HOFFMAN INTERNATIONAL INSTITUTE, 2014
by Maria Camara, MSc, PhD
Review of the existing research (1985-2013)
and remarkable testimonials
A review of the studies that have been done about the Hoffman Process will be described
by focusing on the different areas in which HP has been revealed significant: global psychological
adjustment, relationship with the inner-self, relationships with family, and professional performance.
Moreover, several renowned scientists and experts, from different backgrounds, have given
their views about the HP. The testimonials are of great value for two reasons: the experts’ high
qualification in their specific field of action and their experience of having directly participated in
1. Global Psychological Adjustment and Well-Being
Global psychological adjustment
Improvements in global psychological adjustment (e.g. self-acceptance, anxiety, depression, trust, etc.) and coping strategies used to deal with distress are supported by the Caldwell Study (Caldwell & Hileman, 1985) that measured 11 dimensions of mental health in 58 participants, before and 13 weeks after the HP.
Reducing negative affect, increasing positive affect, health and well-being. Outstanding
effects of forgiveness and spirituality on depression
The HP not only produces significant lasting reductions in negative affect (i.e. depression, anxiety,
hostility, interpersonal oversensitivity, and obsessive-compulsive symptoms) but also engenders
significant lasting increases in positive affect (i.e. emotional intelligence, spirituality, forgiveness
and empathy) along with increases in physical energy and vitality. These changes were demonstrated
in the University of California’s Study (Levenson et al., 2006). This rigorous study with a
one-year follow-up showed that most of these gains were sustained over the time in comparison
with the control group. Depression practically disappeared a week after the HP and remained low
after a year, with only a 17% relapse rate, while, for example, CBT has shown a relapse rate of
30.8% and antidepressant medication of 76.2% after one year (Hollon et al., 2005). The outstanding
effects on depression were mediated by increases in forgiveness and spirituality.
As Lee Lipsenthal, M.D., ABHM*, has acknowledged:
“To understand your intellect, your emotional capacity, your physical self, a whole person is connected with
their Spiritual Center, which they access through the work of the Process. From that place -the Spiritual Center-,
there’s not much room for depression.”
This fact points out one of the idiosyncratic features of the HP since the program directly targets
those positive constructs. Of course, previous research has found that spirituality is associated
with better mental and physical health (Rippentrop, 2005) and forgiveness reduces health-related
risk and promotes health resilience (Worthington & Scherer, 2004). And the known author Dr. Joan
Borysenko** confirmed that:
“The Hoffman Process is the finest and most complete expression of what healing and spirituality are all
More life satisfaction and less depression, somatization and compulsiveness, compared
to 1-year of therapy. Long lasting effects
A German study recently investigated not only the course of depressive mood states but also the
course of depressive disorders in HP participants within three months after intervention. 94% of
the participants diagnosed with a depressive disorder before the HP did not fulfill the criteria three
months later (Grossmann, 2010). The same study aimed at the comparison of the HP and individual
Schema Therapy (Young, 1999) focusing on mental and emotional structures acquired during
childhood. 28 participants of the HP reported significantly more life satisfaction and less depression,
somatization and compulsiveness three month after intervention than did 40 patients after at
least one year of therapy. The results of this comparison study support the effectiveness of the intensive
and well-structured format of the HP as one-week residential course.
Furthermore, HP shows to produce long lasting and ongoing effects like Prof. Michael Ray*** has
“I did the Process over a quarter century ago and I still am benefiting from that experience. Any accomplishments
that someone might list after my name came largely because of this experience.”
* Lee Lipsenthal, M.D., ABHM, Past president of the American Board of Holistic Medicine and the founder and director
of Finding Balance in a Medical Life program.
** Dr. Joan Borysenko, Co-founder of Mind-Body Clinic at Harvard University.
*** Prof. Michael Ray, Professor (Emeritus) of Creativity, Innovation & Marketing at Stanford University Graduate School
The author Oliver James**** describes it in the following way:
“This unique course has a hugely impressive record for helping individuals achieve lasting emotional
growth. Nothing else comes close.”
2.Relationship with the Inner Self
Greater self-awareness and self-esteem
A recent survey (Page, 2012) of individuals who had done the HP across 11 countries worldwide
with a final sample of 2497 respondents is worth mentioning. Results showed that 90% of the participants
found a greater level of self-awareness and 81% greater self-esteem after doing the HP,
qualities that are usually acquired within the context of long-term therapy processes and are considered
as common factors of success in any kind of intervention.
Increased self-worth and self-confidence
The HP stands out for producing rapid therapeutic benefits in regard to self-esteem related variables.
A comparative study (Windhausen, 1997) between the HP and a three-month group therapy,
at the Fliedner Hospital (Düsseldorf, Germany) on a sample of 78 participants, showed higher ratings
for the HP in some of the measured variables related to the self (i.e. self-worth, self confidence,
sensitivity and mood), while it had similar results on the others variables.
