When a person reaches the end of his or her life, it means change. Not only for him or herself, but also for those close to him or her; this is especially true for partners. As different as the circumstances and reasons for dying may be, as different are the needs, fears and wishes that accompany it. At Heidelberg University Hospital, Germany, at the Institute for Medical Psychology in the Centre for Psychosomatic Medicine, Dr. Corina Aguilar-Raab and Dora Hopf work together with Dr. Beate Dietzen and Dr. Monika Eckstein with the concept of Dignity Therapy according to Harvey M. Chochinov and expand it to include the aspect of the couple relationship.
Translated from the original German version.
Dignity Therapy is a short-term intervention with the aim of strengthening the patient's dignity and thus increasing their appreciation for their own life, perceiving it as meaningful and recognising it as significant.
For this purpose, with the help of a catalogue of questions, it is specifically ascertained what the dying person associates with the concept of dignity, which experiences are remembered that have strengthened the feeling of one's own dignity and what is to be passed on to posterity. After the interview, a transcript is made and ordered and finally a generativity document is created and read to the patient and possibly corrected again.
In the context of couples, this means also acknowledging the partner's distress about the impending loss and including them in the conduct of the therapy. To do this, they are asked about the roles they have occupied in life and the catalogue of questions is reworked to fit the couple's context. The focus is on shared experiences and moments and their significance for the partnership. In addition, the partner is involved in the creation of the generativity document. Important questions are how long the couple has been together and how they came together. Both are asked to talk about times together that they remember best, when they felt particularly alive together and whether there are things they still want to share. Life together is recapitulated in this way; even if the partnerships are still recent, this can be of great importance.
At Heidelberg University Hospital, Germany, research and teaching are linked through the university outpatient clinic. There is cooperation with physicians in private practice as well as institutions such as hospices and psychosocial counselling centres, from which patients are referred. However, patients who see a need for themselves can also contact the team directly. The availability of places depends on the respective acute situation.
Although the evidence is insufficient, Dr. Aguilar-Raab's clinical experience suggests that dignity-centred end-of-life therapy for couples can reduce the possibility of grief disorder after the loss of a partner. The therapy itself can help the affected person to deal with the knowledge of the impending end of life and to once again illuminate the personal motives of living and dying in the sense of a biographical work.