Dignity Therapy: Final Words for Final Days
Dignity Therapy is a psychotherapeutic intervention for people approaching the end of their lives. It provides a supported opportunity for them to record a life story which is edited into a written document for them and their loved ones to keep. It was developed following research into dignity in terminal illness, and is designed to enhance certain aspects of a person's dignity.
The practice of giving an account of one's life, and passing on messages to subsequent generations in oral or written form is an ancient one. Professor Harvey Chochinov identifies this frame in a preface describing the ‘ethical will’ of the Hebrew patriarch, Jacob. He reflects on the value of sharing a life story both to individuals approaching death and to their families. Dignity Therapy is identified as distinctive, compared with an ethical will or other forms of life review, in its basis in empirical work on dignity in the terminally ill. Reference is also made to the experimental evidence that supports its use and dissemination as an intervention that ‘can promote spiritual and psychological well being, engender meaning and hope, and enhance end-of-life experience’. (pvi)
The book is structured temporally. The first chapter reflects work in the recent past on dignity and the end-of-life; empirical research undertaken by Chochinov and his team that led to the development of a model of dignity in the terminally ill. This model groups the themes that emerged in the research seen to influence for good or ill a person's sense of dignity, and helps meaningfully represent the complex construct of dignity. Chapter 2 describes the development of Dignity Therapy as informed by the dignity model, and outlines research already undertaken into its use and effectiveness. Chapters 3–5 describe in detail how to do Dignity Therapy; including patient selection, practical considerations, the questions protocol for a session, and the role of the therapist. Chapter 6, which constitutes just over a quarter of the book, records two full Dignity Therapy sessions, and the resultant Generativity Documents. It is important to note that these transcribed sessions are role-played. Nonetheless, the choice to relate them in full is a good one, serving to illustrate the principles and practicalities of applying Dignity Therapy described in the previous chapters. The book finishes with a chapter looking forward into the future both for individuals wanting to commence or progress in using dignity therapy, and asking questions about future avenues for research.
Scattered throughout, there are snippets of narratives from patients who have used Dignity Therapy. These are pertinent illustrations and help make what is essentially a manual for applying a specific therapy an engaging and enjoyable read. I felt that I had not only expanded my understanding of dignity and the use of Dignity Therapy, but had also been introduced to some prior participants in Dignity Therapy through hearing their tales. A profound respect for the stories of patients, and the work these stories do for them at the close of their lives is powerfully communicated throughout the book.
This book is primarily a handbook for those engaged in, or wishing to provide, Dignity Therapy. It will also be of interest to those using other types of creative legacy work or psychotherapeutic interventions in palliative care. I would, however, recommend chapter 1 more broadly. It is an excellent summary of the work of Chochinov and his colleagues into the dignity in the terminally ill, which has relevance for all practitioners involved in the care of those in their final days.
Dignity therapy: Final Words for Final Days. Chochinov, Harvey Max. Oxford University Press Inc. (2012) New York, USA. ISBN 978-0-19-517621-6, Hardcover, 187 pages, Price £32.50.
- Received 22 November 2012.
- Revision received 22 November 2012.
- Accepted 29 November 2012.
- Published Online First 7 January 2013
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions