Journal of Counseling Psychology Copyright 2008 by the American Psychological Association

2008, Vol. 55, No. 2, 185–196 0022-0167/08/$12.00 DOI: 10.1037/0022-0167.55.2.185

Differential Effects of Emotion-Focused Therapy and Psychoeducation in

Facilitating Forgiveness and Letting Go of Emotional Injuries
Leslie S. Greenberg, Serine H. Warwar, and Wanda M. Malcolm
York University

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 therapy
in a psychoeducation 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 relation-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ship between letting go of distressing feelings and forgiveness. A total of 46 clients assessed as having
This document is copyrighted by the American Psychological Association or one of its allied publishers.

unresolved, interpersonal, emotional injuries were randomly assigned to an individual therapy treatment
of EFT or a psychoeducation group. Clients were assessed at pretreatment, posttreatment, and 3-month
follow-up on measures of forgiveness, letting go, depression, global symptoms, and key target com-
plaints. Results indicated that clients in EFT using empty-chair dialogue showed significantly more
improvement than the psychoeducation treatment on all measures of forgiveness and letting go, as well
as global symptoms and key target complaints.

Keywords: interpersonal injuries, forgiveness, letting go, emotion-focused therapy, psychoeducation

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 toward those who injured them (Witvliet,
Ludwig, & Vander Laan, 2001). Most studies on the facilitation of
forgiveness (Al-Mabuk, Enright, & Cardis, 1995; Hebl & Enright,
1993; McCullough & Worthington, 1995; Ripley & Worthington,
2002; Wade, Worthington, & Meyer, 2005; Worthington &
Drinkard, 2000) have involved psychoeducation 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 on the effectiveness of individual therapy in facil-
itating unilateral forgiveness (Coyle & Enright, 1997; Freedman &
Enright, 1996). The present study examined the effectiveness of
emotion-focused therapy (EFT) compared with that of a psycho-
education group (PG) in facilitating emotional resolution and
forgiveness.
Numerous investigators have proposed that both emotion work
and empathy play important roles in forgiveness (Davenport, 1991;
Leslie S. Greenberg, Serine H. Warwar, and Wanda M. Malcolm,
Department of Psychology, York University, Toronto, Ontario, Canada.
This study was supported by Grant CRF 5202 from the Campaign for
Forgiveness Research awarded to Leslie S. Greenberg.
Correspondence should be sent to Leslie S. Greenberg, Department of
Psychology, York University, 4700 Keele St., Toronto ON, M3J 1P3
Canada. E-mail: lgrnberg@yorku.ca
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 healthy boundary setting, self-
respectful anger, and necessary grieving and that adequate pro-
cessing of unresolved emotion leads to its transformation (Green-
berg, 2002). Many clinicians (Akhtar, 2002; Baures, 1996; Enright
& Eastin, 1992) have emphasized the value of facilitating in-
session expressions of adaptive anger at violation and suggested
that facilitating forgiveness requires an acknowledgement of the
legitimacy of emotions such as resentment and hatred toward the
offender. Baures (1996), Boss (1997), and Fincham (2000) con-
sidered resentment and desires for revenge to be closely linked
with self-respect, and Greenberg and Paivio (1997) suggested 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 expe-
riences of violation, the therapist is promoting ownership of the
clients’ emotional experience and is empowering clients to appro-
priately 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 a 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) addressed the relationship

