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Question: Discuss about theCounselling for Suicidal Clients. Answer: Introduction Suicidal clients can cause uneasiness in counselors when they seek help; dealing with suicidal clients is one of the hardest things that a counselor can handle. Todays society associates suicidal thought with failure hence it is assumed that someone who is suicidal is a failure in life. However, suicidal thoughts are often caused by factors like trauma and other factors which have nothing to do with failure. Handling clients coming to seek counseling help because of suicidal thoughts can be challenging to any counselor. Understanding the feelings of the client and making decisions on how to advise them can pose serious ethical and moral dilemma for a counselor. A counselor relies on several factors to help them come up with decisions when dealing with a suicidal client. One factor that a counselor relies upon is the context in which the client came to seek help, the relationship they have with the client and confidence of the counselor (American Counseling Association, 2014). Clients with suicidal thoughts can give unpredictable responses in counseling stemming from fear and anger. The unpredictable responses can lead to a counselor experiencing responses of his own such as intrusive thoughts. Studies show that suicide is one of the most difficult things that a counselor can handle (Ellis Goldston, 2012). Many counselors will, at one time in their career, work with clients who are portraying suicidal thoughts. Due to the weight of dealing with suicidal clients, several ethical issues arise when dealing with such clients. This paper will look into the ethical issue that occurs when dealing with a suicidal client while comparing the situation of an aged client who is suicidal due to trauma and a young client who is suicidal due to psychological pressures. Clients, either due to trauma or psychological reasons have suicidal thoughts, can seek help from counselors. Counselors talk to such clients in the hope of ensuring that the clients do not go through with their plans of committing suicide. A client with suicidal thoughts should be handled well because their actions will have an effect on the client, their family, and for the counselor who was involved with the client. Counselors should be aware of ethical, moral, and legal aspects that come into play when dealing with a suicidal client. The ethical issues arise because of the emotional state of the case and the consequences of the advice the counselor will give to the client. Counselors should be guided by the guidelines on ethics and other guidelines when dealing with suicidal clients. Care for suicidal patients include the components of risk assessment and informed consent (Dexter-Mazza Freeman, 2003). Decision making when dealing with suicidal clients is a matter of life and dea th, and the ethical decisions which are made by the counselor bear the same weight (Jobes, Rudd, Overholser, Joiner, 2008). Confidentiality is one of the key ethical issues and the decision of whether to forcefully commit the client to a mental institution. Informed Consent One important issue that arises ethical issues when dealing with suicidal clients is informed consent. Francis (2003) postulates that informed consent with a client who portrays suicidal thoughts can help a counselor provide a roadmap to treatment, appropriate risk disclosure, and inform the client the limits to the confidentiality of what they will disclose. Confidentiality is necessary since a counselor has the power and duty to warn the clients family and commit the client to a mental hospital for treatment. McGlothlin, Rainey, Kindsvatter (2005) explain that once the counselor has established the ethical issue of informed decision with the client, they have taken a moral and professional duty to assess the risk that a client portrays and act on that risk. Informed consent often bears a legal and ethical weight. If a counselor is found to have lacked informed consent when dealing with a suicidal case, they are often liable for professional malpractice if the client commits suicid e. Lastly, the process in which informed consent is arrived at should not be ignored. Informed consent is often arrived at during the initial meeting with the suicidal client but it can be revisited as the visits progress, and more facts are revealed. In most cases, the issue of suicide does not come up during the first meeting, but it comes when the client has developed a rapport with the counselor. Evidently, for any dealings with suicidal clients, informed consent needs to be established. Risk Assessment Arguably, most ethical issues when dealing with suicidal cases arise from the attempt to determine if the client will indeed commit suicide. This risk assessment is necessary when considering the care to be given to the client. Risk assessment is an ethical issue tied to a legal issue known as foreseeability (Schmidt Zechnich, 1999). The job of the counselor is not to predict if the client will commit suicide but he should determine those clients who are highly likely to commit suicide. This involves reasonable care which is often based on timely and accurate risk assessment. Without risk assessment, counselors will not be able to provide reasonable care to the clients. Assessing whether a client has a high risk of committing suicide will ensure the counselor makes a decision on the type of treatment the client should be given. Risk assessment involves many key factors which can be broken down into warning signs and predisposing factors. Warning signs are carried more weight in providing information to the counselor. Signs are like anger, hopelessness, increased drug abuse, and dramatic mood swings. The decisions that come about when arriving at risk factors and warning signs pose serious ethical issues that must be addressed. Style of Treatment As seen previously, the process of treating suicidal clients is a major factor which gives rise to many ethical issues. The style of treatment is an important factor in providing care to the client. Two styles have come into being when treating suicidal clients; the flight style and the fight style (Jobes Maltsberger, 1995). The fight style of treatment which follows the old-style method of dealing with the crisis; trying to take control of the situation. The fight style creates many ethical issues in that it rarely takes into account the wishes of the client. Counselors use this style to fulfill their need in with the client. Some counselors can achieve their needs through all means including fraud and force leaving the client in a state of mess. This style is seen as being hostile since the counselor often uses it to achieve medication and hospitalization by use of force. The flight style is where the counselor does not discuss suicide with the clients who are suicidal by avoiding the topic or changing the topic. Counselors use this style by asking leading questions such as hope you are not thinking of suicide, right? (Berg, Hendricks, Bradley, 2009) And ignores when the client tells them they are suicidal. Flight is considered to be better that the other option. Knowing the ethical issues leads to other styles of treatment such as one where the counselor and the client maintain both parties discuss a collaborative friendship based on logic and suicide. The client