Day 1: Understanding Dignity Therapy
Dignity therapy is essentially an empirical-based intervention adopted in palliative end-of-life care setting with the intention of decreasing patients’ suffering and bolstering their sense of meaning, purpose, dignity, and quality of life. “Psychology of illnesses is associated with psychology of losses,” said Dr. Harvey as he walked us through the key elements of dignity therapy. Through various research findings and clinical examples, we have come to understand that losing functional abilities often associates with sense of being out of the norm, which then evokes sense of social shame and subsequently diminished dignity. Us, human beings, constantly seek for affirmation through the eyes of our beholders as a reflection of our existence and purpose. We seek to be treated as a whole person even in our final days, and dignity therapy offers just that through understanding the person as who they are, who they were, and what they would like to share with us.
After going through the theoretical groundwork of dignity therapy, the subsequent training workshop sessions focused on the technical aspects. Dignity therapists would go through a series of baseline questions first during the initial interview (Note: this process is also known as “framing history”) such as how patients would like to be addressed, basic demographic information, their purpose of doing dignity therapy, who the identified recipients are etc. This information provides a metaphorical frame within which the dignity therapy interview paints the detailed picture. A copy of the question protocol is given to patients for review prior to the subsequent dignity therapy session. During the dignity therapy session, dignity therapists would explore items highlighted in the question protocol, or address items stood out to patients the most.
Given that patients are in palliative end-of-life care setting, it does not come off as a surprise that patients experience exhaustion or feel unwell during the session. In such situations, dignity therapists may reschedule and resume the session when patients are in a better state and capable of engaging in insightful reflection. Dignity therapists would then proceed with the interview transcription and editing (Note: the edited transcript will be known as “generativity document”) prior to meeting up with patients subsequently to review the document. Patients are allowed to add more stories to or remove stories from the generativity document during the review session before finalizing it. The finalized generativity document will then be given to patients before sharing it with identified recipients. Due to the time sensitivity nature of palliative end-of-life care setting, this entire process should take approximately two weeks, though it may vary depending on patients’ health and the number of edition required prior to finalization. I will elaborate on the technical components in greater detail through the subsequent entries.
I particularly liked how Dr. Harvey used the term “existential readiness” to address individuals who are more likely to be willing to take on dignity therapy and benefit from it. In his words, existential readiness is when a person is ready to explore and review their (Note: gender neutral pronoun is adopted here) sense of existence and lifetime accomplishments. “Dignity therapy is not for everyone; not everyone is ready for and would benefit from it,” said Katherine Cullihall, a research nurse in the Research Institute of Oncology and Hematology (Patient Experience) at CancerCare Manitoba. In her elaboration, patients may not be ready to take up dignity therapy, especially during the first phase of diagnosis because they may need time to process and accept their diagnosis before they feel ready. However, it is acceptable to let them know that dignity therapy service is available for them should they feel ready to talk about it.
Our attention was then directed to this specific question as we were going through the question protocol. “Looking back at your life, when did you feel most alive?” It was a simple question, and yet it resonated in my heart with great intensity. As we live our lives, we often forget how time would pass us by regardless of where we are and what we do; it is unbelievably easy to take our roles and each passing moment for granted. This question, however, creates an opportunity for us to pause and think, “when do I feel most alive, really?” As it brings our attention to what matters the most, we are also given the opportunity to reflect upon the meaning and purpose of our existence, reminding us of who we are.
“Looking back at your life, when did you feel most alive?”