Forgiveness Education for Students in Nursing Program Helps Reduce Anxiety and Depression
A research study published last month, utilizing Dr. Robert Enright’s forgiveness intervention model, showed that students in college nursing programs would benefit from a forgiveness intervention in the areas of self-care and forgiveness facilitation.
The nursing students, randomly assigned to either an experimental group or a no-contact control group, used Dr. Enright’s book 8 Keys to Forgiveness as the project’s treatment manual. After studying one chapter a week for 8 weeks, the students in the experimental group showed greater improvement in forgiveness compared to those in the control group from the pretest to the posttest which was maintained at the four-week follow-up. In addition, those in the experimental group showed statistically significant decreases in anxiety, depression, and fatigue from pre-testing to both post-testing and follow-up testing periods.
The study was conducted by a team of 8 researchers from the Liberty University School of Nursing (Lynchburg, VA) under the direction of Jichan J. Kim, Associate Professor of Psychology at Liberty. Dr. Kim has been the lead investigator on more than a dozen forgiveness-related studies over the past several years.
This latest study, The Efficacy of a Forgiveness Bibliotherapy: A Randomized Controlled Trial with Nursing Students, was published in the Journal of Holistic Nursing (JHN) on Jan. 10, 2022. JHN is a peer-reviewed quarterly journal with a focus on advancing the science and practice of holistic nursing and healthcare.
“The need for forgiveness education for nursing students has risen dramatically as responsibilities have broadened for nursing professionals,” according to Dr. Kim. “Our study positively demonstrated that the use of bibliotherapy can be a cost-effective way to promote the virtue of forgiveness for nursing students who are likely to be in need of exercising self-care and would have opportunities to facilitate forgiveness for their patients.”
Bibliotherapy, Dr. Kim explained, is a therapeutic approach that uses literature (in this case Dr. Enright’s 8 Keys to Forgiveness) to support good mental health. This study, he added, demonstrated not only the effects of forgiveness, as numerous studies have done in the past, but also the feasibility of using a forgiveness bibliotherapy that can be easily adopted into the existing nursing curriculum.
That same approach has been used by Dr. Enright, co-founder of the International Forgiveness Institute (IFI) and the man Time magazine calls “the forgiveness trailblazer,” in a slightly different format over the past two years. Dr. Enright has worked with Dr. Chontay Taylor Glenn, PhD, RN, PMHNP-BC, to enroll a total of eight University of Michigan-Flint nursing students in the IFI’s Forgiveness Therapy training course.
Dr. Glenn is Assistant Professor & Project Director of the Psychiatric Mental Health Nurse Practitioner Residency Program at UM-Flint. In addition to incorporating the IFI’s forgiveness training into the curricula for her nursing students, she also developed a program through which nine Flint-area community counselors completed the Forgiveness Therapy online continuing education course. Dr. Kim provided three hour-long training sessions by Zoom as part of that collaborative effort between Dr. Glenn, Dr. Enright, and himself.
The newly trained counselors in Flint are also undertaking an expanded role in their community, according to Dr. Glenn–providing forgiveness education classes and case coordination to Flint-area adolescents who have experienced adverse childhood experiences. The project is funded by a grant from the W.K. Kellogg Foundation in Battle Creek, MI.
About Dr. Kim
Jichan J. Kim is an Associate Professor of Psychology and the Director of the M.A. in Applied Psychology program at Liberty University, Lynchburg, VA. His research interests include the effects of interpersonal and intrapersonal forgiveness as well as the integration of psychology and Christianity.
Dr. Kim has degrees from the University of Wisconsin-Madison (M.S. & Ph.D.), Harvard University (Ed.M.), Gordon-Conwell Theological Seminary (M.Div. & M.A.), and City College of New York (B.A.). He also has extensive ministry experience in New York City, Boston, and Madison (WI), serving various age groups in Korean immigrant congregations.
- Nursing Students Research Report Abstract
- Bibliotherapy Defined
- Overview of the IFI’s Forgiveness Therapy Course
Forgiveness Therapy and Getting Past Unconscious Resistances
Guest Blog by Gianna Elms, LCSW
My experience as a psychotherapist who has specialized in helping clients resolve unconscious anger through forgiveness for nearly a decade has been a mission of healing. Forgiveness is the most powerful therapeutic method that I have found because it is the answer to what underlies the psychological conflicts that produce psychiatric symptoms in many, yet the medical model would prefer that we believe differently. Forgiveness is the antidote to anger, which is difficult for people to release because the world teaches us that “getting back” at someone for hurting us or at least desiring revenge is healthy and a sign of strength.
