If you have a 14-year-old client who is pregnant and using cocaine daily, what is the most appropriate action?

• A. Inform the client’s mother immediately
• B. Report the drug use to child protective services
• C. Maintain the client's confidentiality but counsel her about the effects of drug use
• D. Encourage the client to terminate the pregnancy

Answer: (C)

The most appropriate action in this situation is to maintain the client’s confidentiality while counseling her about the effects of drug use. This approach respects the ethical principle of confidentiality that is fundamental in therapeutic settings, especially for minors, as it promotes trust and a safe environment for the client to discuss sensitive issues.

Counseling the client about the effects of drug use is a critical step in helping her understand the potential risks to both her health and the health of her fetus. This guidance can aid her in making informed choices moving forward. Additionally, fostering a supportive therapeutic relationship is vital for encouraging her to seek help for her substance use.

While involvement of external parties like the client’s mother or child protective services could be warranted in certain contexts, maintaining the therapeutic alliance and providing education about her circumstances often allows for better outcomes. It also holds the potential for collaboratively exploring treatment options or considering alternative resources without immediately breaching confidentiality. This might leave the client feeling betrayed and less likely to seek help when needed.

Encouraging the client to terminate the pregnancy, while a sensitive issue, does not align with a non-directive ethical approach. The decision regarding the pregnancy should be left to the client, ideally supported by informed counseling rather than directive statements about what she "should