Case Study #2 Substance Abuse

Question

Case Study #2:

You are working in a substance abuse recovery center for adolescents.  In the support group you facilitate, a 15-year old teenage girl reveals that she is sleeping with her 18 year-old boyfriend who is HIV-positive.  They sometimes forget to use condoms, especially when she is high.  She remembers your talk at the beginning of each session about confidentiality.  How will you proceed to help this young woman, while still keeping an ethical code? What factors come into play? 

Answer 1

Great question!

Of course you want to show unconditional positive regard to your client. This is not a time to lecture (even though it feels natural to want to correct the behavior).

It is important to connect with her at some point about this behavior as it poses a risk to her. This can be done individually in order to keep her information as confidential as possible. If you have a solid rapport with her, you might be able to present referrals for services for HIV treatment, or even services that can provide her with free condoms that way they are more accessible during those times. Do not reach out to those resources for her, and make it her choice as to whether she uses them. A useful tactic might be to have them sitting on a table in the waiting room of your office. Whatever you do, do not shame the client.

The factors that come to play with confidentiality are various; however, the first to come to mind is that you cannot control the confidentiality group members hold. So, for example, if this girl brings the topic up in session, even though all of the members agreed to confidentiality agreements, that does not mean that the members will keep everything confidential. It is not the duty of the counselor to follow people to their cars and track phones to ensure confidentiality (and if it were, there would be no basis of trust). The counselor needs to be upfront with the client, and tell her that there is no guaranteeing that people will not share or discuss it with each other or others, but let her know that you take confidentiality very seriously and if it occurs you will handle it.