185
 186 GREENBERG, WARWAR, AND MALCOLM
between mourning and forgiveness, and Greenberg and Paivio
(1997) emphasized that work with betrayal and abandonment often
involves a process of facilitating normal grieving in which anger
and sadness 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 (Elliott, Watson, Goldman, & Greenberg, 2004; Greenberg,
Rice, & Elliott 1993).
Emotion-focused therapy (Greenberg, 2002), which uses empty-
chair dialogue as a major method for the resolution of unfinished
business, has been found to be an effective intervention in the
treatment of depression, interpersonal problems. and trauma
(Greenberg & Watson, 1998, 2006; Paivio & Greenberg, 1995;
Paivio & Nieuwenhuis, 2001). Paivio and Greenberg’s (1995)
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comparative study of a PG 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 showed a significant reduction in symptomatology,
target complaints, and interpersonal distress and more resolution of
unfinished business. The empty-chair method used in EFT is also
a particularly effective tool in promoting empathy toward the
offender (Paivio & Greenberg, 1995; Paivio, Hall, Holowaty,
Jellis, & Tran, 2001; Paivio & Nieuwenhuis, 2001). In imagina-
tively bringing the injurer and injury alive, the client moves from
a cognitive discussion with the therapist to an imaginal confron-
tation 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 impor-
tance of transforming emotions by changing one emotion with
another emotion (Fredrickson, 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, Fredrickson, Mancuso,
Branigan, & Tugade (2000) have shown that positive emotion
undoes the cardiovascular aftereffects of negative emotion. Green-
berg (2002) has suggested that the key to transforming maladap-
tive 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, compas-
sion, empathy, and concern.
McCullough and his colleagues have shown that empathy for
the perpetrator mediates successful forgiveness (McCullough,
Rachal, Sandage, & Worthington, 1997; McCullough, Worthing-
ton, & Rachal, 1997). This proposition is consistent with clinical
observation, theory, and empirical evidence concerning forgive-
ness (Macaskill, Maltby, & Day, 2002; McCullough, Rachal,
Sandage, & Worthington, 1997; McCullough, Worthington, &
Rachal, 1997; Worthington & Wade, 1999). When accessed, em-
pathy involves understanding another’s feelings and is a complex
cognitive/affective state that facilitates forgiveness of an interper-
sonal injury. As Rowe et al. (1989) have pointed out, empathy
toward 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.
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, 2002). Berecz (2001) has suggested 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 com-
plex set of negative feelings toward 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 experiencing a hyperaroused stress re-
sponse resulting from rumination (Harris & Thoresen, 2005). It is
noteworthy that reducing unforgiveness is not the same as promot-
ing 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 composed of the increase of positive emotions such as com-
passion, empathy, or understanding felt toward the injurer.
In our view, forgiveness thus appears to involve two important
emotional processes: resolution of the hurt and anger involved in
the injury; and the possible generation of positive feelings of
compassion, loving, kindness, and empathic concern for the in-
jurer. 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 (i.e., by forgiving).
The main purpose of the present study was to evaluate the
effectiveness of EFT (Greenberg et al., 1993) involving empty-
chair dialogue in the treatment of individuals who had been emo-
tionally injured by a significant other. Empty-chair work was used
to facilitate emotional transformation by asking clients to express
and process their anger and sadness with the offender, thereby
promoting empathy, and by 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 using empty-chair dialogue to process unresolved
emotion would produce better outcomes than 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, pro-
cessing, and transforming emotion would address the emotional
causes of the injury more directly than a PG treatment that is less
emotionally activating.
This study also examined the emotional process of forgiveness
in resolving interpersonal injury and evaluated whether forgive-
ness was necessary to resolution of the injury. In the present study,
recovery from an emotional injury therefore was conceptualized as
 FACILITATION OF FORGIVENESS 187

occurring in one of the following two ways: (a) 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 (b) 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 people who let go would forgive. The third hypothesis
was that reported emotional arousal would be higher in EFT than
in PG.
Treatment focused on facilitating the resolution of specific
unresolved interpersonal emotional injuries that had occurred at
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nantly White, with 1 client of South Asian and 1 of East Asian
origins in each treatment group.
In terms of pretreatment diagnosis on Diagnostic and Statistical
Manual of Mental Disorders (4th ed., text rev.; American Psychi-
atric Association, 2000) Axis I and II, there were 9 clients (39%)
with a least one Axis I diagnosis in the EFT treatment, and 7
clients (30%) with at least one Axis I diagnosis in the PG treat-
ment. In the EFT treatment, 6 clients (26%) had at least one Axis
II diagnosis, and in the PG treatment, 4 clients (17%) had an Axis
II diagnosis. The mean score on the Global Assessment of Func-
tioning was 77 for each treatment group, with the range being
65–95 for the EFT treatment group and 60 –90 for the PG treat-
ment group. There were no statistically significant differences
between treatment conditions on any of these variables.