3.Relationships with Family Members
Greater compassion towards parents
Interpersonal relationships have shown to be positively affected by doing the HP. Compassion for
parents is a dimension that is directly targeted by the HP. As the Graduates Survey (Page, 2012)
showed, 89% of the participants found increased compassion for their parents. Relationship with
parents “dramatically improved” according to Windhausen’s study (1997). In the words of the
known author, Dr. Claudio Naranjo*****:
“Hoffman is the best method I know for the realignment of relationships with parents and parent surrogates.”
Better relationships with partners and children
Another outcome of the HP is improvement in relationships with other family members such as
partners (92%) and children (90%) according to Candate’s study (1991).
**** Oliver James, Best known clinical psychologist in Britain, bestselling author (e.g. Affluenza).
***** Dr. Claudio Naranjo, renown psychiatrist and author who is considered a pioneer in integrating psychotherapy and the
4. Professional Performance
Increased sense of empathy with patients
At the level of professional healthcare, interesting results can also be drawn from a survey of 129
health care professionals (Hoffman Institute Foundation, 2005). 77% of clinicians experienced more
open communication with their patients, 78% felt more connected and present with them. In other
words, clinicians were more empathic with their patients after having done the HP.
Improved emotional competence at Harvard University
For five years the Hoffman Process was offered at the Center for Public Leadership at Harvard.
Preliminary results from a small study suggest benefits for the business world as well, specifically
related to improvements in emotional competence and authentic leadership qualities. In 2008, 35
participants completed emotional competency and effective leadership measures before the program,
two weeks after the program, and 3 months post-process. At the two-week point, students
showed significant improvements in all 52 domains of emotional competence relating to leadership.
Three months later, not only were gains in all 52 domains, but 17 of them demonstrated continued
improvement (Gill, 2008).
The leadership consultant and author, Anni Townend****** had asserted:
“The benefits of the Hoffman Process for people and for business are huge. I recommend it wholeheartedly as
a personal and professional journey to all HR Professionals looking for a course that will make a long lasting
difference to their people and to their business success.”
Current Scientific Theories in line with the Hoffman Process
The HP is consistent with recent and mainstream scientific disciplines and evidence-based therapies
and it is organized in a structured, protocol driven format. Some of the HP core assumptions
will be described here along with corresponding scientific evidence.
Childhood as the core
The basic assumption of the HP is that childhood experiences with parents shape our self-image,
attitudes, moods and behaviors. Mainstream classical psychological theories (i.e. the Psychodynamic
Approach; the Developmental Approach, Piaget, 1928; the Attachment Theory, Bowlby,
1969) as well as more recent ones (i.e. the Schema Therapy, Young, 1999; Brain developmental theories,
i.e. Byrnes, 2001; Trauma theories, i.e. EMDR, Shapiro, 1989, etc.) have consistently demonstrated
an existing relationship between childhood experiences and adjustment in adulthood. For
example, a major American epidemiological study found a relationship between adverse childhood
experiences and adulthood physical and mental health (The ACE Study, Felitti et al., 1998).
In coherence with these theories, much of the work in the HP aims at examining the core influence
of childhood experiences on adult life and resolving repressed childhood pain, anger, shame, and
resentment, and working towards increased forgiveness and compassion for self and other. The
trauma psychologist, Dr. Shawn Katz*******, has described it in the following way:
“HP addresses internalized negative beliefs and self-concepts formed in childhood which lay at the foundation
of one’s destructive and self-sabotaging behavioural patterns in the present. This increased awareness of
patterns enables a person to make better choices for their future.”
Working with the different aspects of the self. An experiential program
The HP follows an integrative model that progressively and skillfully works with four aspects of
self: emotional, cognitive, physical, and spiritual, and their interactions. For example, inducing
dialogue among the different aspects of self, results in a more integrated self. Similar procedures
can be found in humanistic approaches such as Rogers’ Person Centered Therapy (1951) and Gestalt
Therapy (Perls, 1951). The Hoffman program is highly experiential in nature so that functional
patterns, visions, and behaviors are explored at all different levels, i.e., somatic, emotional, and
cognitive. It is widely recognized by brain science that new neurological pathways will only be
“recorded” if multiple aspects of the self are involved (Graham, 2013).
As Dr. Bruce H. Price8 has said:
“Clearly the Hoffman Process works through neurobiology. The extraordinary thing we have found [about
the brain] is the concept we call “plasticity,” that the connections and functions of the brain at all its levels of
organization respond to social forces. The Hoffman Process most likely fundamentally alters brain function.”
