In: The Oxford Handbook of Psychotherapy Ethics (Oxford University Press).

Edited by Manuel Trachsel, Jens

Gaab, Nikola Biller-Andorno, Şerife Tekin, and John Z. Sadler
Published online Sept. 2020. DOI: 10.1093/oxfordhb/9780198817338.013.13

Dignity in psychotherapy

Roberto Andorno

Abstract
The notion of human dignity conveys the idea that every human being has inherent worth and
therefore ought to be accorded the highest respect and consideration. In health care, dignity provides
an overarching moral framework that is called to guide the physician-patient relationship in a great
variety of issues, and especially in the promotion of the patient’s well-being and self-determination.
Dignity plays also an important role in psychotherapy as the patient-therapist relationship involves
confidences of intimate nature and about very personal decisions and attitudes, and may lead to a
patient’s overdependence on the therapist. Taking seriously the patient’s dignity imposes on the
therapist some specific moral duties, such as respecting and promoting patients’ self-determination,
as well as patients’ values, beliefs and life plans. Another direct consequence of the principle of respect
for dignity is the requirement to avoid exploitative interactions with patients, in particular, any form
of sexual harassment and abuse.

Keywords
Dignity; Overdependence; Self-determination; Instrumentalization; Exploitation.

Introduction
Respect for human dignity is generally regarded as the overarching value guiding social interaction
and as the ultimate foundation of human rights. More specifically, respect for the dignity of patients
and research subjects is presented by international documents as the most basic normative principle
governing healthcare practice and medical research. Two significant examples of this view are the
European Convention on Human Rights and Biomedicine (1997) and the Universal Declaration on
Bioethics and Human Rights (2005). Respect for human dignity, not surprisingly, also plays a significant
role in the understanding of the psychotherapeutic relationship. References to human dignity can be
found in various ethical guidelines for the practice of psychology. For instance, the Universal
Declaration of ethical principles for psychologists (IUPsyS and IAAP 2008) states that “respect for the
dignity of persons and peoples” is “the most fundamental and universally found ethical principle
across geographical and cultural boundaries, and across professional disciplines” (Principle 1). It is very
revealing that the Declaration, immediately after having affirmed the principle of dignity, presents
some other values that are important for the practice of psychology as if they were derived from the
basic premise of dignity: “free and informed consent”, “privacy”, “confidentiality of personal
information”, “respect for the diversity among persons and peoples”, “respect for the customs and

1
beliefs” (except when they “seriously contravene the principle of respect for dignity” or “cause serious
harm”), and “fairness and justice in the treatment of persons and peoples”.
Similarly, respect for dignity embodies the first ethical principle of the Code of Ethics and Conduct
of the British Psychological Society, which states that

“[p]sychologists value the dignity and worth of all persons, with sensitivity to the dynamics of
perceived authority or influence over clients, and with particular regard to people’s rights
including those of privacy and self-determination.” (2009, 10).

Also, the Model Code of Ethics of the European Federations of Psychologists’ Association (2015)
places “respect for individual rights and dignity” at the top of the principles that should guide the
psychological profession (Art. 3.1). This document further specifies the meaning of this principle by
providing that “the psychologist […] works in such a way that their expertise will not be used to harm,
abuse, or oppress”. Similarly, respect for “people’s rights and dignity” is among the five ethical
principles put forward by the Ethical Principles of Psychologists and Code of Conduct of the American
Psychology Association (2002/2017, 4). Interestingly, this principle is directly associated with ensuring
respect for privacy, confidentiality and self-determination. Furthermore, it is also put in relation with
the need to take into account that people’s vulnerabilities may impair their autonomous decision-
making, and with the importance of avoiding any prejudices regarding people’s diversity.
This chapter aims, first, to briefly conceptualize the notion of human dignity in general
philosophical and legal terms; second, to stress its central value in the healthcare context; and finally,
to consider what factors can jeopardize patient’s dignity in the psychotherapeutic relationship.