least 2 years prior to the start of therapy and continued to be

distressing. The injuries that clients brought to treatment were both Emotional Injuries
emotional and interpersonal; they were emotional in that they
involved intense lingering unresolved feelings of hurt or anger and The types of emotional injuries clients presented in this study
betrayal, and they were interpersonal in that the injurer was a and the nature of the relationship with the significant other are
significant other in the injured person’s life. Injuries involved summarized in Table 1. Each participant targeted one injury.
abandonment, betrayals, or violations by significant others, such as Parents were the main perpetrators of the injuries. In the EFT
friends, bosses, family members, or intimate partners. treatment, 18 (78%) of the clients were dealing with an interper-
sonal injury in relation to at least one parent, and 2 (8%) with an
ex-partner, while in the PG treatment, 13 (57%) of the participants
Method were dealing with an injury regarding at least one parent and 5
(21%) with an ex-partner. The people in the “other” category
Participants included a boss, a neighbor, and people in nonparental positions of
The sample for the present study consisted of 46 clients who had power relative to children.
an unresolved interpersonal, emotional injury with a significant
other that had occurred at least 2 years prior to the client’s Therapists
commencing treatment. The requirement that the injury not be
There were eight therapists in the EFT condition, two of whom
more recent was to ensure that the natural process of recovering
were male and six female. Two of the therapists were registered
from hurts had been given time to work and that the injured person
psychologists, one had a doctorate, and five were advanced doc-
was not in the midst of coping with the immediate aftermath of the
toral students in clinical psychology. Before training for the treat-
injury. Participants were required to be 18 years of age or older.
ment study, all therapists were required to have had at least 1 year
Exclusion criteria for the study— based on the assumption a brief
of EFT training, including prior empathy training, and 1 year of
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 Table 1
drugs or alcohol; and individuals diagnosed with antisocial, bor- Interpersonal Emotional Injuries Reported by Client Sample
derline, or narcissistic personality disorder, posttraumatic stress
disorder, or a psychotic disorder. Individuals who were already in Emotion-focused Psychoeducation
Variable therapy group
psychotherapy elsewhere were also excluded.
The average age for clients in the EFT treatment was 43 years. Issue
The average age for the PG treatment was 46 years. The overall Betrayal 5 8
population thus had a mean age of 44.5 years (SD ⫽ 8.3; range, Criticism 6 4
Neglect 4 3
22– 67 years). There were 7 men and 16 women in the EFT Abandonment 5 4
treatment and 13 men and 10 women in the PG treatment. In the Physical abuse 2 3
EFT treatment, 8 individuals had never been married, 13 were Sexual abuse 1 1
married, and 2 were separated or divorced. In the PG treatment, 5 Significant other
had never been married, 9 were married, and 9 were separated or Both parents 5 5
Mother 8 7
divorced. In terms of their level of education, in the EFT treatment, Father 5 4
1 individual had completed high school, 3 had some college or Ex-partner 2 2
university training, 12 had graduated from college or university, Sibling 2 2
and 7 had postgraduate experience. In the PG treatment, 5 indi- Child 0 1
Other 1 2
viduals had completed high school, 3 had some college or univer-
sity training, 6 had graduated from college or university, and 9 had Note. N ⫽ 23 in each treatment group. Each participant targeted one
postgraduate experience. Ethnicity in both groups was predomi- injury only.
 188 GREENBERG, WARWAR, AND MALCOLM
experience as a therapist. Therapists in the EFT treatment received
an additional 30 hr of specialized training that was based on a
treatment manual for resolving emotional injuries developed for
this project (Greenberg, Malcolm & Warwar, 2002). The group in
the PG condition 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 through-
out the study to promote adherence to treatment manuals.
Treatments
Both interventions involved 12 hr of treatment distributed over
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approximately 12 weeks.
Emotion-Focused Therapy (EFT)
The treatment manual for this study was based on the principles
outlined for EFT (Greenberg et al., 1993; Greenberg & Rosenberg,
2002), also known as process– experiential therapy. This therapy
includes the implementation of the person-centered relational at-
titudes of empathy, positive regard, and congruence, as well as
marker-guided, process-directive, experiential interventions. In
EFT, the therapist uses the following interventions: gestalt two-
chair dialogues when clients present in-session self-evaluative
conflicts; client-centered systematic evocative unfolding for prob-
lematic reactions over which clients are puzzling; and gestalt
empty-chair dialogue for resolving clients’ currently felt unfin-
ished 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 et al., 1993; Greenberg
& Paivio, 1997).
A specialized EFT treatment manual (Greenberg, Malcolm, &
Warwar, 2002) was developed for this project to focus on facili-
tating the resolution of emotional interpersonal injuries. The treat-
ment protocol is summarized in the following four phases that
overlap rather than being purely sequentially.
Phase 1: Creating an alliance. The first phase of treatment
involves creating a therapeutic alliance with the client by empathi-
cally 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 2: 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 used to help clients
process unresolved feelings toward the injurer. In our study, ther-
apists were advised to begin work on evocation and exploration as
early as the second session if the injury was clear and if safety and
the bond seemed to be sufficiently strong and no later than the
third session if the client appeared ready. In addition, therapists
were advised to continue evocation and exploration up until the
penultimate session if necessary. 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 3: Self-interruptive work. The third phase of therapy
involves interventions facilitated by therapists at client markers of
interruption such as emotional constriction, resignation, or hope-
lessness. 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 them-
selves and to promote change in these interruptive processes so
that emotions preventing resolution can be accessed and processed.
Phase 4: Empowerment and letting go or forgiving. This final
phase entails accessing previously unexpressed emotions and mo-
bilizing and promoting the entitlement of unmet needs. The ther-
apist 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 worldview of the other aids in developing
empathy toward 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 6, clients were given a handout that
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 highlight that change was to come from the client, not the
perpetrator, since the perpetrator may never change. At Session 7,
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 8, clients were given a
handout that 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 (PG)
The PG manual was devised for this study and drew on various
sources for content (Bolger, 1999; Klassen, 2001; Paivio & Green-
berg, 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 expla-
nation of the differences between PG and group therapy. Sessions
2–5 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; understand-
