Before It All Begins
In Singapore, demand for palliative care has surged over the past decade and will continue to rise in the future under the context of population ageing. However, most palliative interventions still focus predominately on pain and symptom management without addressing psycho-socio-spiritual concerns. In addition, there is no available palliative care intervention for dignity enhancement in the Singapore to date, and little has been done with the Asian population. Building on our empirical foundations and expertise in dignity and dignity therapy, we have set off to develop and test a novel Family Dignity Intervention (FDI) for older Asian terminally-ill patients and their family caregivers. The FDI will emphasize on dyad work to strengthen family connectedness and cultivate filial compassion by providing a platform for expressions of appreciation, achieving reconciliation, and passing on transcendental wisdom and values across generations.
Though the FDI design and its intervention protocol are fundamentally based on the original dignity therapy, they are different in the sense that FDI focuses on the family as a collective unit (i.e., patients and family caregivers) in creating the legacy document while dignity therapy focuses on individuals (i.e., patients themselves). Nevertheless, it is crucial for us to gain in-depth understanding on dignity therapy prior to commencing our FDI study. In preparation for our FDI study, my fellow Research Associate, Geraldine, and I were sent by the Nanyang Technological University (NTU) of Singapore to attend the Dignity Therapy Workshop held in Winnipeg, Canada. The training workshop was led by Dr. Harvey Chochinov, our international collaborator, and a team of experienced dignity therapists. It was truly exciting to think about the potential learning outcomes, networking opportunities, and inspirations that would transpire from those interactions.
Prior to attending the training workshop, I found dignity therapy to be an empowering intervention as it offers a platform for patients to review their lives and reflect on their existential accomplishments (e.g., personal identities and social roles, personal achievements, life experiences and memories, interpersonal relationships). Coming from a counselling psychology background, I have received training in assisting individuals to (a) explore their past unfinished business and current struggles, (b) gain further understanding in regards to their thought processes and emotional experiences, and (c) elicit some form of change and achieve healing. Dignity therapy, however, steers the exploration in a different manner. The question protocol takes on a strength-based approach, where the questions were designed to empower patients by validating their existential accomplishments and allowing them to express heart-felt messages for their loved ones via a generativity document. Despite the different approaches, therapists practising dignity therapy and/or other psychotherapies aim to create a safe space where individuals are seen as a person and able to share their stories without the concerns of being judged.
After attending the training workshop, I have come to understand dignity therapy on a deeper level and also appreciate its flexibility in adaptation across settings and cultures. I have summarized the gist of my training experience and learning outcomes in the following entries, hoping to share my excitement of embarking on this journey with you.