Thanks to my supervision group for exploring this issue so openly and frankly in discussing their responses and thoughts on gifts as part of our supervision session. This has led me to summarise some of these thoughts and add a few of my own that I thought might be useful for other students and supervisors to think about.
Gifts in psychological treatment are complicated. They inevitably arouse conflicts and emotions within the therapist including:
Pleasure, feeding of self-esteem, specialness, feelings of approval
Conflict and anxiety to accept or not to accept
Guilt about accepting gift: I want to but I am not allowed but maybe just this once
Guilt about rejecting the gift: I will hurt the client, they will disapprove, become angry, punish me, I may not be able to cope with their rejection
Anger how dare they intrude on my boundaries, how dare they put me in this conflict.
Why do clients give gifts?
Clients may have a genuine appreciation of the therapist. At times of significant change clients may what to genuinely acknowledge the contribution the therapist has made to their lives.
Clients may want to test the boundaries of the relationship with the therapist.Clients may attempt to bind the therapist to them. I have given you a gift now you owe me. Clients may want to see how far they can personalise the relationship with the therapist. Gifts may be given at times in attempt to make the therapist “be nice” to avoid confronting certain issues or themes i.e. to buy the therapist off. They can be a defence or an attempt to ward off perceived therapist anger or criticism A need to feel special may underly some gift giving.A gift may be an attempt to become more special in the eyes of the therapist. Gifts made by the client may reflect “look at what a clever boy/girl I am”. Gifts may be an attempt to personalise the relationship with the therapist and balance the power in the relationship.
Gift giving may have a masochistic or serve the purpose of confirming an underlying negative schema. Clients may give gifts knowing they will be rejected.
Gifts can be an expression of unexpressed feelings about therapy.A client of mine gave me a book of crossword puzzles to do over my holidays. Cross words = angry words. How dare I go and leave him for 4 weeks.
Some ideas on handling gifts
Gifts must be acknowledged.
You have brought me a gift/present
Gifts in general should not be accepted although see the debate below
I know it is important to you that I accept your gift. We have a policy at the clinic of not accepting gifts
The positive intent behind the gift should be acknowledged first.
You feel coming to see me as really important in your life and you felt a need to acknowledge this with a gift.
The trick is to acknowledge and accept the meanings behind the gift but not the gift itself.
I wonder if the your gift doesn’t also have some other meanings?
Some general musings on gifts
If you do decide that accepting a gift is ok what types of gifts will you accept and not accept
- Are gifts under 10.00 OK under 20 under 50 under 100?
- What kinds of gifts are OK? Are flowers, wine and food acceptable?
- Is a carving acceptable? What if the carving is erotic or violent?
- Is it OK to accept gifts at the start of treatment, part way through or at the end?
- Are cards OK even at the end of therapy. Even these can be problematic. One client gave me a card of a half dressed woman standing over a man in stylised modern art. Did I think that termination was successful; no I did not.
My own thoughts: Gifts even at the end of therapy usually indicate some lack of resolution on the part of client with termination. A message to the therapist to "never forget them" to make them still special in the therapist’s eyes. On another level they may reflect also genuine appreciation for what has happened in the therapeutic process. Their complexity is that they are multidetermined. Gifts part way through therapy are always likely to be problematic either accepting or refusing will raise issues that need to discussed and processed.
Clearly the nature of many gifts is symbolic: Carved totems, pictures clearly representing the therapy journey or intrapsychic conflicts or resolutions. Food and drink. (nurturance) Growing plants (growth) and surprisingly often blankets with personal embroidery are not uncommon gits.
Interestingly some state level code of ethics in the USA ban the acceptance of gifts. However both the American Psychological Association (APA) and the Australian Psychological Society (APS) appear to have no comment on how to manage this issue.