Beyond everything else that I have learned, there’s an important factor that must be in place before I recommend working with forgiveness therapy.
In the case of forgiveness therapy, the role of the psychotherapist is to help the client to abandon their anger towards the offender and adopt agape love for the offender. Some clients are not ready to even hear words that are common in forgiveness therapy like forgiveness, love, fear or even anger. I have learned that some other psychotherapeutic interventions are necessary to help these clients to be ready to accept that they are angry, and forgiveness can help them heal.
The greatest challenges that I have witnessed clients face when working towards forgiveness is an unwillingness to let go of the illusion of strength or control that they believe they have when they hold onto their anger and maintain a lack of healthy boundaries, which often leads to continuing or renewing a relationship where there is no forgiveness, trust, apology, or justice between the parties. It’s another attempt to hold onto another illusion that they have achieved forgiveness or reconciliation. Many times, it’s more about learning to let go of what is familiar, such as a belief system that they had prior to beginning psychotherapy or an unconscious defense mechanism (e.g., denial). After all, unconscious defense mechanisms have an original protective purpose. It can be hard for clients to believe that forgiveness, which is so new and unfamiliar, is going to offer them greater freedom and protection.
The journey to learning how to forgive is often challenging and rewarding as clients work through their pain. I have learned that it is important to always demonstrate that I understand by being genuinely empathetic and compassionately normalizing the client’s pain, fear, and other emotions. I also provide teaching and reasoning as a therapeutic intervention about how healthy boundaries, for example, serve as a means of self-protection from future abuse and how it is consistent with healthy self-love and agape love for others.
If a client decides to receive or continue treatment while communicating with the offender, I provide supportive therapy and help the client to identify how the relationship is healing or causing more pain. Clients are typically able to figure out on their own, with the help of this type of psychotherapeutic intervention, that the relationship is unhealthy, and they will ultimately abandon their false belief that somehow they can make a relationship work with the person who is unwilling to change, which then increases their willingness to accept the new, healthier ways of thinking, feeling, and behaving, to include the primary goal of forgiveness.
“I believe that forgiveness should be used more in therapy because it promotes wellness and it’s good for the soul.”
Gianna Elms, LCSW
There are some cases when clients choose not to forgive and the effects are simply the same as when they started treatment, or in some cases, worse. I believe that forgiveness should be used more in therapy because it promotes wellness and it’s good for the soul. The secret to forgiveness though is that once a person learns how to forgive…the person can forgive immediately, even while the injury is happening because they’ve learned the meaning of forgiveness beyond just the therapy model. It comes from their heart that was healed and they adopt it as a new belief system that protects them from anger as long as they put it into practice. It’s like a muscle memory in the unconscious that connects to the heart, which needs to be exercised regularly, so that they never forget. That’s something that I learned one night, and I now teach it to others.
I hope that you will consider your state in life and how forgiveness will be of value to you and others who you have the opportunity to help. We all need forgiveness because we have hurt others, but we need forgiveness to heal us when others hurt us too.
About Gianna Elms:
Gianna Elms, LCSW is a mental health and disability advocate who has been practicing for twelve years and is currently based in Flagstaff, AZ where she provides tele-therapy, spiritual counseling, consultations, and on-site services when travel permits. She has been a passionate ambassador of forgiveness since completing the International Forgiveness Institute’s Helping Clients Forgive course (now called Forgiveness Therapy). She has an MSW in Social Work and has a valid license to practice as a Clinical Social Worker in Arizona and Missouri. She is also a qualified clinical supervisor in Arizona.
Before her MSW, Gianna earned an M.Ed. in Counseling Psychology and a B.S. in Disability Studies and has a valid certification to practice and supervise as a Rehabilitation Counselor nationwide. After receiving her MSW, she completed a Post-Graduate Fellowship in Psychoanalytic Thought and an ADA Coordinator Certification. Her clinical experience includes crisis intervention, treatment of past abuse, trauma, post-traumatic stress disorder (PTSD) and psychogenic non-epileptic seizures (PNES); evaluation and treatment of mood, anxiety, alcohol and substance use disorders and chronic pain; career counseling, case management, advocacy, accommodations of people who experience disabilities, blindness and visual impairments; and training clinicians and others.
