups
25
Clients in each of the treatment modalities were compared on the intensity of selfreported emotional arousal (EA) experienced in the session to test for the hypothesized
difference between treatment in reported emotional arousal. The EA measure was divided into
positive and negative or unpleasant emotion clusters for the following periods: total duration of
treatment and three phases of therapy (early, middle and late). The positive emotion cluster
included happy and content, while the negative cluster included sad, angry, afraid, and pain.
Changes in reported intensity of negative/unpleasant and pleasant in-session emotional
arousal across three phases of each treatment were examined. For treatment comparisons the
EFT sessions were grouped to form early (3 sessions), middle (5 sessions) and late phases (last 2
sessions). This structure was thought to best reflect the phase structure of the treatment. The six
group sessions were broken into three sets of two sessions each. A 2x3x2 repeated measures
ANOVA compared reported in-session intensity of positive and negative emotions in the two
treatment conditions overall and by each phase of therapy. Means and standard deviations are
shown in Table 4 and the graph over phases is given in figure1.
There was a significant emotion by time interaction F (2, 43) =12.853, p<0.001, a
significant emotion by group interaction F (1,44) = 24.6, p<0.001, and a significant three way
emotion by time by group interaction F(2,43) = 3.29, p < .05. Post hoc analyses using a
Bonferonni adjustment for multiple comparisons found the groups differed significantly (p <
.001) on the amount of reported negative affect arousal overall in the treatment but that there
were no significant differences at the .05 level between the treatment in self-reports of overall
positive emotion experienced in-session over all. This acted as a form of implementation check
showing that the individual EFT treatment was effective in arousing more unpleasant emotion.
The clients in the EFT treatment reported significantly higher levels of negative/unpleasant
26
emotional arousal than the PG treatment, in the initial phase of treatment (p<.01) and in the
middle phase of therapy, (p < .01). The clients in the PG treatment reported significantly higher
levels of positive emotional arousal than the EFT treatment, in the middle phase of therapy (p <
.01). Finally, during the late phase of therapy there was no significant difference at the .05 level
between the groups in reported intensity of negative/unpleasant or positive emotional arousal.
The EFT clients’ reports of in-session negative/unpleasant emotional arousal were found
to be relatively stable over the first two phases, demonstrating no significant differences at the
.05 level between early and middle phases. However, the EFT clients reported significantly less
in-session negative/unpleasant emotional arousal in the final phase of therapy as compared to the
middle phase (p< .05). Analysis of the PG clients’ reports followed a similar pattern. Differences
between early and middle phases of treatment were not significant at the .05 level. However, a
significant decline in reported negative emotional arousal from the middle to the late phase of
therapy was present (p< .05).
In an examination of the pattern of reported positive in-session emotional arousal, EFT
clients reported a significant increase in the intensity of positive emotional arousal from the
middle phase to the final phase of treatment (p<.001). In the PG group, a trend of increasing
positive emotional arousal from the early to late phases of therapy was found. The PG clients’
ratings of positive emotions increased significantly from the early to middle treatment phase, p <
.01 and from the middle to late phase, p< .05. Degree of reported in-session intensity of
emotional arousal averaged over the whole treatment, or averaged of any of the phases of
treatment, did not correlate significantly with change on any of the outcome measures for the
combined sample or for either treatment.