ing unfinished business and how it disrupts adaptive functioning;
aspects of forgiveness, including what it is and is not, and why one
 FACILITATION OF FORGIVENESS
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.
The content presentation of the first session was short, and
group discussion was intentionally structured to create safety and
assure group members that their participation in the group discus-
sions was voluntary and at their discretion. In the final session, the
material presented in the first five sessions was reviewed, and
instead of receiving a homework assignment, clients interested in
further reading were given a bibliography on the topics covered in
the workshops.
The group members in PG treatment received the same
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homework assignments as the participants in individual therapy
in the same order and at approximately the same time intervals.
They also received additional journaling and reflection exer-
cises so that they would have homework assignments after each
of the first five workshops. It was assumed that any change
experienced in the PG members would be the result of discus-
sion 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 1 week prior to treatment and 1 week
following treatment. Clients were also assessed at a 3-month
follow-up on measures of letting go, forgiveness, level of depres-
sion, global symptoms, and target complaints.
Measures of Forgiveness
The Enright Forgiveness Inventory (EFI; Enright, Rique, &
Coyle, 2000). The EFI 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 participant is asked to write a description of the
injury in his or her own words. The second part of the inventory
comprises 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 6-point Likert scale (1 ⫽ strongly
disagree, 6 ⫽ strongly agree). The authors have reported a stabil-
ity coefficient in a community sample for total EFI scores of .86
during a 4-week test–retest reliability study. The subscale test–
retest coefficients ranged from .67 to .91. With respect to concur-
rent 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). Cronbach’s 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 measures the extent to which clients have forgiven the
person who injured them. Responses are indicated on a 5-point
Likert scale (1 ⫽ not at all, 3 ⫽ in progress, 5 ⫽ completely). The
189
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 clients’ degree of
forgiveness, a score of 4 or above (i.e., meaning 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). Singh 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 Scale (UFB EA).
The UFB EA comprises six items and measures the extent to
which clients feel acceptance and empathy toward the individual
who injured them. Clients were asked to indicate their agreement
with the statements of empathy or acceptance on a 5-point Likert
scale (1 ⫽ not at all, 5 ⫽ very much). For example, empathy items
consist of statements expressing understanding of the injurer and
the personal difficulties that he or she could be facing. Acceptance
items include statements expressing receptiveness toward the other
person and reverse-scored items expressing negative views of the
other person. The items on the UFB EA have been found to
intercorrelate highly in a sample of clients in treatment for unfin-
ished business (Paivio & Greenberg, 1995) and in a sample of
university students (Singh, 1994), and the overall UFN Scale has
been found to correlate with other outcome measures (Paivio &
Greenberg, 1995; Watson & Greenberg, 1996). Cronbach’s alpha
for the UFB EA in this sample was .87.
Measures of Letting Go
Unfinished Business Feelings and Needs Scale (UFB FN).
The Feelings and Needs Scale (UFB FN) was adapted from
Singh’s (1994) Unfinished Business Scale. It measures the client’s
resolution of feelings and needs as they relate to the injurer and
positive changes in the perception of self. This measure comprises
eight items rated on a 5-point Likert scale (1 ⫽ not at all, 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 a statement describing the client’s unresolved feelings in
relation to the injurer. The Needs subscale includes items such as
a statement reflecting the client’s frustration about not having
needs met by the other person. Items pertaining to self include
statements such as one describing how negative treatment by the
injuring party has affected the client’s self-esteem. The UFB FN
has shown interitem reliability in a sample of clients in treatment
and a sample of university students and has been found to correlate
with other outcome measures in a sample of clients in treatment.
Cronbach’s alpha for the UFB FN 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 assesses the extent to which
clients have let go of their hurt and angry feelings toward the
injurer. Responses are indicated on a 5-point Likert scale (1 ⫽ not
at all, 3 ⫽ in progress, 5 ⫽ completely).
 190 GREENBERG, WARWAR, AND MALCOLM
Measures of Other Outcomes
Target Complaints (TC) Discomfort and Change Scale (Battle et
al., 1968). The TC Discomfort and Change 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 (pretreatment, posttreatment, and 3-month follow-up) in
terms of how distressed they were by the problem. In addition, at
two points in time (posttreatment and 3-month follow-up), clients
were asked to rate how much they felt the problem 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 posttreatment psychiatric interviews.
Global Symptom Index (GSI) of the Symptom Checklist-90 —
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Revised (SCL-90 –R; Derogatis, 1983). The SCL-90 –R is a
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well-known instrument that measures general symptom distress,
with high internal consistency (.77–.90) and test–retest reliability
(.80 –.90) over a 1-week interval with people with a variety of
disorders (Derogatis, Rickels, & Roch, 1976). Calculations of
change on the GSI were used as an outcome measure at three
points in time (pretreatment, posttreatment, and 3-month follow-
up). Cronbach’s alpha for GSI in this sample was .82
Beck Depression Inventory (BDI; Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961). This 21-item inventory is widely used
to assess depression. It has high internal consistency and correlates
highly with other self-report measures of depression and with
clinicians’ ratings of depression (r ⫽ .60 –.90; Beck, Steer, &
Garbin, 1988). Cronbach’s 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 7-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–.93) as well as
the subscales (.89 –.92) (Horvath & Greenberg, 1989). Cronbach’s
alpha for WAI was .89.
Emotional Arousal Session Report Measure (Warwar & Green-
berg, 2002). The Emotional Arousal Session Report Measure
was developed to evaluate the intensity of emotional arousal
experienced during therapy. This measure consists of 18 emotion
items, which the client rates on a 7-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 an emotion
that clients believed to be vital in describing their emotional
experience was absent from the 18 emotion categories, we added
an additional item (Question 19), which gives the client an oppor-
tunity to rate the intensity of any other emotion they may have felt.
The Emotional Arousal 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 shown to predict outcome.
Procedure
Clients were recruited through advertisements in local commu-
nity 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
for individuals older than the age of 18 who had been emotionally
injured by a significant other. The advertisements also indicated
that the injury should have occurred at least 2 years prior to the