For more information about Gianna, you may find her on giannaelmslcsw.com or forgivepraylove.com.
Dr. Enright’s Forgiveness Essays Reach One Million Views
What is the first thing that comes to mind when you hear the phrase “one million?”
- One million dollars?
- One million stars in the sky?
- One million pebbles of sand on a beach?
For Dr. Robert Enright, the psychologist who is often called “the father of forgiveness research,” the term one million gained a new significance recently when he learned that the blog column he writes for Psychology Today has surpassed one million views.
“When I first began studying forgiveness 36-years ago, it was extremely difficult to find even one single academic article on the subject,” says Dr. Enright. “The fact that my blog essays have been read more than one million times during the past few years is an extraordinary story of how important forgiveness has become in our lives.”
Appropriately called “The Forgiving Life,” (the same title as one of Dr. Enright’s most popular books), the Psychology Today column authored by Dr. Enright focuses on how forgiveness benefits individual, family, and community health. At the publication’s request, Dr. Enright wrote his first Psychology Today forgiveness essay in December 2016. Since then, he has written 93 blog entries as part of the series, all of which are available on the publication’s website.
Dr. Enright’s Psychology Today blogs have been accessed online an average of
548 times per day since he began writing them.
Here is a list of 10 of Dr. Enright’s most popular Psychology Today blogs (with hyperlinks to the actual articles):
- Afraid of Mingling with the Relatives This Holiday Season?
- A Message for All Who Bristle at the Idea of Forgiving
- How Forgiving Are You? Take the Forgiveness Test
- 6 Things to Consider Before Reconciling with an Ex
- Whom Do I Forgive in the COVID-19 Crisis?
- Finding True Love: 7 Questions to Ask Your Potential Partner
- Are Some Acts Completely Unforgiveable?
- Why Forgiveness Is Heroic
- Five Forgiveness Exercises for Couples
- Why We Need Forgiveness Education
“My Psychology Today essays are designed to pose a challenge to everyone who reads them,” Dr. Enright says. “I want readers to consider whether they can incorporate forgiveness into their everyday interactions so that they can become more compassionate while at the same time becoming healthier. I call it becoming forgivingly fit.”
You can access all 93 of Dr. Enright’s Psychology Today blogs at The Forgiving Life.
According to the website’s Author Profile page:
Robert Enright, Ph.D., is a professor of educational psychology at the University of Wisconsin-Madison, a licensed psychologist, and the founding board member of the International Forgiveness Institute, Inc., who pioneered the social scientific study of forgiveness. He is the author of over 120 publications, including seven books: Exploring Forgiveness, Helping Clients Forgive, Forgiveness Is a Choice, Rising Above the Storm Clouds (for children), The Forgiving Life, 8 Keys to Forgiveness, and Forgiveness Therapy. His colleagues and he have developed and tested a pathway to forgiveness, called Forgiveness Therapy, that has helped incest survivors, people in drug rehabilitation, in hospice, in shelters for abused women, and in cardiac units of hospitals, among others. Enright has developed Forgiveness Education programs for teachers in Belfast, Northern Ireland, Athens, Greece, Liberia, Africa, and Galilee, Israel.
Which is better, group forgiveness therapy or individual forgiveness therapy?
Both can be effective, as seen in the research section of the book, Forgiveness Therapy, APA Books, 2015. Yet, statistics show that one-on-one therapy (of at least 12 or more sessions once a week for 12 weeks) is more effective than brief therapy (which is about 4 to 8 sessions).
Do you think people get less out of forgiving if the motive is self-preservation rather than a concern for the other as a person?
We have yet to do a research study in which we examine different outcomes for those who have different initial motives for forgiving. One problem in doing such a research study is this: Often people start Forgiveness Therapy because of their own emotional compromise caused by an injustice from others. Yet, as people go through the forgiveness process, their motive often changes from a focus on the self to a genuine concern for the other. Thus, this issue of motive is a moving target and so is difficult to study. Yet, it is worth more careful thought.