By Ofer Zur, Ph.D.
Standard III, Professional Competence and Integrity, states:
3.9 Gifts.Marriage and family therapists attend to cultural norms when considering whether to accept gifts from or give gifts to clients. Marriage and family therapists consider the potential effects that receiving or giving gifts may have on clients and on the integrity and efficacy of the therapeutic relationship.
Dr. Zur’s note: The 2015 AAMFT Code of Ethics wisely deleted the reference to the “substantial value” of the gift. We must be aware that whether the gifts are of substantial value or not is not always the most important aspect of the gift, from a clinical or ethical point of view. Obviously, very expensive gifts are often counter-clinical and may be unethical. However, even very cheap gifts, such as a suggestive image or a condom, are inappropriate.
Section A.10.f., states:
Counselors understand the challengesof accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.
Dr. Zur’s note: The 2014 revision of the ACA Code of Ethics represents thoughtful and appropriate guidelines in regard to accepting gifts from clients. It acknowledges the importance of culture and other context related factors.
Section 2. Fee Arrangements, Bartering, and Gifts:
Mental health counselors are cognizant of cultural norms in relation to fee arrangements, bartering, and gifts. Mental health counselors clearly explain to clients, early in the counseling relationship, all financial arrangements related to counseling.
d) When accepting gifts, mental health counselors take into consideration the therapeutic relationship, motivation of giving, the counselor’s motivation for receiving or declining, cultural norms, and the value of the gift.
Dr. Zur’s note: Unlike the 2000 code, the 2015 AMHCA codes include the above, rather reasonable, mention of “gifts” in therapy.
Principle I: I-11 Multiple/Dual Relationships states:
Addiction Professionals shall make every effort to avoid multiple relationships with a client. When a dual relationship is unavoidable, the professional shall take extra care so that professional judgment is not impaired and there is no risk of client exploitation. Such relationships include, but are not limited to, members of the Provider’s immediate or extended family, business associates of the professional, or individuals who have a close personal relationship with the professional or the professional’s family. When extending these boundaries, Providers take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that their judgment is not impaired and no harm occurs. Consultation and supervision shall be documented.
Dr. Zur’s note: It is important to remember that gifts by themselves, in most situations, do not constitute dual relationships. It is not clear why the reference to gifts is placed under the section of Dual Relationships. As was noted above, we must also be aware that whether the gifts are of substantial value or not is not always the most important aspect of the gift from a clinical or ethical point of view. Arbitrarily, limiting the value of gifts to $25 does not make sense, as books, cakes, or other common appropriate gifts may easily exceed $25 in value.
NCCs shall not accept gifts from clients except in cases when it is culturally appropriate or therapeutically relevant because of the potential confusion that may arise. NCCs shall consider the value of the gift and the effect on the therapeutic relationship when contemplating acceptance. This consideration shall be documented in the client’s record.
The following professional associations’ Codes Of Ethics DO NOT mention “gifts” in their texts:
American Board of Examiners in Clinical Social Work (ABE) – (2006)
American Psychological Association (APA) – (2016)
Association of State And Provincial Psychology Boards (ASPPB) – (2018)
California Association of Marriage and Family Therapists (CAMFT) – (2011)
Canadian Counselling and Psychotherapy Association (CCPA) – (2007)
Canadian Psychological Association (CPA) – (2000)
National Association of Social Workers (NASW) – (2017)
Northamerican Association of Masters in Psychology (NAMP) – (2000)