Forgiveness as a procedure has been gaining prominence. The objective of this article is to provide the basics of forgiveness as an intervention so primary care clinicians can facilitate its use. These clinicians include but are not limited to physicians, nurses, medical assistants, pharmacy professionals, physical therapists, social workers, psychologists, case managers, and clergy. This narrative explains the rationale for understanding forgiveness as a procedure and ways to explain it. To assist clinicians and patients in making informed decisions, samples of forgiveness research are included that describe its positive relationship to specific physical health situations. The article also describes an evidence-based forgiveness therapy, circumstances in which it is harmful to forgive oneself or others, describes the limitations of this article, and suggests future directions.
TutuD.No future without forgiveness.
New York, NY:
Doubleday, 2000.
2.
WadeN.Introduction to the special issue on forgiveness in therapy. J Ment Health Couns2010;
32: 1–4.
3.
WadeNHoytWKidwellJ, et al.
Efficacy of psychotherapeutic interventions to promote forgiveness: a meta-analysis.J Consult Clin Psychol2014;
82: 154–170.
4.
WadeNGJohnsonCVMeyerJE.Understanding concerns about interventions to promote forgiveness: a review of the literature. Psychotherapy2008;
45: 88–102.
5.
HarrisAThoresenC.Forgiveness, forgiveness, health, and disease. In WorthingtonELJr (ed) The handbook of forgiveness. 2005, pp. 321–333. New York: Bruner-Routledge.
6.
EnrightRDand the Human Development Study Group. The moral development of forgiveness. In KurtinesWGerwitzJ (eds) Handbook of moral behavior and development.
Hillsdale, NJ:
Lawrence Erlbaum, 1991, pp. 123–152.
7.
WorthingtonESandageSBerryJ.Group interventions to promote forgiveness: what researchers and clinicians ought to know. In McCulloughMPargamentKThoresenC (eds) Forgiveness: theory, research, and practice.
New York, NY:
Guilford Press, 2001, pp. 228–253.
8.
CosgroveLKonstamV.Forgiveness and forgetting: clinical implications for mental health counselors. J Ment Health Couns2008;
30: 1–13.
9.
Harvard Women's Health Watch. Five for 2005: Five reasons to forgive. Harvard Health Publications 2005 (Jan); 12 (5): 1–4.
10.
FreedmanSChangWE.An analysis of a sample of the general population’s understanding of forgiveness: implications for mental health counselors. J Ment Health Couns2010;
32: 5–34.
11.
MeiselSRKutzIDayanKI, et al.
Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet1991;
338: 660–661.
12.
StrikePCSteptoeA.Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique. Psychosom Med2005;
67: 179–186.
13.
DimsdaleJ.Psychological stress and cardiovascular disease. J Am Coll Cardiol2008;
51: 1237–1246.
14.
SteinRIKenardyJWisemanCV, et al.
What’s driving the binge in binge eating disorder? A prospective examination of precursors and consequences. Int J Eat Disord2007;
40: 195–203.
15.
EnrightRDFitzgibbonsRP.Helping clients forgive: an empirical guide for resolving anger and restoring hope.
Washington, DC:
American Psychological Association, 2000.
16.
WatsonMLydeckerJJobeR, et al.
Self-forgiveness in anorexia nervosa and bulimia nervosa. Eat Disord2012;
20: 31–41.
17.
SvalinaSWebbJ.Forgiveness and health among people in outpatient physical therapy. Disabil Rehabil2012;
34: 383–392.
18.
ExlineJPrince-PaulMRotB, et al.
Forgiveness, depressive symptoms, and communication at the end of life: a study with family members of hospice patients. J Palliat Med2012;
15: 1113–1119.
19.
Prince-PaulM.Understanding the meaning of social well-being at the end of life. Oncol Nurs Forum2008;
35: 365–371.
20.
Prince-PaulMExlineJ.Personal relationships and communication messages at the end of life. Nurs Clin North Am2010;
45: 449–463.
21.
Adler N, Page A, and the Institute of Medicine of the National Academies (eds). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: The National Academies Press, 2008.
22.
HansenMEnrightRBaskinT, et al.
A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients. J Palliat Care2009;
25: 51.
23.
WorthingtonELJr.Forgiveness and reconciliation: theory and application.
New York, NY:
Routledge/Taylor & Francis Group, 2006.
24.
Harper Q, Worthington E, Griffin B, et al. Efficacy of a workbook to promote forgiveness: A randomized controlled trial with university students. J Clin Psychol 2014; 70: 1158–1169.
25.
Greer C, Worthington E, Lin Y, Lavelock C and Griffin B. Efficacy of a self-directed forgiveness workbook for Christian victims of within-congregation offenders. Spirituality in Clinical Practice 2014; 1: 218–230.
26.
GouldnerAW.The norm of reciprocity: a preliminary statement. Am Sociol Rev1960;
25: 161–178.
27.
SkinnerBF.Contingencies of reinforcement.
East Norwalk, CT:
Appleton-Century-Crofts, 1969.
28.
McNultyJ.Forgiveness increases the likelihood of subsequent partner transgressions in marriage. J Fam Psychol2010;
24: 787–790.
29.
McNultyJ.The dark side of forgiveness: the tendency to forgive predicts continued psychological and physical aggression in marriage. Pers Soc Psychol Bull2011;
37: 70–783.
30.
WohlMJAPychylTABennettSH.I forgive myself, now I can study: how self-forgiveness for procrastinating can reduce further procrastination. Pers Individ Dif2010;
48: 803–808.
31.
TangneyJPBooneADearingR.Forgiving the self: conceptual issues and empirical findings. In WorthingtonELJr (ed) Handbook of forgiveness.
New York, NY:
Brunner-Routledge, 2005, pp. 143–158.
32.
WohlMThompsonA.A dark side to forgiveness: forgiving the self and its association with chronic unhealthy behavior. Br J Soc Psychol2011;
50: 354–364.
33.
DeWall C, Pond R and Bushman B. Sweet revenge: Diabetic symptoms predict less forgiveness. Personality and Individual Differences 2010; 49: 823–826.
34.
ClabbyJ.Two minute talks to improve psychological and behavioral health.
Boca Raton, FL:
CRC Press, 2011.