time that the individuals responded to the advertisement and that
respondents should still be experiencing some lingering feelings of
hurt or anger toward the other in regard to the injury.
Eighty-six participants who called in response to the advertise-
ments 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 earlier 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 2-hr assessment
interview was designed to obtain consent for assessment and
treatment and to assess clients in terms of Axis I and Axis II
disorders using the Semistructured Clinical Interview and Diagno-
sis protocol (SCID; Spitzer, Williams, Gibbon, & First, 1990).
Clients also completed the BDI 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 pretreatment 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
twelve 1-hr weekly individual therapy sessions. Clients in the PG
group were seen for six 2-hr sessions that were held biweekly for
12 weeks. Three PG groups (ns ⫽ 9, 8, and 6) were tested for a
total of 23 participants. In the EFT treatment, one therapist saw 5
clients, one saw 4, two saw 3, and four saw 2 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 pretreatment, at termination of treatment,
during a posttherapy interview, and at a 3-month follow-up inter-
view. A short form of the WAI was given to the PG clients
following Session 1 and to the individual EFT clients after Session
3. Therapists completed a postsession questionnaire after each
session.
Results
Adherence to the therapy treatment manual in the EFT treatment
was monitored via therapist and supervisor reports. Adherence to
the PG group manual was monitored only via therapist reports.
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, they reported whether they had used chair dialogues
during the session. The supervisor, using the same 5-point scale,
reported an adherence judgment from viewing a videotape of at
least four of the individual therapy sessions. Mean rating (with
standard deviation) of therapist reports for the individual treatment
 FACILITATION OF FORGIVENESS
over the sessions was 4.23 (SD ⫽ 1.11), and mean supervisor
rating was 4.14 (SD ⫽ 0.52), 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.
Given that clients were gathered in groups (of 9, 8, and 6) in the
three PG groups and that each therapist saw a different number of
clients, there was a nonindependence in the data that could have
introduced a statistical bias in the analyses (Kenny, 1995). Thus,
we investigated treatment outcome scores for bias by looking at
intraclass correlations 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 .10. For the analyses that did not compare treatments, effects
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(the importance of ignoring statistical dependencies among obser-
vations) are likely to be relatively minor, and so in these cases
dependence was ignored.
Correlations were conducted between all pretreatment vari-
ables.1 The pretreatment BDI did not correlate with any of the
other symptom measures at pretreatment. However, there were
positive correlations between the EFI and the Forgiveness Measure
(r ⫽ .35, p ⬍ .05) and between the EFI and the UFB EA (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 examined using one-way analyses of
variance (ANOVAs). A t test that we 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, we performed repeated measures analyses of covariance.
Pretest scores of the dependent measure were used as the covariate
with posttreatment and follow-up scores as the repeated measures
and with the type of therapy received (either PG or individual
EFT) as the between-groups factor. TC Change, which does not
have a measure at pretreatment, was analyzed by a repeated
measure ANOVA, with posttreatment and follow-up as the two
occasions. The means for each of the measures for pretherapy,
posttherapy, and follow-up are provided in Table 2. There were no
significant Group ⫻ 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. EFI, Forgiveness Measure, UFB EA, UFB FN,
and Letting Go Measure) as well as the greatest levels of symptom
reduction (i.e., TC Discomfort, TC Change, and GSI)2. However,
the differences for the BDI were not statistically significant.
Clinical Significance and Effect Size
Cohen’s d, the standardized mean difference, which provides an
index of the practical as well as the statistical significance of the
differences between treatments and between pre- and posttreat-
ment, was calculated. The effect size for differences between
treatments on the EFI was moderate, d ⫽ 0.41; pre–posttreatment
effect sizes were large for both treatments, with d ⫽ 1.0 for EFT
191
and d ⫽0.71 for PG. This shows that both treatments led practi-
cally to a large amount of change and that there was a meaningful
difference between groups on the major measure of forgiveness.
Pre–posttreatment effects on the GSI were d ⫽ 0.62 for the EFT
treatment and negligible for the PG treatment. The between-
treatment effect size was d ⫽ 0.66, again showing large effects for
EFT over PG. The pre–posttreatment effects on empathy and
acceptance (UFB EA) were 1.73 and 0.74 for EFT and PG,
respectively, and the between-treatment effect size was 0.98. For
feeling and needs (UFB FN), the pre–posttreatment effects were
3.22 and 1.62 for EFT and PG, respectively, with a between-
treatment effects size of 1.62. The pre–posttreatment effects on TC
Discomfort were 3.84 and 2.27 for EFT and PG, respectively, and
the between-treatment effect was 1.56. All these effects are very
large. The between-treatment effects on BDI were very small, d ⫽
0.06, and the pre–posttreatment effects of 0.47 and 0.69 for EFT
and PG, respectively, although large, were much smaller than on
other measures.
Forgiving and Letting Go
Cutoff scores were used on the relevant outcome measures to
classify clients according to whether they forgave their injurers or
let go of their negative feelings toward the injurer (Level 4 or
above on each measure). The classification of clients on this
dichotomous classification is shown in Table 3. Dichotomy on
these single-item measures, however, is 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.
1
Readers can request a complete matrix of intercorrelations between all
variables by writing to Leslie S. Greenberg at lgrnberg@yorku.ca.
2
In order to test for possible dependence in the data, we computed
intraclass correlations (ICCs) on the output from two separate one-way
ANOVAs on the effect of the therapists in the EFT condition and of the
three groups in the PG condition. An ICC measures the relative homoge-
neity 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 is 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 does not matter). ICC
recently has been used in the context of hierarchical linear modeling
(HLM) to measure the extent to which data clustering (i.e., nonindepen-
dence of observations) is present. If the ICC is near 0, then HLM gives very
similar results to a traditional ANOVA or regression that assumes inde-
pendence (Raudenbush & Bryk, 2002; Shrout & Fleiss, 1979).
ICCs at posttest were found to be low— below .08 or negative for both
treatment conditions for all of the dependent variables except for the
Unfinished Business Feelings and Needs Scale (UNB FN) in the PG group
(ICC ⫽.15). 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
UNB FN. Fs were adjusted according to the design effect, which is a
function of ICC and sample size (Skinner, Holt, & Smith, 1989) for posttest
scores on the UNB FN, and no significant difference between groups was
found at posttest, F(1, 43) ⫽ 2.65, p ⫽ .112, thereby altering the conclu-
sion 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.
 192 GREENBERG, WARWAR, AND MALCOLM

