6-Fold Path to Self-forgiveness: an Interdisciplinary Model for the Treatment of Moral Injury with Intervention Strategies for Clinicians

Overview

Journal Front Psychol

Date 2024 Dec 10

PMID 39654935

Authors

Michele J DeMarco

Affiliations

Soon will be listed here.

Abstract

Conscience is the indestructible core of one's personal identity and their sense of agency in the world. When it passes judgment against them, it generates inner conflict (i.e., moral injury). At its core, moral injury is about trust and sacred relationships, particularly the loss of safe connection with self, society, God/Divine/a Higher Power, and the world. The clash between a person's conscience and overwhelming existential or psychospiritual experiences, which uniquely defines moral injury, alienates them from life-sustaining relationships. Healing requires more than reordering fractured belief systems. Reestablishing bonds of self-worth, trust, and life-sustaining relationships are essential. This paper presents the 6-Fold Path to Self-Forgiveness (6-FPSF), an interdisciplinary, narrative-based healing writing process for the treatment of moral injury, particularly self-induced moral injury. Self-forgiveness has been associated with psychospiritual and relational well-being. The protocol draws upon theoretical literature, evidence-based psychological interventions, spiritual-oriented practices, creative arts, and somatic exercises for mental health counseling and spiritual/religious ministration. In addition to describing the 6-component therapeutic model, the author offers intervention strategies for clinicians.

References

Litz B, Stein N, Delaney E, Lebowitz L, Nash W, Silva C . Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009; 29(8):695-706. DOI: 10.1016/j.cpr.2009.07.003. View

Galletta M, Cherchi M, Cocco A, Lai G, Manca V, Pau M . Sense of coherence and physical health-related quality of life in Italian chronic patients: the mediating role of the mental component. BMJ Open. 2019; 9(9):e030001. PMC: 6756344. DOI: 10.1136/bmjopen-2019-030001. View

Forster D, Billingsley J, Russell V, McCauley T, Smith A, Burnette J . Forgiveness takes place on an attitudinal continuum from hostility to friendliness: Toward a closer union of forgiveness theory and measurement. J Pers Soc Psychol. 2019; 119(4):861-880. DOI: 10.1037/pspi0000227. View

Park C . Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull. 2010; 136(2):257-301. DOI: 10.1037/a0018301. View

Richards P, Barkham M . Enhancing the evidence base for spiritually integrated psychotherapies: Progressing the paradigm of practice-based evidence. Psychotherapy (Chic). 2022; 59(3):303-306. DOI: 10.1037/pst0000438. View

Breines J, Chen S . Self-compassion increases self-improvement motivation. Pers Soc Psychol Bull. 2012; 38(9):1133-43. DOI: 10.1177/0146167212445599. View

Brosschot J, Thayer J . Heart rate response is longer after negative emotions than after positive emotions. Int J Psychophysiol. 2003; 50(3):181-7. DOI: 10.1016/s0167-8760(03)00146-6. View

Gordon K, Baucom D . Understanding betrayals in marriage: a synthesized model of forgiveness. Fam Process. 1999; 37(4):425-49. DOI: 10.1111/j.1545-5300.1998.00425.x. View

Corona C, Van Orden K, Wisco B, Pietrzak R . Meaning in life moderates the association between morally injurious experiences and suicide ideation among U.S. combat veterans: Results from the National Health and Resilience in Veterans Study. Psychol Trauma. 2019; 11(6):614-620. PMC: 6722007. DOI: 10.1037/tra0000475. View

10.

Griffin B, Worthington Jr E, Lavelock C, Greer C, Lin Y, Davis D . Efficacy of a self-forgiveness workbook: a randomized controlled trial with interpersonal offenders. J Couns Psychol. 2015; 62(2):124-36. DOI: 10.1037/cou0000060. View

11.

Worthington Jr E, van Oyen Witvliet C, Pietrini P, Miller A . Forgiveness, health, and well-being: a review of evidence for emotional versus decisional forgiveness, dispositional forgivingness, and reduced unforgiveness. J Behav Med. 2007; 30(4):291-302. DOI: 10.1007/s10865-007-9105-8. View

12.

Frymann T, Whitney S, Yaden D, Lipson J . The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences. Front Psychol. 2022; 13:863247. PMC: 9168432. DOI: 10.3389/fpsyg.2022.863247. View

13.

Brom D, Stokar Y, Lawi C, Nuriel-Porat V, Ziv Y, Lerner K . Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. J Trauma Stress. 2017; 30(3):304-312. PMC: 5518443. DOI: 10.1002/jts.22189. View

14.

Barnes H, Hurley R, Taber K . Moral Injury and PTSD: Often Co-Occurring Yet Mechanistically Different. J Neuropsychiatry Clin Neurosci. 2019; 31(2):A4-103. DOI: 10.1176/appi.neuropsych.19020036. View

15.

Buhagar D . The Forgiveness Interview Protocol: A Narrative Therapy Writing-Process Model for the Treatment of Moral Injury. J Relig Health. 2021; 60(5):3100-3129. DOI: 10.1007/s10943-021-01395-3. View

16.

Rushton C . Moral Resilience: A Capacity for Navigating Moral Distress in Critical Care. AACN Adv Crit Care. 2016; 27(1):111-9. DOI: 10.4037/aacnacc2016275. View

17.

De la Fuente-Anuncibay R, Gonzalez-Barbadillo A, Ortega-Sanchez D, Ordonez-Camblor N, Pizarro-Ruiz J . Anger Rumination and Mindfulness: Mediating Effects on Forgiveness. Int J Environ Res Public Health. 2021; 18(5). PMC: 7967311. DOI: 10.3390/ijerph18052668. View

18.

Hsu H . The Psychological Meaning of Self-Forgiveness in a Collectivist Context and the Measure Development. Psychol Res Behav Manag. 2021; 14:2059-2069. PMC: 8687689. DOI: 10.2147/PRBM.S336900. View

19.

Nieuwsma J, OBrien E, Xu H, Smigelsky M, Meador K . Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers. J Gen Intern Med. 2022; 37(8):2033-2040. PMC: 8982664. DOI: 10.1007/s11606-022-07487-4. View

20.

Wenzel M, Woodyatt L, Okimoto T, Worthington Jr E . Dynamics of Moral Repair: Forgiveness, Self-Forgiveness, and the Restoration of Value Consensus as Interdependent Processes. Pers Soc Psychol Bull. 2020; 47(4):607-626. DOI: 10.1177/0146167220937551. View