Chrome 2001
Aetna Intelihealth InteliHealth Aetna Intelihealth Aetna Intelihealth
. .
Chrome 2001
Chrome 2001

Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Minding Your Mind Minding Your Mind

Learning How To Say 'I'm Sorry.'

October 24, 2012

By Michael Craig Miller M.D.

Harvard Medical School

Anyone who's had to apologize for something knows how difficult it can be to get the words out. Yet an apology is often the first step toward repairing a damaged relationship, be it personal or professional. Although not all mental health experts agree on this, an apology may be a prerequisite for forgiveness.

Back to top

A Genuine Apology Fosters Healing

Conflict and error can occur in any relationship. People make mistakes, lash out in anger or say things they regret later. In fact, one of the main reasons people undergo psychotherapy is to try to resolve personal conflicts, betrayals and hurts. And some therapists integrate formal apologies into couples or family therapy.

To be effective, an apology has to be genuine, says Dr. Aaron Lazare, a professor of psychiatry and former chancellor of the University of Massachusetts Medical School, who has been studying this topic since 1993. Dr. Lazare has said, "A good apology can foster healing, but a faulty apology only makes a bad situation worse."

You need to understand the nature of the hurt you've caused and then address it in the apology. For example, if a person you have offended feels humiliated, then the apology might be worded in a way to restore self-respect and dignity. If you've made a mistake that causes someone an injury, damages property or causes some other financial loss, an apology might include a promise to provide compensation or take corrective action so the mistake doesn't happen again.

An apology doesn't guarantee forgiveness, of course. And in some cases the offended party may be too hurt or angry to accept an apology. One dramatic example is sexual abuse: Some victims may need to hear a genuine apology in order to come to terms with the injury, while others never want to deal with the perpetrator again.

Back to top

Four Steps to a Genuine Apology

A genuine apology acknowledges an offense and expresses remorse. But it's hard for people to get it right. According to Dr. Lazare, an effective apology has four parts while ineffective apologies usually miss the mark in one of these areas.

  1. Acknowledge the offense. The most common error people make is not to adequately acknowledge the offense by using vague or evasive language, or by wording the apology in a way that minimizes the offense or questions whether the victim was really hurt. Take responsibility for the offense, whether it was a physical or psychological harm, and confirm that the behavior was not acceptable. Sometimes people apologize for the wrong offense or address the wrong party.
  2. Explain what happened. The challenge here is to explain how the offense occurred without excusing it. In fact, sometimes the best strategy is to say there is no excuse. "A humble remark is better than a dumb excuse," Dr. Lazare says.
  3. Express remorse. If you regret the error, feel ashamed or humiliated, say so: This is all part of expressing sincere remorse.
  4. Offer to make reparation. If the offense has hurt someone's feelings or caused a specific loss, acknowledge the pain, promise to be more sensitive in the future and offer appropriate compensation for any financial losses.

When apologizing, listen carefully to the offended person. This may be as important as speaking. Although it's never easy to remain quiet while someone else expresses anger, sadness or disappointment, it's necessary to truly hear what the person is saying. Active listening can help you understand what the other person wants from your apology, such as to restore dignity or to recognize fault.

Timing and delivery of an apology also matter. Although you should apologize as soon as possible after the mistake is discovered or acknowledged, a sincere apology may not be enough to restore trust after a significant personal betrayal. The person who feels wronged may need to know what specific steps will be taken to make amends and minimize future pain. This may take time and several conversations.

Back to top

Examples of Good and Bad Apologies

Here are examples of effective apologies and why they work:

From one spouse to another: "I'm sorry I lost my temper last night. I've been under a lot of pressure at work, but that's no excuse for my behavior. I love you and will try harder not to take my frustrations out on you."

Why it works: The speaker is taking responsibility, explaining but not excusing the mistake, expressing remorse and caring, and promising reparation.

From a doctor to a patient: "I prescribed the wrong dose of your medication. I apologize for this mistake. It shouldn't have happened. I'd like to talk with you about what how we can safeguard your health in the future."

Why it works: The physician is taking responsibility, describing the mistake, expressing a caring attitude and beginning a conversation about how to remedy the error.

Here are examples of ineffective apologies and why they are a problem:

"I apologize for whatever happened."

Why it doesn't work: The language is vague and the offense isn't specified.

"Mistakes were made."

Why it doesn't work: Using the passive voice avoids taking responsibility.

"To the degree that you were hurt..."

Why it doesn't work: The wording casts doubt on whether the injured party was really harmed.

"Even the best people make mistakes."

Why it doesn't work: This expresses arrogance rather than humility.

If you are interested in making a genuine apology, try to validate that an offense has occurred and that you are at fault. In some instances, you may need to help restore a person's dignity and power. Make sure you show that you feel bad and that you care about the person you have hurt. This approach can provide an entrée into a dialogue based on shared values, and you can begin to right a wrong.

(Note: This article was written after discussions with Dr. Lazare in 2008. His book, On Apology, was published in 2004.)

Allan A, et al. "Exploration of the Association Between Apology and Forgiveness Amongst Victims of Human Rights Violations," Behavioral Sciences and the Law (2006), Vol. 24, No. 1, pp. 87–102.

DiBlasio F. "The Use of a Decision-Based Forgiveness Intervention Within Intergen-erational Family Therapy," Journal of Family Therapy (Feb. 1998), Vol. 20, No. 1, pp. 77–94.

Kohn LT, et al. To Err is Human: Building a Safer Health System (Washington, D.C.: National Academies Press, 2000).

Lazare A. "Apology in Medical Practice: An Emerging Clinical Skill," Journal of the American Medical Association (Sept. 20, 2006), Vol. 296, No. 11, pp. 1401–04.

Lazare A. On Apology (Oxford: Oxford University Press, 2004).

Leape LL. "Full Disclosure and Apology: An Idea Whose Time Has Come," Physician Executive (March–April 2006), Vol. 32, No. 2, pp. 16–18.

Legaree TA, et al. "Forgiveness and Therapy: A Critical Review of Conceptualizations, Practices, and Values Found in the Literature," Journal of Marital and Family Therapy (April 2007), Vol. 33, No. 2, pp. 192–213.

Roberts RG. "The Art of Apology: When and How to Seek Forgiveness," Family Prac-tice Management (July-Aug. 2007), Vol. 14, No. 7, pp. 44–49.

When Things Go Wrong: Responding to Adverse Events (Boston: Massachusetts Coalition for the Prevention of Medical Errors, 2006).

Back to top

Michael Craig Miller, M.D. is Editor in Chief of the Harvard Mental Health Letter. He is also associate physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. He has been practicing psychiatry for more than 25 years and teaches in the Harvard Longwood Psychiatry Residency Program.

More Minding Your Mind Articles arrow pointing right
    Print Printer-friendly format    
HMS header
 •  A Parent's Life
 •  Woman to Woman
 •  Focus on Fitness
 •  Medical Myths
 •  Healthy Heart
 •  Highlight on Drugs
 •  Food for Thought
 •  What Your Doctor Is Saying
 •  What Your Doctor Is Reading
 •  Minding Your Mind
 •  Man to Man

This website is certified by Health On the Net Foundation. Click to verify.