The family as an interacting system
Taking a systemic paradigm, the individual has to be approached as an active participant of dynamic
and interacting systems, at macro and micro levels, rather than from an isolated perspective.
In particular, Systemic Family Therapies (e.g. Haley, Minuchin, Nardone, Watzlawick, etc.) focus
on the functioning of the family system as a whole; and the individual is understood in the context
of the family system. The HP’s main target is to help participants understand the internalized family
system with their specific roles they had to adopt in their family in order to support the family
The ‘Negative Love Syndrome’ as an explaining model
Hoffman’s concept of the ‘Negative Love Syndrome’ – the adoption of the negative behaviors,
moods and attitudes and roles from parents to secure their love and attention – adds an explanation
on how the personality and character patterns have been formed and compulsively acted out
in an ongoing attempt to be loved. Its conceptual framework has common factors with the Psychodynamic
theory of personality, particularly ‘self –psychological’ and kohutian perspectives.
Existential Perspective of the Hoffman Process
Irvin Yalom sees the awareness of an individual’s own mortality, if properly confronted, as a way
to “alter one’s life perspective and promote a truly authentic immersion in life” (Yalom, 1980, p.187) as
well as diminish anxiety as “the fear of death constitutes a primary source of anxiety” (Yalom, 1980, p.
188). The HP contextualizes ‘death’ within a trans-personal framework that helps participants alleviate
death anxiety and uses the recognition of mortality as a motivating force to initiate positive
Emotional regulation and expression; behavioral change strategies
An important outcome of participating in the HP is an improvement in emotional literacy and
emotional intelligence. In other words, individuals will learn to have deeper insight and perception
of their emotions, as well as how to better regulate them. That is, of course, a common factor in any personal development work. This program not only works with increasing self-awareness,
but also with transforming disruptive behaviors into functional ones. The methodology employed
is basically the kind of relaxation and visualization techniques that have been successfully used in
hypnosis, biofeedback, meditation, and other neuroscience and psychotherapeutic disciplines.
Enhancing the positive: The power of forgiveness, compassion, and spirituality.
A relative recent approach to psychology comes from Positive Psychology where, rather than focusing
on negative affect and illness, the aim is to enhance the resources of the person and the
positive affect. Humanistic approaches (e.g. Maslow, 1943), among others, had already emphasized
that focusing on the person’s potential has, in itself, therapeutic effects. Similarly, HP highly promotes
positive affect by working on forgiveness, acceptance, compassion, love and appreciation
for oneself and others. The therapeutic power of “acceptance” has been shown in Mindfulness based
therapeutic approaches (such as the Acceptance and Commitment Therapy, Hayes et al.,
(1999), which, contrary to other models, does not focus on changing what is dysfunctional but on
accepting it. Spirituality is also key in explaining the potential HP has to make people rely on their
inner self and to enhance trust and self-confidence. In the words of Dr. Ken Blanchard*********:
“The Hoffman Process brings forth spiritual leadership in a person.”
The discipline of Transpersonal Psychology has also addressed the spiritual or trans-personal aspect
of the self as core in the process of self-actualization.
– The Hoffman Process has a highly beneficial effect on overall adjustment: reducing
negative affect, enhancing positive affect, and improving health and wellbeing.
– Depression levels drastically decrease through working on forgiveness and spirituality
as presented in the HP.
– Relationship with the inner-self and with others improves after the HP.
– Emotional intelligence relating to leadership, and empathic responses are more present
in the work environment after participating at a HP.
– The HP is in line with existing scientific models and its evidence-based practices.
– To strengthen the promising findings about the HP, future studies should explore
quality of life benefits for larger populations, as well as specific clinical effects, such
as trauma reduction and stress prevention with rigorous randomized control and
Article written by Maria Camara Serrano, MSc, PhD
Dr. Camara has an MSc in Health Psychology and a PhD in Psychology and Family. Her research career, at
the University of Deusto, Spain, has mostly focused on studies related to early childhood experiences and
their effects on distress, coping strategies and social support, families and resilience, etc. with several publications
and participation in scientific conferences as a result. She also works as clinical practitioner following
various therapy approaches, such as Gestalt Therapy, Schema Therapy, Positive Psychology, and
Mindfulness-based programs. She started to work as a Hoffman Process teacher in 2005. She is also currently
co-director of the Spanish Hoffman Institute, and co-director of the Hoffman International Institute.
My deepest gratitude to Hoffman International Institute for supporting the materialization of this report,
which could only come as a result of the thousands of people who have participated in the Hoffman Process.
And in particular, I want to thank Raz, Tim, Shawn, David, Anne, Volker, and Katrin for their invaluable
feedbacks in the consecution of this report.
Byrnes, (2001). Mind, brain, and learning. New York : Guilford Press.
