Therapists, Counselors, and Social Workers
Giving And Receiving Gifts During The Holidays
By Zur Institute
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Our online course, Gifts In Psychotherapy: Ethical & Clinical Considerations
We hope the holiday season is treating you well! As Chanukah has just passed, and Christmas is soon approaching, the subject of gifts in psychotherapy is quite current. Many people - clients and therapists alike - are thinking of giving, thanking and sharing in this season. Similar to touch, dual relationships and bartering, gift-giving and receiving in the therapeutic relationship can be done appropriately 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.
This season, I have 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.
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 just began seminary study and a rock from Jerusalem to a client for whom the holidays bring up difficult memories.
Giving gifts around the holidays is very common. This is addressed in our online course:
Gifts in Psychotherapy: Ethical and Clinical Considerations (2 CE Credits)
You can also watch our new video: Gifts in Psychotherapy
Here are some points to remember
- Giving a gift is an ancient and universal way to express gratitude, appreciation, altruism, and love.
- Appropriate gifts in therapy are ethical and enhance authentic therapeutic relationships, which is the best predictor of therapeutic outcome.
- Rejecting clients' clinically appropriate gifts is likely to 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.
- There are several types of gifts in psychotherapy:
- Gifts from clients to therapists
- Gifts from therapists to clients
- Gifts from clients' families
- Gifts in therapy can be symbolic (e.g., a poem or card) or concrete (e.g., a CD or book).
- The meaning of gifts can be only understood within the context of therapy.
- 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.
- Most often, clinically and ethically appropriate gifts from clients, given around the holidays, other special occasions, or at termination, are inexpensive.
- Symbolic and appropriate gifts from children to therapists or therapists to children are very common and most often are clinically appropriate.
- Therapists do not need to always explore the meaning of the gifts with clients. Sometimes just a simple "thank you so much" is sufficient.
- Sometimes very inexpensive gifts can be inappropriate, such as those with sexually or racially offensive connotations.
- Gifts in therapy can be:
- An expression of appreciation and gratitude
- A way to enhance or cement a bond
- Level the playing field between therapists and clients
- A way to "buy" love
- A way to counteract negative feeling (e.g., given to therapist after a disagreement)
- Used to create indebtedness or manipulation
- 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 bi-polar patient)
- 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)
- Clinically appropriate gift-giving is ethical and clearly falls within the standard of care.
- Understanding the meaning of gifts in therapy requires a look at the context of therapy and 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.
- Cultural aspects of gift-giving must always be taken into consideration.
- While therapists should pay attention to the meaning of clients' gifts, they must handle interpretation with clinical sensitivity. They must weigh the benefit of interpretation (rather than a simple "thank you") against the clients' potential feelings of rejection, shame or insult.
- 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.
- Wealthy clients are most often aware of the significant impact of their wealth on other people and, therefore, therapists should be careful when dealing with expensive or inexpensive gifts from wealthy clients.
- Excessive gifts, gifts by a client who has a history of buying love through gifts, gifts by a borderline patient who regularly oscillates between love and hate, should not be accepted uncritically.
- Examples of unethical and clinically inappropriate gifts include:
- Gifts a therapist gives in response to a referral of a new client
- Stock market investment tips
- Financial loans are most often unethical as they are likely to result in conflicts of interest
- None of the ethics codes declares all gift exchange as unethical.
- 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. should 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.