Dignity Therapy

Dignity Therapy

Dignity Therapy is a unique, individualized, brief psychotherapy, developed by Canadian Psychiatrist Harvey Max Chochinov. Its purpose is to restore dignity in both patients and their families living with life threatening or life limiting illness, by focusing on their existential needs (Chochinov , 2012). Chochinov and his collaborators studied the concept of dignity starting from suicidal ideas and requests for euthanasia and assisted suicide in patients with terminal illness. They found that feelings of dependence and demoralization are the determinants of suffering and subsequent loss of dignity in these patients (Chochinov et al., 2011).

Patients’ responses are video or audio-recorded, and together they result into the “Generative Document”. Such document is drawn up during psychotherapy sessions (usually four meetings) together by the therapist and the patient, and it constitutes a sort of legacy that the dying person will leave to his loved ones.

Thanks to these results, the importance of psychological support within palliative care has been better understood. Therefore, in addition to pain management, palliative care team have implemented in the therapy psychological interventions aimed at reducing demoralization, supporting hope and restoring a sense of dignity to life (Biondi et al., 2014). To do so, therapists trained to use empathic and encouraging communication methods engage patients using the Dignity Therapy Question Protocol, a semi-structured interview consisting of 8 question (Chochinov & Cann, 2005). The protocol of Dignity Therapy aims to insert patients’ histories into a narrative frame, in order to make them talk about what is most important to them and thus help them strengthening their dignity and face their suffering. The questions focus on various aspects of the patient’s life, fostering a reflection and a balance of their life.

The last session of psychotherapy is the most emotional moment. The therapist reads the Generative Document to the patient, asking if that is all he or she has to say, if there are any corrections to be made, and so on.

The efficacy of DT has been proven by RCT a study (Chochinov et al., 2011), as the brief psychotherapy sessions showed a reduction in depressive symptoms and a renewed sense of purpose and will to live in the patients. Thanks to DT, dying people can reduce their psychological and existential suffering. The psychotherapy sessions and the drafting of the Generative Document help both the patients and their families to redefine their choices, failures, successes and biography in general, in order to arrive prepared for their “last evolutionary task” (Testoni, 2020).

References

Chochinov, H.M. (2012). Dignity Therapy: Final Words for Final Days. Oxford: Oxford University Press.

Chochinov, H. M., & Cann, B. J. (2005). Interventions to enhance the spiritual aspects of dying. Journal of Palliative Medicine, 8 (supplement 1), s-103.

Chochinov, H. M., Kristjanson, L. J., Breitbart, W., McClement, S., Hack, T. F., Hassard, T., & Harlos, M. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. The lancet oncology, 12(8), 753-762.

Biondi, M., Costantini, A., & Wise, T. N. (2014). Psiconcologia. [Psychoncology]. Milano: Raffaello Cortina Editore.

Testoni, I. (2020). Psicologia palliativa: Intorno all’ultimo compito evolutivo. [Palliative Psychology: Around the last evolutionary task]. Torino: Bollati Boringhieri.