Chanukah has just passed and Christmas is approaching, bringing to both therapists and clients the joys and opportunities of the holiday season–as well as the beauty and dilemma of gift giving. The old Scroogian notion of the impenetrable blank screen therapist has become a two-way permeable membrane, making the therapy relationship richer and more complex. The holiday season is a perfect time for therapists and clients to express the specialness of the therapy relationship. At its heart, therapy is a human interaction, and gifts are both a tangible and symbolic way to express gratitude, care, love, and other complex feelings. Similar to touch, dual relationships and bartering, gift giving and receiving in the therapeutic relationship can be done appropriately and ethically and provide a sense of bond and warmth for both parties.
In my own practice, I receive and give gifts throughout the year–on special occasions, to commemorate a successful therapeutic relationship, a graduation and many more moments worth marking. The holidays are an especially ripe time for this. A couple of years ago, I received a toy car from a teenage client who was allowed to get his license due to the impressive work he did in therapy. A Jewish client gave me a loaf of challah (traditional bread); a Christian client gave me a tree ornament she made herself. An Hispanic client gave me homemade tamales as a holiday gift, a winemaker gave me a bottle of his pride vintage wine, and parents of a teenage client sent me a CD of the music the family recorded for the holidays.
In the same season, I gave a special card to a Christian client for whom Christmas is a time of bonding, a book on religion to a client who had just begun seminary study and a rock from Jerusalem to a client for whom the holidays bring up difficult memories. I gave a Jewish client a Chanukah card, and the Power of Now CD for a client who is struggling with holiday anxiety.
Our online course:
Gifts in Psychotherapy: Ethical and Clinical Considerations (1 CE Credit Hour)
Especially appropriate at this time of year, this course examines the many complexities of–and offers guidelines for–gift giving within the therapeutic relationship.
Some things to keep in mind about gifts, whether the therapist is giving or receiving:
- Giving a gift is an ancient and universal way to express gratitude, appreciation, altruism, and love.
- None of the ethics codes declare all gift exchange as unethical. Some do not even mention the word “gift”.
- Appropriate gifts in therapy are ethical and enhance authentic therapeutic relationships, which is the best predictor of therapeutic outcome.
- Rejecting clients’ gifts may be perceived as personal rejection, or even as insult, and may harm the therapeutic alliance or end therapy.
- A standard “no gifts policy” does not resolve the negative impact on a client, who is likely to experience it as rejection or insult.
- Gifts in therapy can be a way to:
- express appreciation and gratitude
- enhance or cement a bond
- level the playing field between therapist and client
- “buy” love
- counteract negative feeling (e.g., given to therapist after a disagreement)
- create indebtedness or manipulation
- Understanding the meaning of gifts in therapy requires a look at the context of therapy with special attention to the client’s culture, timing of the gifts, client’s history, patterns in regard to gifts, and the nature of the therapeutic relationship.
Some tips for gift giving and receiving:
- Clinically and ethically appropriate gifts from clients should be generally inexpensive.
- Appropriate therapists’ gifts to clients may include:
- A symbolic gift (e.g., a card that has meaning to the client)
- A gift that serves as a transitional object (e.g., a rock from the office rock collection)
- A clinical aid (e.g., a note from the therapist with a specific saying, as a way to help a client who is dealing with anxiety)
- Therapy-related educational materials (e.g., a CD on mood swings for a patient who was diagnosed with bi-polar disorder)
- Following social convention by giving an affirming or acknowledging gift (e.g., a small or symbolic graduation or wedding gift)
- A supportive, reassuring gift (e.g., giving a flashlight to a child-patient who is going on his first overnight camping trip)
- An affirmation of the relationship (e.g., a small/symbolic souvenir from a trip abroad)
- Gifts can be appropriate or inappropriate in regard to their type, monetary value, timing, content, intent of the giver, perception of the receiver, and their effect on the giver or the receiver.
- Sometimes very inexpensive gifts can be inappropriate, such as those with racially offensive or sexual connotations.
- Therapists do not need to always explore the meaning of the gifts with clients. Sometimes just a simple “thank you so much” is sufficient.
- Timing of gifts is important. While an appropriate present at termination is common, a present at the very beginning of therapy may need more careful examination. A gift following a confrontation or a difficult session may also invite exploration or discussion of its meaning.
- Examples of unethical and clinically inappropriate gifts include:
- Gifts for referrals of new clients
- Investment or stock market tips or financial loans
- Excessive gifts, gifts from a client who has a history of buying love
- Extremely expensive gifts from wealthy clients
- Therapists should consult with experts when they receive gifts in a client’s will upon the death of the client.
- Document all gift exchanges in the clinical records. If possible, greeting cards, paintings, poems, etc. could be part of the clinical records. Articulate, briefly, who gave the gift, exactly what the gift was, what the response to the gift was, and any related discussions with the client. When appropriate, add a clinical note in regard to your thoughts and interpretation of the meaning of the gift.
- Consult in complex cases and document the consultation in the clinical notes.