A qualitative study exploring the perceptions of young people, parents, and therapeutic counsellors on young people’s engagement with therapeutic counselling in Malawi

Malawi experiences a critical unavailability of treatment of youth depression with therapeutic counselling (TC) being one of the readily available psychological interventions provided through both formal and informal providers. Little is known about how young people (YP) engage with such services. We thus explored perceptions of the young people themselves, their parents, and therapeutic counsellors on how the young people engage with TC in Malawi. This exploratory qualitative study involved sixteen young people with a history of depression and utilisation of TC, seven counsellors and a guardian. Participating young people were randomly divided into two focus groups (FG) of seven participants in each group and remaining two young people took part in in-depth interviews (IDI). Semi-structured interviews were carried out and analysed using Interpretive Phenomenological Analysis (IPA). The interviews were transcribed verbatim and coded using IPA. Analysis of the data led to five themes of parental reaction when TC is indicated for their child, parental influence on YP’s perception, perceptions of the young people themselves, perceived benefits of TC, challenges with counselling and enablers of counselling. It was noted that young people’s perceptions towards counselling were mostly negative and their engagement with it was influenced by their parents. However, young people’s experiences with TC were mixed with positivity and negativity; and the majority expressed satisfaction with the services. The study further identified challenges that young people face while engaging with counselling like re-traumatization during counselling session. Our study revealed that before engaging with therapeutic counselling, many participants were reserved with it due to negative perception towards mental health services. To increase mental health service-utilisation, there is need for service providers to consider and address the YP’s negative perceptions.