Correlational Analyses
27
Correlations calculated between residual gains in the forgiveness and letting go related
variables, and symptom variables are displayed in Table 5. Pre-post changes were calculated as
the standardized residuals by regressing initial scores onto final scores for all the symptom and
outcome measures (Cronbach & Furby, 1970). As can be seen in the table, an increase in
forgiveness and empathy and acceptance, and of feelings and needs all were related to a decrease
in overall symptom distress
Discussion
The results of this study showed that clients in the individual EFT treatment showed
significantly more improvement than those in the PG treatment on all measures of forgiveness,
on measures assessing the degree to which clients had let go of distressing feelings and unmet
needs in relation to the injurer and on target complaints at termination and follow-up. The two
groups however were found to not differ significantly on the change in feelings and needs at
termination, when possible dependence in the PG group was taken into account. Greater
improvement also was reported in the EFT condition on the Global Symptom Index of the SCL90-R. There however was no difference between groups on the BDI, but given clients in this
study were not depressed this is not surprising. The significant change in general psychological
symptoms on the SCL 90-R in EFT, with no change in PG on symptoms, is notable, suggesting
that an individual emotion-focused treatment in addition to enhancing forgiveness and letting go
of the emotional injury, has positive effects on a person’s general level of well being that exceed
that of a psycho-education group. Taken as a whole, this study provides support for the
differential effectiveness of an EFT approach for promoting forgiveness, resolving emotional
injuries and reducing general symptoms over a PG treatment intervention of the same duration.
28
In addition all those clients who reported that they forgave the injurer, regardless of
group, also indicated that they had let go of the distressing feelings and unmet needs previously
associated with the injury. In contrast, there were some individuals who indicated that they had
let go of the distressing feelings and unmet needs associated with the injury, but had not forgiven
the injurer. This suggests that letting go of persisting unresolved feelings such as anger, grief,
sadness and/or hurt may be a necessary step in resolving past interpersonal hurtfulness, but may
not be sufficient nor equivalent to forgiveness. Further research on this question is needed but
seeing that the process of reducing un-forgiveness or letting go of bad feelings is distinct from
the process of generating positive feelings, such as loving kindness, may be useful ones when
examining the process of forgiveness and the possibility of the resolution of an emotional injury
in the absence of forgiveness.
Contrary to what the forgiveness literature suggests (McCullough & Witvliet, 2001,
Orcutt 2006), forgiveness was not initially correlated with the pre-treatment variables measuring
emotional health such as the BDI and particularly the Global Symptom Index (GSI) of the SCL90R. Thus clients at the start of treatment who were more forgiving were not psychologically
healthier. This however may have been due to lack of range on both the forgiveness measure and
the GSI and BDI and because participants were seeking help for presenting problems involving a
lack of letting go and forgiveness. In our study pre-post increases in forgiveness and letting go
variables however were related to a decrease in GSI. Thus, it seems that increases over treatment
in forgiveness, in empathy and acceptance, toward the injurer, and being able to resolve feelings
and needs, were related to improved health as measured by the GSI suggesting health benefits to
resolving injuries both by forgiveness and letting go. Recently Orcutt (2006) found that offencespecific forgiveness at initial assessment correlated significantly with symptom distress
29
approximately 9 months later controlling for symptoms distress at initial assessment, and that
time since offence mediated the relationship between forgiveness and symptom distress,
suggesting a complex relationship between forgiveness and symptoms. Data on our treatment
seeking population does not support that forgiveness correlates with distress at initial assessment
but does show that increase in forgiveness certainly correlates with reduction in distress.
In addition to showing better outcomes, the EFT group was found to involve more clientreported emotional arousal, especially of negative emotions in the mid-phase of treatment,
confirming that the EFT treatment was more emotion- arousing than the PG treatment. The
finding that there was more negative emotional arousal in the early phase of therapy for the EFT
treatment than for the PG treatment was probably because EFT clients were more likely to access
negative emotions right from the start as a function of therapy, rather than because they entered
treatment with more negative emotions than clients in the PG treatment. This finding also
suggests than the emotional change processes in therapy are not necessarily simply ones of
replacing bad feelings with good feelings in a linear process but that at times feeling bad can in
fact lead to feeling good. Thus working through bad feelings by facing them, allowing and
accepting them, can lead to change (Greenberg 2002). It should be noted however that reported
in-session emotional arousal did not relate to outcome in either group. This is likely because not
all arousal of emotion is the same. For example some arousal may be a sign of distress rather
than a sign of working through distress (Greenberg & Watson, 2006). Recently Greenberg,
Auzra and Hermann (2007) showed that arousal alone is not necessarily a measure of productive
emotional processing and that it is productive processing of arousal emotion that best
discriminates good from poor outcome cases. In other studies the intensity of observed expressed
emotional arousal however has been shown to predict outcome in the working phase of the EFT
30
treatment of depression (Missirilian, Toukmanian, Warwar & Greenberg, 2005; Warwar, 2003).