Table 2
Means and Standard Deviations of Outcome Measures at Pretreatment, Posttreatment, and Follow-Up

Prettreatment Posttreatment Follow-Up

Analysis of
EFT PG EFT PG EFT PG Covariance

Measure M SD M SD M SD M SD M SD M SD F(1, 43)

Enright Forgiveness
Inventory 199.22 60.58 197.09 58.14 261.13 47.24 237.30 51.28 277.52 51.41 243.43 55.01 4.98*
Forgiveness Measure 2.18 0.72 2.39 0.78 3.74 0.81 2.87 1.06 3.83 0.75 3.43 1.01 7.91**
Unfinished Business Scale
Empathy and Acceptance 14.04 4.43 14.26 4.97 22.17 5.42 17.78 5.48 22.13 4.38 18.87 4.78 9.28**
Feelings and Needsa 14.87 5.06 17.48 4.63 30.95 6.00 25.58 8.35 31.32 6.56 28.05 7.15 4.32*
Letting Go Measure 2.00 0.71 2.17 0.94 4.09** 0.79 2.17 0.98 4.06 0.71 3.42 0.76 437.69**
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Target Complaints Scale

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Discomfort 10.48 1.53 10.07 1.64 4.40 2.25 6.48 3.03 4.61 2.41 6.22 2.56 7.03*
Change — — — — 7.16 1.64 5.39 1.99 7.70 1.29 6.36 1.91 12.67**
Global Symptom Index .70 .43 .58 .36 .46* .47 .60 .45 .35 .31 .45 .32 6.73*
Beck Depression Inventory 12.18 10.32 10.79 6.34 7.26 7.59 6.39 5.88 6.79 7.13 5.47 5.43 1.1

Note. Pretreatment scores were used as covariates. EFT ⫽ emotion-focused therapy; PG ⫽ psychoeducation group.
a
See Footnote 2.
*
p ⬍ .05. ** p ⬍ .01.

All of the 9 clients in EFT who forgave the injurer also let go of Test of Emotional Arousal in Groups
their negative feelings, as did the 4 people in the PG treatment who
forgave the injurer. However, 5 people in the EFT treatment and 3 We compared clients in each of the treatment modalities on the
in the PG treatment let go but did not forgive. The result of a intensity of self-reported emotional arousal they experienced in the
chi-square analysis of the distribution comparing forgivers and session to test for the hypothesized difference between treatments
those who let go was significant, ␹2(l, N ⫽ 46) ⫽ 21.5, p ⬍ .001, in reported emotional arousal. The emotional arousal measure was
showing that 100% of those who forgave let go, while 38% of divided into positive and negative or unpleasant emotion clusters
those who let go did not forgive. This suggests that letting go may for the following periods: total duration of treatment and three
be a necessary requirement of forgiveness (i.e., everyone who phases of therapy (early, middle, and late). The positive emotion
forgave also let go), but it is not by itself sufficient for, nor is it the cluster included happy and content, while the negative cluster
same thing as, forgiveness, since clients who met the criteria for included sad, angry, afraid, and in pain.
letting go did not always consider themselves to have forgiven the Changes in reported intensity of negative/unpleasant and pleas-
injurer. It is important to note that in both groups, a large propor- ant in-session emotional arousal across three phases of each treat-
tion of those people who were classified as not forgiving or letting ment were examined. For treatment comparisons, the EFT sessions
go rated themselves as in progress (Level 3) on these tasks, so it were grouped to form early (three sessions), middle (five sessions),
was not the case that they did not benefit from treatment. They and late phases (last two sessions). This structure was thought to
simply had not yet reached as full a resolution, according to our best reflect the phase structure of the treatment. The six group
cutoff criteria, as those who indicated they had more fully forgiven sessions were broken into three sets of two sessions each. A 2 ⫻
or let go. 3 ⫻ 2 repeated measures ANOVA was used to compare reported
in-session intensity of positive and negative emotions in the two
treatment conditions overall and in each phase of therapy. Means
and standard deviations are shown in Table 4, and the graph over
Table 3 phases is given in Figure 1.
Frequency of Forgiveness and Letting Go of Negative Feelings There was a significant Emotion ⫻ Time interaction, F(2, 43)
⫽12.853, p ⬍ .001; a significant Emotion ⫻ Group interaction,
No. of clients who let go of negative feelings
F(1, 44) ⫽ 24.6, p ⬍ .001; and a significant three-way Emotion ⫻
Emotion- Psychoeducation Time ⫻ Group interaction, F(2, 43) ⫽ 3.29, p ⬍ .05. Post hoc
focused therapy group % of total analyses using a Bonferroni adjustment for multiple comparisons
Forgiveness found the groups differed significantly, p ⬍ .001, on the amount of
achieved Yes No Yes No Yes No
reported negative affect arousal overall in the treatment but that
Yes 9 0 4 0 28.26 0 there were no significant differences at the .05 level between the
No 5 9 3 16 17.39 54.34 treatment in self-reports of overall positive emotion experienced
in-session over all. This finding acted as a form of implementation
Total % 30.43 19.56 15.21 34.78 45.65 54.34
check showing that the individual EFT treatment was effective in
Note. A chi-square analysis of the distribution comparing forgivers and arousing more unpleasant emotion. The clients in the EFT treat-
those who let go was significant, ␹2(l, N ⫽ 46) ⫽ 21.5 p ⬍ .001. ment reported significantly higher levels of negative/unpleasant
 FACILITATION OF FORGIVENESS 193