Caldwell, A.B. & Hileman, C.S. (1985). The Caldwell Report. Downloaded from http://www.hoffman-international.com/caldwell-report.htm
Candate, A. (1991). The Candate Report. Downloaded from http://www.hoffman-international.com/candate-report.htm
Felitti, M. D., Vincent, J., Anda, M. D., Robert, F., Nordenberg, M. D., Williamson, M. S., … & James, S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
Gill, A. (2008). Improved Emotional Competence and Leadership among Harvard Student Leaders. Downloaded from http://hoffman-international.com/emotional.competence-and-leadership.htm
Graham, M. F. T. (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being. New World Library.
Grossman, I. (2010). Is schema therapy also effective in 50 hours therapy within 8 days, called Hoffman-Quadrinity-Process (HQP or HP) also and in comparison to behavioral therapy?. Unveröffentlichte Diplomarbeit, Humboldt-Universität zu Berlin.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Hoffman Institute Foundation (2005). The Health Care Professionals Survey. Downloaded from http://hoffman-international.com/health-care-professionals-survey.htm
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of general psychiatry, 62(4), 417.
Levenson, M.R., Aldwin, C. M., & Yancura, L. (2006). Positive emotional change: mediating effects of forgiveness and spirituality. Explore, 2 (6).
Lanius, R. A., Vermetten, E., & Pain, C. (Eds.). (2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.
Maslow, A. H. (1943). A theory of human motivation. Psychological review, 50(4), 370. Page (2012). The Graduates Survey. Downloaded from http://hoffman-international.com/the-graduates-survey.htm.
Perls, F., Hefferline, G., & Goodman, P. (1951). Gestalt therapy. New York.
Rippentrop, A. E. (2005). A Review of the Role of Religion and Spirituality in Chronic Pain Populations. Rehabilitation Psychology, 50(3), 278.
Rogers, Carl (1951). Client-Centered Therapy. Cambridge Massachusetts: The Riverside Press. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of traumatic stress, 2(2), 199-223.
Windhausen, C. (1997). Transformed Self-Images. Downloaded from http://www.hoffman-international.com/windhausen-study.htm
Worthington, E. L. & Scherer, M. (2004). Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health resilience: Theory, review, and hypotheses. Psychology & Health, 19(3), 385-405 Yalom, I. D. (1980). Existential psychotherapy. Basic Books.
Hoffman Process Research Papers
Mild Depression: Medical Illness or Invitation For Self-Growth?
by Lee Lipsenthal, MD, ABHM
Summary of Research Findings on the Hoffman Quadrinity Process
This article was published in the Spring 2007 issue of Holistic Primary Care. It was mailed to approximately 80,000 physicians.
University of California Grant Research Study (2003)
Summary of Research Findings on the Hoffman Quadrinity Process – Mild Depression: Medical Illness or Invitation For Self-Growth? – by Lee Lipsenthal, MD, ABHM
This article was published in the Spring 2007 issue of Holistic Primary Care. It was mailed to approximately 80,000 physicians.
“When looking at mild to moderate depression, it (The Hoffman Process) appears to produce at least as good or better results than other programs, therapies or medications. In addition, positive long-lasting benefits result, including increased emotional intelligence, spirituality, forgiveness, empathy, physical energy and vitality. Research findings (click here to get to research findings summary by Dr Ron Meister) indicate that the overall changes available to a participant are, by any standard, quite remarkable.” ( Dr Ron Meister)
Reprinted from “Research at the Hoffman Institute,” by Ron Meister, Ph.D., Administrative Research Director. © 2004 by the Hoffman Institute Foundation
Dr Joan Borysenko Ph.d.
Dr. Joan Borysenko talks about the lasting positive effects of the Hoffman Process.
Published on Sep 3, 2013
The Windhausen Study
A study of the Quadrinity/Hoffman Process, and probably the most significant long-term study to date was written in 1997 as the dissertation of the German psychologist Christiane Windhausen, at the Wilhelms-University Muenster in Westphalia. Mrs. Windhausen studied theology before graduating in psychology at the above university. Her dissertation is based on studies carried out with 65 randomly selected clients, all of whom completed the Quadrinity Process in its present form during 1994 and 1995.
Hoffman at Harvard University
Graduate Students Explore the Inner Side of Leadership.
Steps to Effective Leadership
This “Standing Out from the Crowd” article was published in the July 2008 Issue of Incentive Magazine, a US publication. This article uniquely explores the importance of the Hoffman Process for business leaders.
The Candate Sudy, 1991
As part of her graduate studies at JFK University in 1991, Alison Candate, M.F.C.C. (intern), conducted a survey of 31 randomly selected individuals who took the Hoffman Quadrinity Process (HQP) between the years 1985 and 1991. The survey set out to study what gains the HQP could provide for its graduates after they left the eight-day environment.