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The selection of perplexity as a response to the client's announcement about her pregnancy while on lithium can be understood in the context of the emotional and clinical complexities involved. Expressing perplexity indicates an empathetic acknowledgment of the client's situation and the challenges she faces. This emotional reaction allows the social worker to convey that the situation is indeed complex and that they recognize the client's concerns and feelings.

By showing perplexity, the social worker creates a space for further exploration of the client’s thoughts and feelings about her pregnancy and her use of lithium. This response encourages open dialogue where the client can express any fears, hopes, or uncertainties she may have, making it a valuable part of the therapeutic process. It also shows that the social worker is engaged with the client and aware of the multifaceted nature of her circumstances, which is essential when dealing with mental health and medication during pregnancy.

In this situation, discussing the risks and benefits directly, referring the client to a specialist, or simply documenting the statement may lack the necessary emotional engagement that can help the client feel heard and supported. While those actions have their importance in the overall case management, they may not convey the emotional nuance and support needed in such a delicate matter. Acknowledging perplexity promotes a dialogical approach