Counselling in the context of suicidal ideation in Malaysia

Abstract

Counselling is particularly challenging in the context of potential harm through suicide. This is a time when it is clear that responsibilities for and influences on practice go beyond the client in the room. Socio-cultural and political influences range across the legislative, medical, religious, cultural, institutional and educational considerations that counsellors must give attention to. In complex and challenging situations counsellors must negotiate roles and responsibilities, make difficult clinical judgements and ethical decisions, and take responsible actions. The ethical principle of ‘do no harm’ becomes complex and may not be universally understood and agreed upon. Decisions are not simple and straightforward, and care must be delicately considered for each individual in his or her specific context. Manualised approaches to suicide prevention may not always be sufficient in the face of practice complexities. In this study, I examine the shaping effects of socio-cultural and political aspects on counselling practice in Malaysia in the context of suicidal ideation. I particularly emphasise how counsellors are positioned when these aspects intersect with the counselling process; how counsellors respond to, resist and change their positioning in order to minimise the risk of harm, and enhance life-affirming possibilities. Data were generated in semi-structured interviews with counsellors in Malaysia. Analysis of data included a focus on the investigation of discourses-in-action to bring forward a range of discourses that positioned counsellors, clients and their families in a conflicting or collaborating relationship, and thus defined client resistance differently. A discursive analysis of data illustrated that within the tensions between ethical choice of respecting clients’ right to autonomy and protecting client safety, counsellors found ways to engage in practice wisdom and work to co-construct with clients a relational, flexible, care-ful, creative, ethical responsive dialogic practice. The analysis shows how counsellors skilfully and delicately wove counselling, cultural/religious and personal knowledge together to produce practices tailored to the particularity of a specific client, while taking account of serious considerations for client safety. I argue that these practices should be understood through the imaginative possibilities of philosophy, showing how a Levinasian understanding of the Face of the Other, and a Derridean understanding of hospitality, highlight the highly developed relational-dialogic-responsive skill critical to counselling practice alongside clients where there is risk of serious self-harm.