Suicide is a complex human behaviour, best understood as being multidimensional and the result of interaction between some basic causal factors that render the individual susceptible and those that interact with this susceptibility to cause suicide. There may be myriad factors that push a person into a suicidal crisis, but it is not a state of mind easily switched around by another's optimism.
Perspective
The book by Andrew Reeves, who has expertise and vast experience in the field as counsellor, social worker and researcher, seeks to equip the counsellors with the knowledge, skills and self-awareness necessary for dealing with suicidal clients. The first of the seven parts in the book provides a historical perspective on suicide and discusses the transition from a moralistic and religious stance to a psychiatric and medical model. There is a brief mention about current trends and incidence with particular reference to the United Kingdom.
The second part describes the various socio-demographic, clinical, psychological, and socio-cultural risk factors associated with suicide. There is, however, no mention of factors that protect persons from engaging in suicidal behaviour, something that is crucial in the counselling process. The chapter on ‘Policy and the Prediction Prevention Culture' emphasises that it is for the mental health workers to recognise and assess the suicide risk and to intervene and prevent suicide. It also highlights the dilemmas that are faced when one's personal beliefs come into conflict with public policy. This dissonance between individual choice and society's duty to intervene is brought out lucidly and with a lot of sensitivity. The discussion on confidentiality, record-keeping capacity, and consent are more general than specific to suicide. While the third part makes an analysis of the influence of organisations, having their own procedures and practices that impinge on the counselling process, the fourth that deals with the thinking process of the suicidal client is pedestrian. Much of what figures in the chapter on “understanding suicide” appears to be from Leenaar's book Psychotherapy with suicidal people . The author rightly emphasises that counsellors should be proactive and explorative in their approach to suicidal clients, not ‘reflective' as in the case of non-suicidal clients.
The author expatiates on the need for establishing rapport, assessing suicide risk, and exploring options other than suicide. But he fails to mention how the counsellors can work on the transient nature of the stressors or the ambivalence felt by the majority of suicidal clients to reduce the immediate risk of suicide. It is accepted that, quite often, suicide is a permanent solution to a temporary problem. In contrast, the fifth part that deals with “The Counsellor Process” discusses at length the various intra-personal and inter-personal experiences, besides the cultural, religious and spiritual beliefs of the counsellor, and how they impact on the counsellors in their response to suicidal clients. The author is palpably honest when he speaks about the disturbing prospect of losing a client to suicide and the temptation for a counsellor to find ways of disconnecting from the client. Dangers of counter-transference and the need for supervision are dealt with clearly and frankly.
The penultimate part emphasises the need for support, training, and the provision of safety nets for the counsellors, while the concluding one presents an overall summary of the work.
Message
What emerges as the core message is that counsellors are often the first ‘port of call' for suicidal clients and so must be equipped to face the difficult, even daunting, task of dealing with them. They should be able not only to identify, explore, and assess suicide risk but also to steer them to a state of lesser risk and to access both formal and non-formal support. Although essentially placed in the U.K. context, the book is no less relevant elsewhere and the key elements are applicable to a variety of cultures and countries. One felt the number of illustrative dialogues between clients and counsellors on key issues could have been more. There is however little doubt that the publication would be of immense value as a guide to practising counsellors in understanding their suicidal clients better and coping with the challenges they face in their work.