The difference in the finding on the relationship between emotional arousal and outcome in this
study to the finding in the studies on depression, if they are not because of differences in a
depressed and an emotional injury population, may be explained by the differences between the
nature of the experience of emotion, as measured by post session self-reports of emotional
arousal in the session, and the expression of emotions, captured by observational measures of
arousal. In the present study we observed that the session in which some clients reported high
emotional intensity in the session (experienced emotion) showed few visible signs of the
reported arousal (expression) and in fact often the clients were quite constricted in their
expression of emotion in the session. They appeared to have felt a lot of anger or sadness but not
necessarily expressed it, so although the self reports were indicative of emotion experienced,
they were not indices of how much emotion was allowed and expressed in the session and made
accessible for further processing. As Greenberg (2007) has suggested emotion awareness and
expression are different emotion change processes and the latter, by revealing the self to the
other, overcoming constriction and altering physiology and neurochemistry may be what is most
therapeutic when dealing with unresolved painful emotions.
Limitations
The clients in this study were volunteers who responded to advertisements, and
therefore may not be representative of the general population seeking help for emotional injuries.
Furthermore, equivalence of type and intensity of injuries was not taken into consideration in
assigning clients to groups, based on the assumption that this would be handled by
randomization, but in small samples such as this, this may not be the case. In addition,
resolution or forgiveness was not assessed in relation to whether the injured person still had an
31
ongoing relationship with the injurer, (as in the case with a living parent versus a deceased
parent) or not. It also would have been preferable to insure a balance of men and women in both
groups. To the extent that there were more women in EFT, this may have introduced a confound.
Taking all these factors into consideration will require further research with a larger sample of
clients.
Because therapist and researcher allegiance to treatment model (and their possible ability
to persuade clients of the relevance of the treatment process to their presenting problems) is a
common factor known to improve outcomes, regardless of specific treatment models employed,
one might attribute observed differences in this study to therapist training/allegiance, or
researcher allegiance, rather than differences in specific treatment techniques. The EFT
therapists had at least 1 year of experience with EFT, and received an additional 30 hr of training
in this specific intervention prior to participation in the study. Similar training did not occur for
the PG treatment leaders although the one leader was the developer of the group Psychoeducation treatment. Investigators were proponents of EFT and this too could influence results.
In addition differences between factors operating in group and individual therapy
modalities could account for the differences in effectiveness of treatment. Clients receiving
individual therapy receive a treatment tailored to their needs, whereas in groups there is less
flexibility and individualization. Spacing of sessions also was different in the two treatments.
Individual therapy met weekly whereas the group sessions were twice the length of individual
sessions, but met only once every two weeks. This could provide more continuity of treatment
and support in the individual therapy. On the other hand group participants benefit from other
factors in groups that promote change that are not available to the individual participants, such as
group support and a sense of the universality of their problems and having two therapists.
32
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40
Authors Footnotes
1. Readers can request a complete matrix of intercorrelations between all variables by writing to
the first author at lgrnberg@yorku.ca.
2. In order to test for possible dependence in the data Intra Class correlations (ICC) were
computed on the output from two separate one-way ANOVAs on the effect of the therapists in
the EFT condition and of the 3 groups in the Psycho-Ed condition. ICC measures the relative
homogeneity within groups in comparison to the between group variation. ICC is large and
positive when there is no variation within the groups, but group means differ. It will be at its
largest negative value when group means are the same but there is great variation within groups.
