Giving and Receiving Gifts as a Therapist

As we enter the holiday season, therapists come face-to-face with the dilemma of gift-giving. Clients may wish to buy gifts for a therapist for a variety of understandable reasons – Gratitude, as part of a holiday ritual, to celebrate the joy of reaching a milestone, or feelings of kinship.

A therapist holds a privileged position. One that involves trust, compassion, and a sense of closeness. Aspects that, in a relationship outside of practice, encourage the swapping of gifts. But the dynamics and purpose within a therapist-client relationship aren’t like those outside of it. This can make for murky waters.

So, there are important considerations and boundaries to contemplate before giving and accepting gifts. It is best to set your guidelines in advance so that you can craft appropriate responses and not falter awkwardly when one-on-one with a client.

So, how do you set gift-related guidelines? First, it’s important to understand if and when gifts may or may not be appropriate.

Are gifts for and from therapists appropriate?

Generally, from an ethics standpoint, it’s a safe bet to create an overarching policy that you can’t accept gifts as a therapist, as it runs the risk of adding stress to the therapeutic relationship and hurting the therapeutic progress. For example, if a therapist is given a gift of value, they may feel pressured to give preferential treatment or refrain from challenging the gift-giver. Exchanging gifts may also suggest or invite a change in the nature of the therapeutic relationship from a professional relationship to a relationship that is too casual or too friendly.

However, in other circumstances, gifts can be appropriate (i.e. a child giving their therapist a drawing they drew at school or a therapist gifting a patient a print of an inspirational quote ass a source of motivation). Ultimately, the choice comes down to you.

When establishing your guidelines — and when faced with gifting — it helps to ask yourself some questions. Questions like these:

• What are the potential clinical consequences of giving, refusing, or receiving gifts?
• What are the potential cultural clinical consequences of giving, refusing, or receiving gifts?
• What are the potential ethical and legal consequences of giving, refusing, or receiving gifts?
• Is the gift appropriate?
• How much is the gift worth?
• What is the client’s motivation for giving, refusing, or receiving a gift?
• What is your motivation for giving, refusing, or receiving a gift?
• How might the acceptance, refusal, or delivery of a gift be perceived?
• Most importantly, how might gift receiving, refusing, or giving affect the therapeutic relationship?

There are, of course, other considerations. However, the answers to these questions will form a broad baseline in deciding how to proceed in general, and with specific clients.

Let’s look at potential challenges in more detail.

Potential challenges associated with receiving gifts as a therapist

Some believe that gifts for a therapist are a no-no. Many therapists are taught they should not accept gifts from a client in any circumstance. Abiding by this rule limits conflict of interest or perceived wrongdoing. Some suggest that the financial transactions between a therapist and a client should be limited to session fees.

On one level this makes sense. For some clients, a gift can be a cry for acceptance, used to gain favor, be a way to feel valued, or even be an act of manipulation. In this case, you may decline the gift.

But for others, a gift may be given out of holiday tradition, as a cultural custom, or as a genuine token of appreciation. When a gift does not have the potential to damage the therapist-client relationship, you may decide it’s appropriate to accept.

It is up to you to determine whether gift-receiving is an opportunity to strengthen a productive therapeutic relationship or may bring harm, in which case refusal is likely best.

Potential challenges associated with giving gifts as a therapist

Giving a gift to a client may interfere with the therapeutic relationship or it may strengthen rapport in a helpful way. So, if you are to offer gifts you must deeply consider the many layers of your gift’s meaning. Including whether the possibility exists for client misinterpretation.

The deciding factor, once again, should be whether the action will support the client to achieve better outcomes safely. Ask yourself …

• What is the reason for gift-giving?
• Do you present this gift to dozens of people at a certain time of year?
• Is it a once-off offering?
• And most importantly, does this action have the potential to weaken or fracture the therapeutic relationship?

One expert opinion reported in an article published in the journal, Professional Psychology: Research and Practice, said:

In my opinion, no blanket rule can realistically be made. The therapist, who has spent time establishing a relationship with the patient, must decide on an individual basis about giving a gift to that singular and unique patient.

If you decide that a gift is appropriate and will support a client upon its receipt, you might consider:

• A thoughtful, professional card
• A therapy-related book or journal
• A token to serve as a reminder or support
• An audio recording that might resonate with, and support, a client. For example, a guided meditation
• Other suitable gifts for clients at end of therapy

Setting your rules for gift receipt, refusal, and giving

You may have been advised to implement a blanket “no gifts” rule. But this may not be the best approach.

As the California Association of Marriage and Family Therapists (CAMFT) said:

Whether or not a therapist chooses to accept a client’s gift, reject a client’s gift, or offer a gift of their own, the therapist’s intent should be to ensure their response — and the manner in which it is communicated and handled — strengthens the therapeutic alliance, reinforces the effectiveness of therapy and enhances clinical outcomes.

Therein lies the secret to ethical gifting: strengthening the therapeutic relationship in a way that best serves the client.

The refusal of a gift may come across as unnecessarily cold for many of your clients. It may halt progress or even fracture the therapeutic relationship, leading to client harm.

On the flip side, accepting a gift may be problematic. For example, not all gifts are given with good intentions. Some may aim to persuade or manipulate.

Consider the pros and cons when setting some (flexible) ground rules. These will provide a general path for you to follow on a case-by-case basis. One that determines whether or not it’s appropriate to receive or refuse a gift from a client, or give a gift of your own. This way you’ll never be caught off guard.

Final gifting thoughts

Research shows that giving gifts to a therapist is a commonplace practice. If you haven’t yet received a present, you will. With this in mind, let’s touch on three final pieces of advice.

1. Have sensitively pre-prepared responses crafted for a yes and a no, and a plan for if and when you may give your clients gifts.
2. If you are unsure about the ethics of receiving, refusing, or giving a gift — or the gifting rules you wish to establish — ask for help. Reach out to experienced colleagues, mentors, and your professional body. They’ll be able to provide insight and guidance.

Tip: If you’re caught in a gift-offering moment and feel unsure how to proceed, pause. Thank your client. Then gently share that you need to confirm if you’re able to accept their thoughtful gift with your professional body.

3. Keep notes. Discuss the reasons you accepted, refused, or offered a gift. State what the gift was, and any information relevant to your motivation, the exchange, and the session.

Jocelyn Van Saun

Jocelyn is a Marketing Manager at Brighter Vision. When she's not creating and sharing content for our network of therapists, she loves spending time outdoors - rock climbing, trail running, hiking, camping, mountain biking, and skiing!

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