Dignity Therapy –Finding Peace While Facing End-of-Life
By Chelsea Peddle, MEd, RCC
Imagine your life is a photo album that you are holding on your lap. When you flip through that album, what memories stand out to you?
People facing a life-limiting illness often wish to reflect on their lives. They long to walk the paths they did in their youth, and to share their stories and learnings with the people they care about. This process of life review is more than an opportunity for nostalgia. Recalling the memories, the people, and the experiences that made us who we are – both the light and the dark – can be healing for the person who is dying, and their people. As a counsellor at MindKey Health, I am pleased to now be able to support this creative way of healing by facilitating a therapeutic experience called Dignity Therapy.
Developed by Dr. Harvey Chochinov, Dignity Therapy is a brief intervention developed to reduce end-of-life emotional distress and promote dignity and hope in people approaching death. It’s evidence-based and one of the most well-researched psychotherapies for people with a terminal illness. Dignity Therapy has been shown to improve anxiety, including worry and guilt, sadness and depression, and address demoralization and hopelessness. Other studies have found Dignity Therapy can help people cope with their suffering, improve spiritual wellbeing, and maintain peace of mind through their end-of-life experience. Dignity Therapy offers more than just individual benefits, with many participants feeling it helped bring them closer to their loved ones by changing how their people saw them. Dignity Therapy helped these families understand and appreciate the dying person in a new light, and many loved ones reported benefits for themselves including feeling that Dignity Therapy supported their own grief experience and helped them prepare for their person’s death. Dignity Therapy may help people to find clarity and threads of meaning through their lives to create a sense of peace and purpose.
Dignity Therapy is a brief intervention – only 2 sessions with the therapist. It involves participants answering questions about their life history and work, prompts to help define their legacy and what they want to pass down to loved ones, and encouragement to say things that have remained unsaid to achieve closure. The therapist transcribes and lightly edits the recording of the interview to create a story that flows. The resulting document is shared with the participant and the people of their choosing. This document with the participant’s stories and final messages written in their own voice, can bring comfort and allow people with life-limiting conditions to feel their words will transcend beyond their death.
So how does Dignity Therapy work?
1. The therapist meets with the person who is dying to explain Dignity Therapy, the risks and benefits of participating, and what to expect. Participating in Dignity Therapy, like any therapy, can be a bitter-sweet process. It can summon joy, pride, appreciation, love, and laughter. It can also surface sadness and longing, anger, or past hurts. With the support of the trained therapist, the participant experiences these feelings and through storytelling, may create meaning in the complexities of life and death.
2. If the participant agrees, the participant and therapist arrange a time for a 1-hour interview. This can take place in-person (in your home, hospice, or care facility, for example) or online. The therapist will send the participant a few questions in advance to help them organize their thoughts, but really, we want the conversation to be as organic as possible, so no advance preparation is required.
3. The interview prompts the participant to reflect on important moments in their life. Participants are encouraged to tell stories about the people that influenced them and why, their formative experiences and accomplishments, and to share messages, wishes or words of advice for loved ones.
4. The therapist records the interview, transcribes it, and lightly edits it for clarity. The aim is to create a written document in the participant’s own voice that speaks directly about their life and to their loved ones.
5. The participant and therapist meet again about 2 weeks after the first interview (this can happen more quickly if time is of the essence). This time, the therapist reads back the participant’s story, encouraging the participant to listen and take in their own words, life experiences and learnings. The participant can make changes to the document to improve its accuracy and clarity.
6. The therapist tidies up the document, makes the edits requested by the participant, and prepares the document as a PDF. This document is shared with the participant who can then share it with their chosen loved ones. Some people choose to read their document to their loved ones so that they can experience their loving reactions. Others choose to wait until they have died for their loved ones to receive the document. How you share your story is up to you.
I’ve had the honour of facilitating Dignity Therapy for people preparing for end of life, including those who are pursing medical assistance in dying (MAiD). As a therapist, it’s one of the most rewarding experiences of my career and I’m profoundly humbled to witness people’s stories. Like any therapy, the experience of Dignity Therapy and the therapeutic results are different for everyone. A client, Simon (name changed for privacy) gave me permission to share his experience of Dignity Therapy so that others might understand the impact it had on him:
“It was difficult for me to answer some of your questions – they really made me think. But I am glad. You have done a phenomenal job of understanding me, understanding this process I’m going through. And you know, I remember, when I was a kid, asking my dad and mother to tell my brother and I stories, stories of their lives or of when we were children. Those stories are all very important to me. I really enjoyed them, so much so that when I met Marcus [my partner], I would often ask him to tell me a story – any story – of his life. He struggled with that. I don’t know if he understood the positive experiences attached to telling good stories. Even difficult stories are valuable for me. Sharing our stories is so important. So, thank you for this.”
If you or a person in your life has a life-limiting illness and is interested in learning more about Dignity Therapy, please send me an email at [email protected].
References
Chochinov HM, Kristjanson L, Breitbart W, et al. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol. 12:753–762
Scarton, L. J., Boyken, L., Lucero, R. J., Fitchett, G., Handzo, G., Emanuel, L., & Wilkie, D. J. (2018). Effects of Dignity Therapy on Family Members: A Systematic Review. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association, 20(6), 542–547.