Table 4 posttreatment changes as the standardized residuals by regressing

In-Session Emotion Clusters by Phase of Therapy for Clients initial scores onto final scores for all the symptom and outcome
Receiving Psychoeducation Group Treatment and Emotion- measures (Cronbach & Furby, 1970). As can be seen in the table,
Focused Therapy an increase in forgiveness, in empathy and acceptance, and in
feelings and needs all were related to a decrease in overall symp-
Phase of Therapy tom distress
Early Middle Late
Discussion
Emotion PG EFT PG EFT PG EFT
The results of this study show that clients in the individual EFT
Positive treatment experienced significantly more improvement than those
M 3.03 2.97 3.62** 2.73 4.17 3.82 in the PG treatment on all measures of forgiveness, on measures
SD 1.17 1.16 1.26 1.23 1.53 1.44
Negative assessing the degree to which clients had let go of distressing
M 2.82 3.58* 2.67 3.50** 2.11 2.60 feelings and unmet needs in relation to the injurer, and on target
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SD 1.40 0.91 1.12 0.98 1.04 1.09 complaints at termination and follow-up. The two groups, how-
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ever, were found to not differ significantly on the change in

Note. N ⫽ 23 for each treatment group. Asterisks indicate between group
feelings and needs at termination, when possible dependence in the
differences. PG ⫽ psychoeducation group; EFT ⫽ emotion-focused ther-
apy. PG group was taken into account. Greater improvement also was
*
p ⬍ .05. ** p ⬍ .01. reported in the EFT condition on the GSI of the SCL-90 –R.
However, there was no difference between groups on the BDI, but
given that the clients in this study were not depressed, this finding is
not surprising. The significant change in general psychological symp-
emotional arousal than clients in 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 those in the EFT 4.5
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. 4.0
The EFT clients’ reports of in-session negative/unpleasant emo-
tional arousal were found to be relatively stable over the first two
phases, showing no significant differences at the .05 level between
Means

early and middle phases. However, the EFT clients reported sig-
nificantly less in-session negative/unpleasant emotional arousal in 3.5
the final phase of therapy compared with that reported in 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 signif-
icant decline in reported negative emotional arousal from the 3.0
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
2.5
to the final phase of treatment, p ⬍ .001. In the PG clients, 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 treat- 2.0
ment phase, p ⬍ .01, and from the middle to late phase, p ⬍ .05. Early Middle Late
Degree of reported in-session intensity of emotional arousal aver-
aged over the whole treatment, or averaged over any of the phases Phase of Therapy
of treatment, did not correlate significantly with change on any of
the outcome measures for the combined sample or for either PG
treatment. EFT
Negative Emotion
Correlational Analyses Positive Emotion

