Re:Cognitive behavior therapy for depressed people who are NOT willing to forgive themselves.

As Jim suggests near the end of his response, an analysis of the reasons why clients cannot forgive themselves would provide a good starting point. A cost/benefit analysis of self-forgiveness may help the client to see the costs of their position and help them and the therapist to view the issue strategically. Positive beliefs about not forgiving oneself may include the belief that one is being too easy on oneself, that self-damning means they are making restitution of sorts, that God will know they have changed their ways if they keep on being hard on themselves, to reassure themselves that they have changed etc etc.) Revelation of the costs may act as a motivation to change their response while the exploration of the benefits (i.e.positive beliefs about non-forgiveness) gives the opportunity of undermining them using guided discovery. Maybe we should be cautious about just reassuring the client that the "bad act" is not too bad really as this is a value judgement anyway and may be perceived as invalidating. It might be better to help the client to talk about the act and for the therapist to respond with empathy while acknowledging, validating and normalising the feelings expressed. Most people have probably done some things they would, with hind-sight, prefer they had not.The therapist could go on to explore with the client how people generally manage to cope with this fact. It may even be possible and appropriate not to forgive the behaviour but to decide to desist from the self-attacking and endless ruminative responses that may be activated by reminders of the act and which may really be the source of the current emotional difficulty. If the client is endlessly ruminating on the event another analysis exploring the positive beliefs about rumination may reveal the motivation for this response (these will probably be metacognitve beliefs similar to the costs of self-forgiveness identified previously). They could be asked to engage in an experiment over the next six weeks whereby they catch any intruding thoughts about the incident, acknowledge their feelings of regret but then to switch out of self-attacking and rumination and re-engage attentionally with whatever is going on externally. Practicing helpful and compassionate self-talk may also be useful at this point (e.g. "talk to yourself as you would to a good friend who was being hard on themself"). The client can be instructed to pursue this type of responding repeatedly for the six-week period of the experiment and then see how it feels. The client can also be reassured that if they do not like the outcome they can go back to non-forgiveness, self-attacking, and rumination. Hopefully the negative responses will be undermined over the six-week period of practicing these alternative mental responses and some of the positive metacognitive beliefs about non-forgiveness, self-attacking, and rumination will be challenged. Other interventions like helping the client to take a third person perspective may be useful but helping the client to look at and modify their cognitive/attentional/behavioural responses upon experiencing intrusions about the act and identifying and challenging relevant metacognitive beliefs may ultimately be the most effective intervention.

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