A negative ICC occurs when between-group variation is less than within-group variation. In this
situation, checking for independence, we would want the ICC to be close to 0 or negative,
indicating that group mean differences are negligible relative to individual differences i.e., the
grouping doesn’t matter. ICC recently is used in the context of hierarchical linear modeling
(HLM) to measure the extent to which data clustering (i.e., non-independence of observations) is
present. If the ICC is near 0, then HLM will give very similar results to a traditional ANOVA or
regression that assumes independence (Raudenbush & Bryk, 2002, Shrout, & Fleiss1979).
ICCs on post test were found to be low, below .08 or negative for both treatment
conditions for all of the dependent variables except for Feelings and Needs (ICC=.15), in the PG
group. This provides evidence that the grouping of clients within therapists and within groups
was not a strong factor influencing the findings on the majority of measures in the study except
possibly for the Feelings and need scale. Fs were adjusted according to the design effect, which
is a function of ICC and sample size (Skinner, Holt, & Smith, 1989) for post test scores on the
Feelings and need scale and no significant difference between groups was found at post
41
F(1,43)=2.65, p=.112 thereby altering the conclusion of difference on this measure. There was
no difference in the between group comparisons on the other measures in which ICC had been
lower than .08
42
Table 1
Interpersonal Emotional Injuries Reported by Client Sample
___________________________________________________________________
EFT
PG
___________________________________________________________________
Issue
Betrayal
5
8
Criticism
6
4
Neglect
4
3
Abandonment
5
4
Physical abuse
2
3
Sexual abuse
1
1
23
23
Total
Significant other
Both Parents
5
5
Mother
8
4
Father
5
4
Ex-partner
2
5
Sibling
2
2
Child
0
1
Other
1
2
23
23
Total
____________________________________________________________
Note. Each participant targeted 1 injury only
43
Table 2
Pre, Post and Follow-up Means and Standard Deviations of Outcome Measures
Measure
Enright
Forgiveness
Pre
Post
EFT
PG
EFT
(n = 23)
(n = 23)
(n = 23)
M SD
M SD
199.22
197.09
60.58
58.14
Follow-up
EFT
PG
(n = 23)
(n = 23)
(n = 23)
M SD
M SD
M SD
M SD
261.13
237.30
277.52
243.43
51.28
51.41
55.01
2.87
3.83
3.43
47.24
PG
Ancova
F(1,43)
4.98*
Inventory
Forgiveness
Measure
UFB Empathy
and Acceptance
UFB Feelings
and Needs1
Letting Go
2.18
.72
14.04
4.43
14.87
5.06
2.00
.71
1
See footnote 2
2.39
.78
14.26
4.97
17.48
4.63
2.17
.94
3.74
.81
22.17
5.42
30.95
6.0
4.09**
.79
1.06
17.78
5.48
25.58
8.35.
2.17
.98
.75
22.13
4.38
31.32
6.56
4.06
.71
7.91**
1.01
18.87
9.28**
4.78
28.05
4.32*
7.15
3.42
.76
437.69**
44
Table 2 (continued)
Measure
Pre
Post
Follow-up
M SD
M SD
M SD
M SD
M SD
M SD
10.48
10.07
4.40
6.48
4.61
6.22
Ancova
TC Discomfort
1.53
1.64
--
--
--
--
.70
.58
2.25
3.03
2.41
7.03*
2.56
TC Change
7.16
1.64
5.39
1.99
7.70
6.3
1.29
1.91
.35
.45
12.67**
GSI
.43
.36
.46*
.47
.60
.45
.31
6.73*
.32
BDI
12.18
10.32
10.79
6.34
Note. Pretreatment scores used as covariates
*p < .05, **p < .01
7.26
7.59
6.39
5.88
6.79
7.13
5.47
5.43
1.1
45
Table 3: Frequency of Forgiveness and Letting Go*
Let Go
EFT
PG
% of Total
Yes
No
Yes
No
Yes
9
0
4
0
No
5
9
3
16
Yes
28.26%
No
0
Forgive
Total
30.43%
19.56%
15.21%
34.78%
17.39%
54.34%
45.65%
54.34%
Note: A Chi square analysis of the distribution comparing forgivers and those who let go was
significant, X = 21.5 p<.001.