is then able to tell the counselor why he feels suicidal and the counselor gives feedback based on what the client has said with no judgment. This type of understanding should be sought when dealing with clients. The only time the counselor should do something without the clients will is when there is no available option in the treatment mode. Most counselors, however, uses the fight method hence giving rise to many ethical issues. It is important for counselors who are dealing with clients who are suicidal to make sure that the ethical issues brought about by risk assessment are dealt with so that it does not distract the treatment process. Counselors should know that the clients have feelings and should deal with them in a humane manner. The counselors should treat clients in a pr oper manner as respect to the client and to the counseling profession which relies upon the counsellor-client relationship to ensure proper treatment methods. Client Assessment Tools A no-suicide contract is an assessment tool which is used by most counselors when dealing with patients who have suicidal thoughts (Barnett, Hayes, Large, Nielssen, 2007). This assessment tool is signed by both the counselor and the client as an agreement that the client will not commit suicide when he is under the care of the counselor. The ethical issues arise from the fact that the agreement has no legal support but may be used as evidence in court if the counselor is sued for malpractice (Mishna, Antle, Regehr, 2002). This agreement is often used and is seen as one of the tools used by the counselor to measure the impact of the treatment he is giving. Some of the clients may see the agreement as a sign that the counselor cares for their well-being and this may create a genuine bond which is useful in treatment. Other clients may see the agreement as something used by the counselor to ensure victory hence may decide to sue the counselor for malpractice. There are several alternatives to this form of contract between the counselor and the client. Some counselors sign an agreement with the client which is to make the client commit to being treated by the counselor. This agreement is to show the willingness of the client that they will agree to attend all therapy sessions and agree to communicate their feelings with the counselor openly. This type of agreement is seen to be more humane than the assessment tool. Ethical Decision Making: Young Adult and Aged Client Infringement of Confidentiality The Australian code of ethics defines confidentiality as a means of ensuring the privacy of the clients and their safety(Robinson, 2006). The code further advises counselors to do everything in their power to ensure that no harm befalls the client. This can mean that the counselor takes certain actions so as to ensure that the client is not put in harms way. Several factors often guide the decision on whether or not to alert the immediate family of the client of the risk that client portrays. Among these factors is the age of the client. In elder clients who have been traumatized, it is difficult to inform their families on the impending suicide because it is usually the loss of family that is causing them to be suicidal. Aged clients will be protected from harm by talking to them and other strategies which will seek to protect them. Young adults parents, however, who are often suicidal due to psychological reasons are informed of the impending suicide of the client. The counselor ca n even take the initiative of informing the authorities that the client is likely to commit suicide. The pressure which comes when making the decision on whether or not to inform is often made easier with the age of the client. It is easier to talk an elder client of suicide with reason, but for a young client, the counselor may have to seek the intervention of the parents and even the authorities. Decisions to break the confidentiality of the client is often done so as to protect the client and their family. This decision often opens the way for potential lawsuits and dealing with a young person will be more understandable than breaking the confidentiality of an elder client. Breaking confidentiality is often necessary in some cases because if the client commits suicide, then the counselor if liable and can be sued by the family. A counselor decides whether or not to break confidentiality and to what extent due to the age of the client. Ethical issues arise when a counselor decides if to save a life or to do something and open themselves to lawsuits. A high value should be placed on saving the life of the client and not on protecting oneself. Professional responsibility is an ethical issue which arises when dealing with aged and young clients. Involuntary Commitment to a Hospital It often comes to a point where the counselor has to decide whether or not to commit the client to a mental hospital as part of the treatment. In elderly clients, the decision to commit them to a mental hospital is often made when there is no further option for treatment, and the psychological impact of the trauma is worsening. Young clients who are suffering from psychological stresses causing them to be suicidal can be committed to a mental hospital when the counselor realizes that they may go on with the suicide. Breaking the trust which a suicidal client has on you as a counselor may have to necessitate involuntary hospitalization of the client so that they are put on suicide watch. Hospitalization is often necessary so that the patient can be monitored closely by the doctors. The decision to hospitalize a patient is often due to factors like age. Involuntary hospitalization of a client is not an easy decision to be done by the counselor and it should only be done when there is n o further option to continue with the treatment for the suicidal client. Committing a client to a mental hospital against their will is often seen as a degrading intervention that a counselor should do as a last resort. Deciding whether or not to commit a client to a hospital, though seen by some as dehumanizing, is known to save a lot of lives and a counselor should apply it to both aged clients and young clients. When a counselor knows that they will have to make the decision to commit a client without their will, the counselor should be clear about the decision and be straightforward with the client on why the decision has to be taken. Conclusion Suicidal thoughts are sensitive issues which counselors face while dealing with clients. This essay has outlined the aspects of counseling that lead to ethical issues and how a counselor deals with an aged client and a young client when dealing with some of the ethical decisions which have to be taken. The aspects of counseling such as risk assessment and informed consent lead to ethical issues such as the need to break confidentiality, breaking a relationship for the sake of the client, and other ethical issues as entailed in the Australian code of ethics. Complications may arise when faced with certain options such as suicidal clients. There can be hitches in ethical decision making when dealing with clients who are suicidal. The paper looked at the risks and the ethical decisions which the counselor has to make to ensure the best for their clients. The paper the looks at these ethical decisions when dealing with aged and young clients. 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