Respect for human dignity

‘Dignity’ is defined as “the state of being worthy of honour or respect” (The Oxford Encyclopedic
English Dictionary). When this concept is associated with the adjective ‘human’, it denotes that all
human beings possess equal and inherent worth and therefore ought to be accorded the highest
respect and care, regardless of age, sex, socioeconomic status, physical or mental health, ethnic origin,
religion, or any other particular feature. In other words, every human being is worthy of respect simply
by virtue of his or her human condition.
The concept of ‘dignity’ is very close to that of ‘respect.’ Respecting persons is not but the
consequence of acknowledging the intrinsic worth they possess. Respecting persons involves
regarding them as being entitled to make a rightful claim on our conduct, and deserving moral
consideration in their own right, regardless of their merit or ability (Feinberg 1973). In modern times,
Kant was the first major philosopher to put the notions of respect (Achtung) and dignity (Würde) at
the very center of moral theory. According to his famous categorical imperative, we should always
treat people as an end in themselves, and never merely as a means to our ends. People should not be
instrumentalized because they are not ‘things’, but ‘persons’ (i.e. rational beings). While things have
a price (i.e. the kind of value for which there can be equivalent), ‘dignity’ makes a person irreplaceable
(Kant 1996, 79). In other words, to be a ‘person’ is to have such a status and worth that is incomparable
to that of any other being. The point is that respect is the only appropriate response to such an entity.
Respect is the acknowledgment, both in attitude and behavior, of the dignity of persons as ends in
themselves. Moreover, respect for persons is not only an appropriate attitude but also morally and
unconditionally required (Dillon 2018).
Although the notion of human dignity has a very long tradition in the history of philosophy, it has
re-emerged with great vigor after the Second World War as an international legal and political
concept, which provides the ultimate foundation to human rights. In response to the horrors of that
tragic period of history, the international community felt the need to emphasize the idea that every
individual has inherent worth and accompanying rights in order to prevent “barbarous acts which have

2
outraged the conscience of mankind” from ever happening again (Preamble of the Universal
Declaration of Human Rights 1948, thereafter UDHR). Indeed, the emphasis on human dignity that
dominates the ethical and political discourse since 1945 can be to a large extent explained by the
horror caused by the revelations that prisoners of concentration camps, including children, were used
by Nazi physicians as subjects of brutal experiments (Baker 2001).
In the aftermath of the Second World War, the Member States of the newly created United
Nations appealed very explicitly to the notion of human dignity when they reaffirmed their “faith…in
the dignity and worth of the human person” (Preamble of the United Nations Charter 1945).
Subsequently, the UDHR, which would become the cornerstone of the new international human rights
system, was grounded on the “recognition of the inherent dignity and of the equal and inalienable
rights of all members of the human family” (UDHR, Preamble). From the very beginning, the
Declaration puts forward that “all human beings are born free and equal in dignity and rights” (Article
1). This provision is the bedrock of all the rights and freedoms set forth in the Declaration and, in
particular, the basis for the prohibition of all forms of discrimination (Article 2), of slavery (Article 4),
and of torture and any cruel, inhuman or degrading treatment or punishment (Article 5). In this
respect, the statement made in Article 1 has been featured as a “seismic shift in human consciousness”
which is “so profound that, paradoxically, its importance may not be fully realized” (Mann 1998, 31).
As noted above, human dignity is today regarded by international law as the foundation and
source of human rights, that is, as the ultimate rationale for the recognition of equal rights to every
human being regardless of ethnic origin, social status, sex, age, health condition, or any other
particular feature. This means that human rights are conceived as universal. Indeed, if they were not
universal, they could not be called ‘human’ rights at all, but the rights of a particular category of
individuals. Moreover, human rights could not even be thought of if they were not understood as
universal claims, but as exclusive prerogatives of some individuals. Indeed, respect for human dignity
and human rights rests upon the belief in the existence of a truly universal moral community
comprising all human beings.
Philosophers of all times have generally associated the special moral standing we confer to every
human individual with the unique rational abilities and moral self-determination that characterize
human beings. Importantly, this intrinsic worth is not conceived as conditioned on the circumstance
that the human being in particular actually possesses or is able to exercise such intellectual abilities.
Rather, this intrinsic worth is connected to features that characterize human beings as a kind, even if
they are not necessarily present in every individual (Sulmasy 2007). In other words, such respect also
applies to those individuals who have not acquired such rational and moral faculties yet (such as
newborn infants) or to those who have irremediably lost those abilities, either totally or partially (such
as persons with serious mental disorders, neurodegenerative diseases, or patients in persistent
vegetative state). Dignity is therefore not a privilege of adult, perfectly competent and morally
autonomous persons, but a value that we attach to every human being.
Despite the great value attached to dignity by contemporary societies, it must be acknowledged
that the concept is inevitably vague and abstract. Very often, its precise meaning and practical
implications in concrete situations are not easy to determine. Moreover, the notion of dignity is never
defined by the same legal and ethical standards that appeal to it. The elusiveness of the concept has
attracted serious criticisms from some scholars, who see appeals to dignity as purely rhetorical or
political statements, which are vague restatements of other more precise notions such as, for
instance, ‘respect for autonomy’ or ‘informed consent’ (Macklin 2003, Caulfield and Chapman 2005).
Some of these criticisms may make sense when the concept of dignity is just invoked to end an
ethical discussion and to avoid the effort of providing substantive reasons about the ethical issues at
stake: given that not respecting dignity is always bad to do, the discussion about a particular topic is
over. However, the potential rhetorical misuse of the concept of dignity should not lead us to ‘throw
away the baby with the baby water’. Appeals to dignity can be meaningful in many cases, in particular
when other ethical principles (e.g. autonomy, privacy, etc.) are incapable to convey in an equally
powerful manner the idea that the intrinsic value of a person is disregarded in a given situation. For

3
instance, it is clear that the wrongness of sexual exploitation of a patient by a therapist cannot be
adequately grasped just in terms of a lack of ‘respect for autonomy’ or as a ‘privacy infringement’. Like
in this example, the recourse to human dignity is particularly helpful with regard to any practices that
involve commodifying human beings, or that entail degrading or humiliating treatment.
In this connection, it is noteworthy that the concept of human dignity usually plays a negative role
by setting limits to certain practices or banning them altogether. In contrast, dignity is less often used
to positively promote certain practices or behaviors. This is due to the fact that the meaning of dignity
can be better grasped by considering what is contrary to people’s intrinsic value rather than what is
in conformity with it. This ex negativo approach is visible, for instance, in some scholars’ attempts to
give a glimpse of what dignity means. According to Ronald Dworkin (1994, 236), dignity embodies the
idea that people must “never be treated in a way that denies the distinct importance of their own
lives”. Similarly, it has been claimed that human dignity and human rights presuppose that “there are
some things that should not be done to anybody, anywhere” (Midgley 1999, 160). It is not by chance
that, while most human rights are couched in positive terms (‘Everyone has the right to…’), those that
aim to protect people against the most serious and direct violations of human dignity are formulated
in negative terms, as prohibitions: ‘No one shall be held in slavery or servitude’; ‘no one shall be
subjected to torture or to cruel, inhuman or degrading treatment or punishment’ (Articles 4 and 5 of
the UDHR, respectively). Precisely because these rights and freedoms are more immediately
connected with human dignity, they are thought of as absolute, in the sense that they are not subject
to any exceptions (Andorno 2013).

Human dignity in medical ethics and law

The notion of human dignity is not only regarded as the foundation and ultimate source of human
rights. It also plays a very central role in modern medical ethics and law. The first impact of the notion
of dignity on this area took place immediately after the Second World War and concerned medical
research involving human subjects. In 1947, the requirement of free and informed consent of research
participants was formally included into the famous Nuremberg Code developed by the military court
that condemned the Nazi physicians. Although the ten principles for medical research contained in
the Nuremberg Code do not explicitly refer to human dignity, they are clearly based on this notion.
The categorical nature of the Code principles shows that the judges who formulated them had the
idea of unconditional human worthiness in mind. In this respect, it is pointed out that “never before
in the history of human experimentation, and never since, has any code or any regulation of research
declared in such relentless and uncompromising fashion that the psychological integrity of research
subjects must be protected absolutely” (Katz 1992, 227). Interestingly, the only provision relating to
medical ethics that appears in the International Covenant on Civil and Political Rights (1966) is the
requirement of informed consent for medical research (Article 7).
Human dignity also holds a prominent position in the international instruments dealing with
bioethics that have been developed since the end of the 1990s, such as the Universal Declaration on
the Human Genome and Human Rights (1997) and the Universal Declaration of Human Rights and
Bioethics (2005), both adopted by the UNESCO Member States, and the Council of Europe’s
Convention on Human Rights and Biomedicine (1997), also known as ‘Oviedo Convention’. The
emphasis on human dignity in international instruments dealing with biomedicine over the past few
decades is impressive enough to lead scholars to characterize the notion of dignity as “the shaping
principle” of international bioethics (Lenoir and Mathieu 2004, 16) or as the “overarching principle”
of the global norms governing biomedical issues (Andorno 2009).
However, respect for human dignity is not only a general, abstract principle guiding the normative
frameworks relating to biomedicine, but also a very concrete moral standard in the patient-physician
relationship. It also helps to identify the practices or attitudes of health care professionals that
contribute –or not– to promote patients’ intrinsic value and self-determination. In medical ethics, the

