July 2023. There is a fascinating initiative at Harvard called “The Human Flourishing Program.”1 The Program proposes to unite and synthesize topics that are fundamental to human well-being. Founded in 2016, the program is directed by Tyler VanderWeele, PhD, a Professor of Epidemiology at Harvard. The Program has developed a Flourishing Measure, to “uncover factors that might be determinants of either positive or negative life outcomes,” and it focuses on 5 domains: (1) happiness and life satisfaction, (2) mental and physical health, (3) meaning and purpose, (4) character and virtue, and (5) close social relationships. In an ambitious project, the Program launched a Global Flourishing Study, one component of which is called “Promoting Forgiveness,” carried out in Hong Kong, Colombia, Indonesia, South Africa, and Ukraine. This study has been completed, and its first report has just been posted, entitled the “International REACH Forgiveness Intervention: A Multi-Site Randomized Controlled Trial.”2 Involving 4598 participants, the study found that those who received a “forgiveness workbook” at the beginning of the study, compared with the control group, showed greater reductions in unforgiveness, depression, and anxiety. New York Times journalist Catherine Pearson3 reported on this study, in a piece called “The Emotional Relief of Forgiving Someone.” She had the opportunity to interview Tyler VanderWeele, the senior author of the study. She asked him, “What does it mean to forgive someone?” His reply: “My working definition is just to replace ill will toward the offender with good will. Forgiveness is not forgetting the action or pretending it didn’t happen; it’s not excusing or condoning the action, and it’s not the same as reconciling or forgoing justice. One can forgive while still pursuing a just outcome.”

Among the many things that intrigue me about this report is its relevance to the work of psychotherapy. In the May issue of Journal of Psychiatric Practice, Eric Plakun provided Part 1 of his overview of psychodynamic therapy, and Part 2 of this series of columns is presented in this July issue. In Part 1, he summarized some basic fundamentals of human development, notably that “… without experiences of mastery in response to failed caretaking, opportunities to learn to manage unpleasant feelings, or to achieve self-sufficiency and move from dependence toward independence, are lost.” Let me highlight “in response to failed caretaking” in the sentence above. There will always be times of failed caretaking, even in the sturdiest of families. And learning to overcome these failures stimulates growth, mastery, and healthy development. When the caretaking is “good enough,” I would argue, this trial and error process involves forgiveness and reconciliation, instilling fortitude and confidence to surmount obstacles and disappointments. But when the caretaking is not good enough, or when things are fine yet severe trauma or tragedy lands, mastery may be impossible and trouble lies ahead.

Fast forward to Part 2 of the series, “The Therapeutic Stance,” in which Plakun expertly walks us through the fundamental basics of psychodynamic therapy, with special emphasis on the therapeutic alliance. He says that for many patients who are “… struggling with trust because of experiences of abuse, neglect, profound experiences of misattunement or other reasons, achievement of an alliance is an initial goal of treatment ….” I entirely agree; I would suggest that achieving this goal is a trial and error process, one that will inevitably involve failures and mistakes on our parts as therapists, and failures and mistakes by our patients. Mastery involves understanding these failures on both sides, and it requires the capacity for forgiveness, including self-compassion by the therapist and by the patient. The alliance can then be truly therapeutic, and the patient can start to believe that a flourishing future might become a reality.

1. Harvard University. Website for the Human Flourishing Program at Harvard University. 2022. Accessed May, 2023. https://hfh.fas.harvard.edu/files/pik/files/human-flourishing-programme_brochure_2021-2022.pdf. 2. Ho MY, Worthington E, Cowden R, et al. International REACH Forgiveness Intervention: a multi-site randomized controlled trial. OSF Preprints; March 3, 2023. Accessed May 19, 2023. https://doi.org/10.31219/osf.io/8qzgw. 3. Pearson C. The emotional relief of forgiving someone. New York Times; April 28, 2023. Accessed May 19, 2023. https://www.nytimes.com/2023/04/28/well/forgiveness-mental-health.html?searchResultPosition=1.