Forgiveness Therapy for
Substance Use Disorder
J e s u s P e r e z , P s y. D .
Satori waters
&
K a t h e r i n e O r t e g a , M . S . W.
H i s h o u s e c h i l d r e n ’s h o m e
Henry’s Story
 Henry, age 37, had a long hx of alcoholism and cocaine
abuse. He had been through several rehabilitation efforts
and was aware that his anger and need to rebel played a
major role in subsequent relapses. Even though he had
known for years that forgiving his father for being
controlling and punitive would help diminish his anger and
benefit his recovery, he was unable to take the next step.
 Why?
Why Forgiveness?
 Forgiveness is about transformation of people (Enright &




Fiztgibbons, 2000)
Has been shown effective in reducing client’s anger,
anxiety, and depression while increasing their sense of
hope and self-esteem. (Enright & Fiztgibbons, 2000).
Forgiveness is one of the ways of dealing with angers born
out of injustice in a way that is constructive and healing.
There is no professional protocol other than forgiveness
therapy, that offers a systematic approach for dealing with
the injustice and working through anger toward emotional
health. (Enright & Fitzgibbone, 2000).
The Big Book of Alcoholics Anonymous says resentment
destroys more alcoholics than anything else because deep
resentment leads to futility and unhappiness and shuts us
off from the "sunlight of the Spirit."
Importance of Forgiveness
 Fitzgibbons (1986) demonstrated that teaching clients to
forgive can help reduce anger and increase self-esteem.
 Enright and Zell, (1989), and Smedes, (1984) pointed that
those who forgive tend to have more positive emotions
(e.g., compassion and love) and lower negative emotions
(e.g., resentment, sadness, anxiety, and anger).
 Enright & Fitzgibbons (2000) stated that based on the
clinical evidence forgiveness decreases excessive anger.
 Case studies and therapist observations both suggest that
forgiveness of deep offenses from other people can be
psychologically healing in many ways. (Fitzgibbons, 1986)
Forgiveness Intervention
 Gordon & Baucom (1998), forgiveness has become a
major topic of discussion and scientific study within the field
of psychology.
 McCullough and Hoyt (2002) indicate that when people
forgive, they experience (a) reduced motivations to seek
revenge, (b) reduced motivations to avoid their
transgressor, and (c) increased in benevolence or good will
for their transgressor.
Forgiveness as a Construct
 Though the term “forgiveness” is widely used, there is no universally
accepted definition of what constitutes “forgiveness” (Enright & Coyle,
1998).
 All definitions point to the commonality that forgiveness involves a
change in cognitions, emotions and behaviors toward another
individual.
 More recently two models of forgiveness have emerge, Robert
Enright’s (Enright & the Human Development Study Group, 1996)
“Process Model of Forgiveness,” and Everett Worthington’s (1998)
“Empathy Based Model of Forgiveness.”
 Two ways of defining forgiveness:


What forgiveness is
What forgiveness is not
Forgiveness: Construct
 Enright and his colleague defined forgiveness as:
A willingness to abandon one’s right to resentment,
negative judgment, and indifferent behavior toward one
who unjustly hurt us, while fostering the undeserved
qualities of compassion, generosity, and even love toward
him or her.
Literature Review
Process Model of Forgiveness:
 Enright and the Human Development Study Group (1991,
1996). Forgiveness as an interpersonal process. Describe
units and model.
 Enright & Coyle (1998). Described the psychological
model of forgiveness.
 Enright, Freedman, & Rique (1998). Emphasized
forgiveness as a flexible process.
 Al-Mabuk & Downs (1996). Study of forgiveness with
parents survivors of adolescents suicide.
Forgiveness Theory and Intervention
 Al-Mabuk, Enright & Cardis (1995). Study # 1. The
participants were 48 parentally love-deprived college
students. Findings, Students in the experimental group
increased in the areas of hope and willingness to forgive.
This study only included the first phases of the model.
 Study # 2. Participants were 45 college students. Reported
positive attitudes toward parents, increased self-esteem,
hope and forgiveness, and decreased anxiety. (The whole
process model.)
 Coyle & Enright (1997). Results suggests that participants
experienced a reduction in anxiety, anger and grief, along
with an increase in forgiveness.
Forgiveness Theory and Intervention
 Freedman & Enright (1996). Participants were 12 adult
females sexual abuse survivors. Participants increased
forgiveness and self-esteem and decreased anxiety and
depression.
 Hebl & Enright (1993). Participants 24 elderly females.
Decreased in negative feelings and hostile thoughts, and a
willingness to offer love and support to the one who hurt
them.
The Process Model of Forgivenees
 This process models consists of 20 psychological variables
that are organized into four distinct phases.
 The model incorporates the affective, behavioral and
cognitive aspects of forgiveness.
 Teaches the client that forgiveness is an ongoing process
rather than a single event.
 Forgiveness is multidimensional in its comprising cognitive
processes, emotions and overt behaviors.
Phases
 Uncovering Phase- client gains insight into whether and how the
injustice and subsequent injury have compromised his or her life.
 Decision- client gains an accurate understanding of the nature of
forgiveness and makes a decision to commit to forgiving on the basis of
this understanding.
 Work- client gains a cognitive understanding of the offender and begins
to view the offender in a new light, resulting in positive change in affect
about the offender, about the self, and about the relationship.
 Deepening- client finds increasing meaning in the suffering, feels more
connected with others, and experiences decreased negative affect and,
at times, renewed purpose in life.
Phases and Units of Forgiving
Uncovering Phase:
1.Examination of psychological defenses and the issues involved (Kiel,
1986).
2.Confrontation of anger; the point is to release, not harbor, the anger
(Trainer, 1981/1984).
3.Admittance of shame, when this is appropriate (Patton, 1985).
4.Awareness of depleted emotional energy (Droll, 1984/1985).
5.Awareness of cognitive rehearsal of the offense (Droll, 1984/1985).
6.Insight that he injured party may be comparing self with the injurer (Kiel,
1986).
7.Realization that oneself may be permanently and adversely changed by
the injury (Close, 1970)
8.Insight into a possibly altered “just world” view (Flanigan, 1987).
Phases and Units of Forgiving, cont.
Decision Phase9.
A change of heart/conversion/new insights that old resolution
strategies are not working (North, 1987).
10. Willingness to consider forgiveness as an option (Enright, Freedman
& Rique, 1998).
11. Commitment to forgive the offender (Neblett, 1974).
Work Phase12. Reframing, through role-taking, who the wrongdoer is by viewing
him or her in context (M. Smith, 1981).
13. Empathy and compassion toward the offender (Cunningham, 1985).
14. Bearing/accepting the pain (Bergin, 1988).
15. Giving a moral gift to the offender (North, 1987)
Phases and Units of Forgiving, cont.
Deepening Phase16.Finding meaning for self and others in the suffering and in the
forgiveness process (Frankl, 1959).
17.Realization that self has needed others’ forgiveness in the past
(Cunningham, 1985).
18.Insight that one is not alone (universal, support) (Enright et al., 1998).
19.Realization that self may have a new purpose in life because of the
injury (Enright et al., 1998).
20.Awareness of decreased negative affect and, perhaps, increased
positive affect, if this begins to emerge, toward the injurer; awareness of
internal, emotional release (Smedes, 1984).
Substance Use Disorders
 Levels of anger and violence among alcohol and other




substance abuser. (Clancy, 1997)
State Trait Anger Expression Inventory and substance
abusers (Aharonovich, Nguyen,& Nunes, 2001)
Anger and Resentment (Nowinski, Baker & Carol, 1999)
Anger and Frustration (Marllat, 1985)
Anger management vs Forgiveness Therapy (Lin, Mack,
Enright, Krahn & Baskin, 2004)
Role of Trauma in SUD
 Illinois- 42 % of women in a shelter receiving
services for substance abuse revealed hx of domestic
violence (Bennett & Lawson, 1994).
 90 % of women in substance abuse tx has experience
domestic violence from a partner in their life time.
(Miller, 1994)
 74 % of women in substance abuse tx have
experience sexual abuse (Kubbs, 2000).
Forgiveness Phases for SUD
 Uncovering Phase
 Decision Phase
 Work Phase
 Deepening Phase