4
notion of dignity is often employed to emphasize the importance of promoting patient’s self-
determination and to question autonomy-denying attitudes of healthcare professionals.
The idea of dignity contributes to see every patient not merely as someone suffering from a
disorder, disease or condition, but as a person, that is, a unique, irreplaceable human being with an
intrinsic value. This idea compels health care professionals to keep in mind that every patient has his
or her own rich personal story and life experiences, which make them who they are, and distinct from
any other individual. The awareness of the uniqueness and incommensurable worth of every patient
is not something merely desirable in medical practice. Rather, dignity is a moral imperative that plays
a key, humanizing role in the physician-patient relationship (Andorno 2013).
The need to promote patients’ dignity has become especially urgent in the context of time
pressure that characterizes modern healthcare practice. This is particularly relevant for psychotherapy
as every session is very time consuming and a psychotherapy treatment can last for years. The point
is that in increasingly bureaucratic and impersonal clinics the risk is high of overlooking that kindness,
humanity and respect for each individual patient are still core values of the practice of medicine
(Pellegrino 2008). Hence, emphasizing that every patient, no matter what degree of dependency or
disability, possesses intrinsic dignity is probably today more relevant than ever.
Undoubtedly, the quality of healthcare depends to a large extent on physicians and nurses paying
adequate attention to the distinct worth of every single patient. This is especially the case with
hospitalized patients, who are placed in a situation of particular vulnerability as they are highly
dependent on the assistance of others for the improvement of their health condition and for their
daily needs. Such patients’ self-esteem may be affected if they find that certain behaviors or attitudes
of health care professionals disregard their intrinsic value as ‘persons’ (Andorno 2013).
Worth mentioning is the term ‘patient’ itself, which comes from the Latin verb ‘patior’ and means
to endure or suffer, shows this close association with vulnerability. Patients are indeed exposed to
suffering, not only as a result of their disease or condition, but also as a consequence of the power
and knowledge imbalance that exists between them and health care professionals, and of the situation
of inescapable dependence in which they are placed. Their sense of dignity and their self-esteem are
therefore challenged by their changing health circumstances.
Several surveys show that paying attention to patients’ dignity is of crucial importance to the
quality of healthcare, and can contribute to recovery (Matiti and Trorey 2008; Baillie 2009). A number
of key themes that help enhancing patients’ dignity include: protecting their privacy, facilitating
communication between patients and healthcare providers, assisting patients in their need for
information and self-determination, and ensuring decency and correctness in the forms of address
(Matiti and Trorey 2008).
Many of these studies point towards the promotion of patients’ self-determination (or autonomy)
as one of the key requirements for ensuring respect for their dignity. Self-determination (i.e. the ability
to govern oneself) is indeed one of the most powerful expressions of human dignity. However, these
two notions are not synonymous. The imperative of respect for dignity is far broader and foundational
than simply ensuring respect for self-determination. Let us note that the principle of dignity is not only
applicable to adult individuals with full decision-making capacity, but also covers the respect for those
who are not yet, or are no more, morally autonomous (newborn infants, senile elderly, people with
mental disorders, comatose patients, etc.).
At this point it is worth stressing that, although respect for autonomy is generally recognized as
one of the most important bioethical principles and an expression of dignity, it does not have absolute
value. According to principle-based bioethics, famously developed by Beauchamp and Childress
(2009), autonomy is just one of the four ethical principles guiding healthcare practice, together with
beneficence, nonmaleficence, and justice. These four principles have prima facie validity, which means
that they apply as long as there is no conflict between them. If there is, they have to be balanced to
determine which one carries more weight in the particular case at hand. According to Beauchamp and
Childress (2009, 23), a set of conditions must be met to justify infringing one of the prima facie
principle to adhere to another (a sufficient reason for doing so, a realistic chance of success, absence