46
Table 4
In Session Emotion Clusters by Phase of Therapy: PG and EFT
________________________________________________________________________
Phase of Therapy
Emotion
Early
Middle
Late
PG
EFT
PG
EFT
PG
EFT
(N=23)
(N=23)
(N=23)
(N=23)
(N=23)
(N=23)
________________________________________________________________________
Positive
Emotions
M
SD
3.03
1.17
2.97
3.62**
2.73
4.17
3.82
1.16
1.26
1.23
1.53
1.44
3.58*
2.67
3.50**
2.11
2.60
Negative
Emotions
M
2.82
SD
1.40
0.91
1.12
0.98
1.04
1.09
________________________________________________________________________
Asterisks indicate between group differences
* p<.05
**p<.01
47
Table 5: Correlations between Pre-Post Residual Gain Scores On Forgiveness, Letting go and
Symptom Variables(n=46):
GSI
BDI
Enright Forgiveness Inventory
-.41**
-.08
Forgiveness Measure
-.36*
-.22
UFB Empathy & Acceptance
-.37*
.05
UFB Feelings & Needs
-.38**
-.29
Letting Go Measure
-.23
-.17
Target Complaints
(Discomfort)
.27
.14
* p < .05, ** p <.01
48
Table 2
Pre, Post and Follow-up Means and Standard Deviations of Outcome Measures
Measure
Enright
Forgiveness
Pre
Post
EFT
PG
EFT
(n = 23)
(n = 23)
(n = 23)
M SD
M SD
199.22
197.09
60.58
58.14
Follow-up
PG
Ancova
EFT
PG
(n = 23)
(n = 23)
(n = 23)
M SD
M SD
M SD
M SD
261.13*
237.30
277.52
243.43
47.24
51.28
51.41
55.01
2.87
3.83
3.43
F(1,43)
4.98
Inventory
Forgiveness
Measure
UFB Empathy
and Acceptance
UFB Feelings
and Needs2
Letting Go
2.18
.72
14.04
4.43
14.87
5.06
2.00
.71
2
See footnote 2
2.39
.78
14.26
4.97
17.48
4.63
2.17
.94
3.74**
.81
22.17**
5.42
30.95*
6.0
4.09**
.79
1.06
17.78
5.48
25.58
8.35.
2.17
.98
.75
22.13
4.38
31.32
6.56
4.06
.71
7.91
1.01
18.87
9.28
4.78
28.05
4.32
7.15
3.42
.76
437.69
49
Table 2 (continued)
Measure
Pre
Post
Follow-up
M SD
M SD
M SD
M SD
M SD
M SD
10.48
10.07
4.40
6.48
4.61*
6.22
Ancova
TC Discomfort
1.53
1.64
--
--
2.25
3.03
2.41
7.03
2.56
TC Change
7.16
5.39
7.70**
6.3
12.67
--
--
.70
.58
1.64
1.99
1.29
1.91
.35
.45
GSI
.43
.36
.46*
.47
.60
.45
.31
6.73
.32
BDI
12.18
10.32
10.79
6.34
Note. Pretreatment scores used as covariates
*p < .05, **p < .01
7.26
7.59
6.39
5.88
6.79
7.13
5.47
5.43
1.1
50
Figure 1. Emotional Arousal Across Phases
4.5
◦
4.0
□
Means
◦
□
□
3.5
○
3.0 □
○
□
◦
2.5
◦
2.0
Early
Middle
Phase of Therapy
◦
□
PG
EFT
Negative Emotion
Positive Emotion
Late