Correlations calculated between residual gains in the

forgiveness- and letting-go-related variables, and symptom vari- Figure 1. Emotional arousal across phases. PG ⫽ psychoeducation
ables are displayed in Table 5. We calculated the pre– group; EFT ⫽ emotion-focused therapy.
 194 GREENBERG, WARWAR, AND MALCOLM
Table 5
Correlations Between Pre–Posttreatment Residual Gain Scores
on Forgiveness, Letting Go and Symptom Variables
Posttreatment measure
Global Beck
Symptom Depression
Pretreatment measure Index Index
Enright Forgiveness Inventory ⫺.41** ⫺.08
Forgiveness Measure ⫺.36* ⫺.22
Unfinished Business Scale
Empathy and Acceptance ⫺.37* .05
Feelings and Needs ⫺.38** ⫺.29
Letting Go Measure ⫺.23 ⫺.17
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Target Complaints Scale—Discomfort .27 .14
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Note. N ⫽ 46.
*
p ⬍ .05. ** p ⬍ .01.
toms on the SCL-90 –R in the EFT clients, with no change in the PG
clients 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 psychoeducation
group. Taken as a whole, this study provides support for the differ-
ential effectiveness of an EFT approach for promoting forgiveness,
resolving emotional injuries, and reducing general symptoms over a
PG treatment intervention of the same duration.
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, some individuals indicated that they
had let go of the distressing feelings and unmet needs associated
with the injury but had not forgiven the injurer. This finding
suggests that letting go of persistent unresolved feelings such as
anger, grief, sadness, or hurt may be a necessary step in resolving
past interpersonal hurtfulness but may not be sufficient for, nor
equivalent to, forgiveness. Further research on this question is
needed, but viewing the process of reducing unforgiveness or
letting go of bad feelings as distinct from the process of generating
positive feelings, such as loving kindness, may be useful when one
is examining the process of forgiveness and the possibility of the
resolution of an emotional injury in the absence of forgiveness.
Contrary to what has been suggested in the forgiveness literature
(McCullough & Witvliet, 2001; Orcutt, 2006), forgiveness was not
initially correlated with the pretreatment variables measuring emo-
tional health such as the BDI or (particularly) the GSI of the
SCL-90 –R. Thus, clients who at the start of treatment were more
forgiving were not psychologically healthier. This finding, how-
ever, may have been due to lack of range on the Forgiveness
Measure as well as on the GSI and BDI and due to the fact that
participants were seeking help for presenting problems involving a
lack of letting go and forgiveness. In our study, pre–posttreatment
increases in forgiveness and letting go variables were related to a
decrease in GSI. Thus, it seems that increases during treatment in
forgiveness and in empathy and acceptance toward the injurer and
the ability to resolve feelings and needs were related to improved
health as measured by the GSI, suggesting that there are health
benefits to resolving injuries both by forgiveness and by letting go.
Recently Orcutt (2006) found that offence-specific forgiveness at
initial assessment correlated significantly with symptom distress
approximately 9 months later (after controlling for symptoms
distress at initial assessment) and that the length of time since the
offence mediated the relationship between forgiveness and symp-
tom distress, suggesting a complex relationship between forgive-
ness and symptoms. Data on our treatment-seeking population do
not support the idea that forgiveness correlates with distress at
initial assessment but do show that an increase in forgiveness
certainly correlates with a reduction in distress.
In addition to clients showing better outcomes, the EFT treat-
ment was found to involve more client-reported emotional arousal,
especially of negative emotions in the mid phase of treatment,
confirming that the EFT treatment was more emotionally arousing
than the PG treatment. The finding that there was more negative
emotional arousal in the early phase of therapy in the EFT treat-
ment than in 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 that the emotional change processes in ther-
apy 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, Auszra, and Herrmann (2007) showed that
arousal alone is not necessarily a measure of productive emotional
processing and that it is productive processing of aroused emotion
that best discriminates good from poor outcomes. In other studies,
the intensity of observed expressed emotional arousal, however,
has been shown to predict outcome in the working phase of the
EFT treatment of depression (Missirlian, Toukmanian, Warwar, &
Greenberg, 2005; Warwar, 2003). The difference in the finding on
the relationship between emotional arousal and outcome in this
study and the finding on the relationship between the two in the
studies on depression (if not attributable to differences between a
depressed and an emotional injury population) may be explained
by the differences between the nature of the experience of emotion
as measured by postsession self-reports of emotional arousal ex-
perienced in the session and the expression of emotions captured
by observational measures of arousal. In the present study, we
observed that in the sessions in which some clients reported having
felt high emotional intensity (experienced emotion), those clients
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 great deal
of anger or sadness but did not necessarily express it. Therefore,
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 process-
ing. As Greenberg et al. (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 one is dealing with unresolved painful emotions.
 FACILITATION OF FORGIVENESS
Our study had some limitations. The clients in this study were
volunteers who responded to advertisements and therefore may not
have been 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 because we assumed that this would be handled by ran-
domization. However, 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 ongoing
relationship with the injurer (as in the case with a living parent vs.
a deceased parent). It also would have been preferable to ensure 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
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
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 used, one might attribute observed differences in this study
to therapist training/allegiance or to researcher allegiance, rather
than to differences in specific treatment techniques. The EFT
therapists had at least 1 year of experience with EFT and had
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 psychoeducation group treatment. Investigators were pro-
ponents of EFT, and this too could have influenced 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 re-
ceive a treatment tailored to their needs, whereas in group treatment,
there is less flexibility and individualization. Spacing of sessions also
was different in the two treatments. Individual therapy sessions took
place weekly, whereas the group sessions were twice the length of
individual sessions but met only once every 2 weeks. This could have
provided more continuity of treatment and support in the individual
therapy. On the other hand, group participants may benefit from other
factors in groups that promote change that are not available to the
individual participants, such as having two therapists, group support,
and a sense of the universality of their problems.
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Received January 16, 2007
Revision received November 29, 2007
Accepted November 29, 2007 䡲