Reflection of Providing Culturally Safe Counselling to LGBTQIA+ Clients in Malaysia

Dear Sir,

Counselling services for LGBTQIA+ clients in Malaysia are influenced by the Legal Code Act 1997 within Section 377A of the Penal Code 574 that criminalizes non- heterosexual forms of identities, ¹ as well as other religious laws that penalize these groups. This means counsellors are likely to be clouded by stigma and stereotypes if they do not reflect on the conscious and unconscious bias related to cisheterosexism that has historically marginalized, pathologized and criminalized LGBTQIA+ individuals.^2,3 Cisheterosexism relegates LGBTQIA+ people to a minority position in Malaysia, which has a major impact on LGBTQIA+ people’s health, well-being and quality of life.^3–5

In this letter, I (first author) am sharing the perspective of a counsellor providing culturally safe counselling ⁶ supporting LGBTQIA+ individuals in Malaysia. Counsellors in Malaysia are guided by the Counsellors Act 580 ⁷ and the Malaysian Counsellor Code of Ethics. ⁸ The Act and the professional code govern Malaysian counsellors through a series of legal–ethical responsibilities when they offer counselling services to clients. In addition, the Act and the professional code also position counsellors as professional authorities by recognizing them as experts with knowledge and abilities to care for and support people who come to seek their services. This ‘role power’ ⁹ of counsellors indirectly situates them in a privileged position and presents clients as vulnerable to counsellors’ positions of power and influence. Experiences of conflicts when navigating goals, roles and interests with LGBTQIA+ clients, however, are common for Malaysian counsellors. ¹⁰

My counselling work has centered on LGBTQIA+ individuals’ struggles with minority stressors, identity concealment and cisheterosexism. My clients talked about minority stressors in the form of receiving hurtful responses from family members and friends when they made the decision to come out as an LGBTQIA+ person. Some told the story of being disowned by families who failed to demonstrate understanding for their gender and/or sexuality. In this instance, love is offered on the condition that my clients renounce their LGBTQIA+ identities. Some clients expressed that they had to endure conversion treatment prescribed to ‘cure’ their LGBTQIA+ identities. The discrimination displaced them; they felt disconnected and were no longer sure where they belonged. Their experiences with mental health services also taught them that mental health professionals hold power and authority that are difficult to challenge. There were few people that they felt they could trust. LGBTQIA+ clients whom I counselled have developed coping responses to endure the repeated experience of being dismissed and made invisible by counsellors.

In my culturally safe practice, first, I connected the clients’ experiences to the playing out of cisheterosexist discourses in various dimensions (e.g., legal, medical, religion, culture, education and institution). These discourses consign LGBTQIA+ people to a marginalized position and restrict their access to mental health care. This positioning disrupts LGBTQIA+ people’s sense of belonging in society as they are alienated from participating in mainstream society unless they conceal their non-normative identities. The understanding of the shaping effects of discourses opens up a space for me to stand and reposition myself, to see, listen to and interpret my own practice and client responses to my therapeutic plans. For example, if I invite myself to consider how the discourse of criminalization of LGBTQIA+ identities may shape a client’s view about disclosing their identities, perhaps I can interpret their resistance in this context as a way to keep themselves safe from experiencing the potential gaze of judgement and being stigmatized in the public perception. In this new positioning, I took up the responsibility and action to shift my approach from the continuum of blinded care and cultural competency to promoting culturally safe care for LGBTQIA+ people.

Second, I actively challenge power imbalances by empowering LGBTQIA+ clients to make decisions about their own care and learning about each client’s specific health needs through centering their voices within the therapeutic relationship. Lastly, I constantly work towards creating a community of care for LGBTQIA+ clients by working collaboratively with their ‘families of choice’ ¹¹ ; these include intimate relationships and friendships that are viewed by LGBTQIA+ clients as places where they feel valued and safe. ¹² I have been in the position of inviting LGBTQIA+ clients to bring family members or significant others in counselling and calling on their support networks to care for their safety needs. I experienced this as a time of delicate negotiation as I attempted to promote active participation by my client in counselling, find support for my client, and support a family to manage the shame or fear that they may experience.