Dignity therapy

Domain III · Humanistic, existential & experiential · Harvey Max Chochinov · 2005 · Winnipeg

What it is

Dignity Therapy is a brief, individualised, semi-structured psychotherapy for people facing a life-limiting illness, usually in palliative care. Through a recorded conversation guided by a fixed set of questions, the patient talks about their life history, the roles and achievements that matter…

Format

• DT is a short, linear protocol, not a phased course of therapy. Across sources it takes 2–4 contacts over about 1–4 weeks. Beck et al. (2019) note that traditional DT can take 2–7 sessions when patients tire or need several visits.

Who practises it, and how they are trained or regulated

• Who delivers it: psychologists, psychiatrists, experienced palliative-care nurses, other palliative clinicians (physicians, chaplains/spiritual-care workers), and trained volunteers in some services. In the 2011 trial, therapists had a 3-day workshop with Chochinov and then supervision every 6–8 weeks. Barwon Health volunteers had 2.5 days of DT training, observed 1–2 interviews and then led 1–2 under support.
• Version followed: standard individual Dignity Therapy (DT) as developed by Harvey Max Chochinov and colleagues (Manitoba Palliative Care Research Unit, Winnipeg), described in Chochinov et al. 2005 (J Clin Oncol), the 2011 Lancet Oncology RCT and the manual-style book Dignity Therapy: Final Words for Final Days (Oxford University Press, 2012). It is built on the 9-question protocol and the interview → transcribe →…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• A companion who censors or takes over; offer some time alone.
• Over-questioning a tired patient; small gaps can be bridged in editing.
• Emotional impact on transcriptionists, who hear intimate end-of-life material. Arrange debriefing.
• Going through the list mechanically. Signs it's working: answers become more specific and come with feeling.
• Ask in advance what should happen to an unfinished or undelivered document if the patient dies (see Section 5).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.