5
of a morally better alternative available, etc.). In other words, autonomy can be trumped in some
contexts and under certain conditions by beneficence and/or nonmaleficence. There are indeed
circumstances in which the imperative of promoting patient’s dignity is better served by upholding
beneficence/nonmaleficence instead of autonomy. This can best be illustrated by an example
provided by Knapp and VandeCreek (2007, 401):
“Dr. Rodriguez is treating a patient who has made a serious attempt to harm herself. After a thorough
review of the patient and situational factors, Dr. Rodriguez determines that the patient is very intent
on killing herself and is resistant to treatment. Dr. Rodriguez then institutes procedures for an
involuntary psychiatric hospitalization”
However, patient’s dignity cannot only be promoted through negative actions (i.e. actions aiming
to prevent harm). According to the above mentioned studies, patients’ dignity can also be positively
promoted by the behavior of healthcare professionals. The ways of preserving patient’s dignity are
very diverse and include, among others: ‘presence’ (keeping others company); ‘concealment’
(covering up embarrassing markers of illness); ‘independence’ (facilitating, as far as possible, patient’s
self-sufficiency and moral agency); ‘levelling’ (minimizing asymmetry); ‘creativity’ (allowing patients
of making or sharing art); ‘courtesy’ (demonstrating common respect); and ‘authenticity’ (honoring
individuality and personhood) (Jacobson 2009). It results from this that the efforts aiming at preserving
and promoting patients’ dignity have to take into account very heterogeneous elements such as
feelings (feeling comfortable, in control and valued by others), physical presentation, and staff
behavior (Baillie 2009).
Consistent with this, it has been advanced that all forms of psychotherapy have in common their
effort to alleviate the patients' sense of powerlessness to change themselves or their environment, a
condition that may be termed ‘demoralization’ (Frank and Frank 1991). If this claim is correct, it could
perhaps be argued that all psychotherapies ultimately aim to help patients recover their self-esteem
and thereby the awareness of their own dignity.
Consistent with the above mentioned studies, the Canadian psychiatrist Harvey Chochinov claims
that the concept of dignity offers an overarching conceptual framework that enables physicians,
patients and families to better define the objectives and modalities of any medical intervention (2002,
2007, 2008). Based on the results of surveys about the understanding of dignity by patients in a
terminal condition, he developed a model of patient care called the ‘dignity-conserving care’ model.
This approach includes three broad areas of influence of individual perceptions of dignity: illness-
related concerns (i.e. those things that directly result from the illness itself); the dignity-conserving
repertoire (i.e. those aspects of patients’ psychological and spiritual landscape that influence their
sense of dignity); and the social dignity inventory (i.e. those social issues or relationship dynamics that
enhance or detract from a patient’s sense of dignity) (Chochinov 2002). Chochinov has also developed
what he calls the ‘patient dignity inventory’, which aims to measure various sources of dignity-related
distress among patients nearing the end of life (2008). He stresses, however, that the dignity
conserving care model applies across the broad spectrum of medicine, and not only in the field of
palliative care because “whether patients are young or old, and whatever their health problems, the
core values of kindness, respect, and dignity are indispensable” (Chochinov 2007).
Similarly, a study conducted in the context of psychiatric nursing practice has identified a number
of attitudes and behaviors of nurses that may contribute –or not– to promote patients’ dignity. For
instance, dignity is preserved when caregivers take the time to be present for patients and pay
empathic attention to their stories and needs; on the contrary, patients’ dignity is offended when
caregivers abuse their power, ‘punish’ patients who do not behave as expected, and neglect patients’
requests (Lindwall et al. 2011).

6
The importance of dignity in psychotherapy
Psychotherapy presupposes regular personal interactions between the therapist and the patient on
sensitive and intimate matters. The goal of these regular encounters is to treat emotional and
psychological problems by means of talking and understanding, by persuasion and rhetoric. Most
therapies assume that the inner landscape of the patient can be changed (otherwise it would be
meaningless to offer therapy at all) (Adshead 2015). This implies, to a greater or lesser extent, an
effort by the therapist to influence some particular thoughts, attitudes or behaviors of patients. When
considered from the point of view of the patient’s dignity, the ethical problem of psychotherapy lies
precisely here. Indeed, the vulnerable and dependent situation in which patients are placed in the
psychotherapeutic relationship creates the conditions for potential threats to their self-
determination, which is a crucial component of their dignity as persons.
The key ethical dilemma in psychotherapy is to what extent the influence exerted by the therapist
on the patient is balanced by a true collaborative relationship between both individuals. The concept
of ‘therapeutic alliance’ presupposes that the patient and the therapist work together to promote a
therapeutic change. Over the last decades, an egalitarian relationship is gaining in prominence and
regarded as more humanitarian and facilitative of exchange than the traditional medical model
(doctor-patient) or the behavioral model (teacher-student). (Karasu 2013, 42). However, there are
concerns that a friendship-like relationship involving an excessive familiarity between both individuals
may impair the effectiveness of the therapy. Therefore, it seems that a balance has to be found
between these two extreme positions. The question here is how to avoid therapists’ misuse of power
while maintaining appropriate professional boundaries.
What is undeniable is that psychotherapy patients find themselves in a situation of particular
vulnerability, not only as direct consequence of their emotional and psychological problems, but also
because they are revealing intimate aspects of their lives and exposing their inner weaknesses and
fears to another person in a one-way transaction which is not a peer-to-peer relationship (Adshead
2015). Certainly, in any patient-healthcare professional relationship there is an asymmetry of power
and knowledge. However, that asymmetry becomes even more pronounced in psychotherapy, since
it involves disclosing feelings and thoughts, and this, in regular meetings which generally take place in
a long period of time.
From the point of view of patient’s dignity, the challenge for psychotherapy consists therefore in
helping people overcoming their psychological problems, but without making them overdependent
on the relationship with the therapist. If self-determination is a prominent expression of dignity,
psychotherapy should encourage patients to remain the main actors of the healing process. For
instance, regarding the treatment of depression, it has been suggested that self-knowledge achieved
through psychotherapy has moral value in that it promotes the autonomy of stressor-related
decisions. (Biegler 2010).
Respect for autonomy also involves being sensitive to the patient’s values, religious beliefs and
life plans, even if they are not shared by the therapist. Of course, values issues arise during treatment.
If adequately negotiated, values can contribute to treat the patient’s emotional and psychological
problems. The issue is how to resolve value conflicts while preserving the therapeutic mission. In this
regard, Bergin has suggested that if therapists disclose, at least implicitly, their own value preferences,
they should be extremely careful to do it a non-directive and respectful manner, so as to preserve
patient’s personal views and moral agency (Bergin 1991).
Respect for patients’ dignity requires not only preserving and promoting their self-determination,
but also strictly avoiding any form of patients’ exploitation, in particular, sexual abuse. This latter
behavior seriously disregards patients’ inherent worth and misuses the trust they have placed in the
therapist. Sexual abuse of patients can indeed be labelled as ‘exploitation’, since exploiting people
means taking unfair advantage of them, or using them exclusively as means to an end rather than as
ends in themselves, according to the famous Kantian moral imperative. The misuse by therapists of
the professional relationship to advance their sexual interests clearly constitutes a serious violation of

7
patients’ dignity. It should be noted that the possibilities for sexual exploitation are increased by the
patient’s dependence on the therapist over a long period of time. In this regard, it has been pointed
out that “the inherently intimacy and dependency of the therapeutic relationship makes it more
difficult to scrutinize transgression and more likely that the injured patient remain silent” about the
sexual abuse (Holmes and Adshead 2009, 373). Moreover, as Rüger and Reimer (2010) report, patients
having been sexually abused by therapists suffer from long-term psychological harm, which may
include depressive developments with suicidal tendencies and drug and alcohol misuse, along with
psychological and psychosomatic symptoms. Not surprisingly, ethical guidelines for psychotherapy
condemn very explicitly and unconditionally any form of sexual harassment of patients.

Conclusion
The notion of dignity plays a crucial role in medical ethics by emphasizing the importance of valuing
the patient as a ‘person’, that is, as a unique and irreplaceable individual who is endowed with intrinsic
worth. The relevance of dignity in this context results from the special vulnerability of people suffering
from physical or psychological health problems. The idea of dignity requires from healthcare
professionals to actively promote patients’ intrinsic worth in every encounter, and to avoid any
behavior that might hurt patients’ self-esteem. In psychotherapy, the notion of dignity mainly aims to
emphasize the need to promote, as far as possible, patient’s self-sufficiency and moral agency, and to
avoid making them overdependent on the relationship with the therapist. Dignity also requires from
the therapist to carefully respect the personal values and beliefs of patients, and to absolutely abstain
from any behavior that may constitute patient exploitation, such as sexual harassment and other
forms of abuse.

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