Exchanging Gifts With Your Therapist

It’s that time of the year again — the time where gift-giving is a part of many people’s holiday rituals. While we don’t think twice about buying little gifts for close friends and family, sometimes it gives us pause to consider giving a gift to our therapist. Here’s a relationship with a professional that we see once a week, and yet it is a professional relationship (even if it doesn’t always feel that way).

What should you do? Should you exchange a little gift with your therapist?

Of course, before you do anything, you and your therapist should talk about exchanging gifts (especially if you don’t know your therapist’s policy). Some therapists are okay with it — as long as the gifts are small — while others have a strict, “No gifts” policy. In either case, it’s good to know — and respect — your therapist’s policy when it comes to gifting. So if you feel in the mood and don’t know what your psychotherapist’s policy is when it comes to exchanging gifts, please ask them during your next session.

Dr. Ofer Zur of the Zur Institute has put together a little CE course for mental health professionals on just this topic, Gifts in Psychotherapy: Ethical and Clinical Considerations (which if you’re a professional and need a few spare CE credits, I encourage you to check out).

As he notes about exchanging gifts with one another, “Giving a gift is an ancient and universal way to express gratitude, appreciation, altruism, and love.” Indeed, the tradition of exchanging gifts can be traced all the way back to ancient Rome, and likely even earlier, when it was traditional to exchange small tokens during important spiritual ceremonies.

Here are some of the tips you should remember about therapy gifting, according to Dr. Zur:

• 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 psychotherapy client, who is likely to experience it as rejection or insult.
• Most often, clinically and ethically appropriate gifts from clients, given around the holidays, other special occasions, or at termination, are inexpensive.
• However, sometimes very inexpensive gifts can be inappropriate, such as those with sexually or racially offensive connotations.
• Symbolic and appropriate gifts from children to therapists or therapists to children are very common and most often are clinically appropriate.

Dr. Zur also notes the meaning of a gift given by a client to their therapist can vary widely and is best understood within the context of therapy. While he notes it can be a simple expression of appreciation and gratitude, or a way to enhance or cement the relationship between therapist and client, it can also be used as a way to level the playing field between the two or even an attempt for the client to “buy” the therapist’s love. He cautioned that therapists do not need to always explore the meaning of the gifts with clients: “Sometimes just a simple ‘thank you so much’ is sufficient,” says Dr. Zur.

Appropriate therapists’ gifts to clients in psychotherapy, according to Dr. Zur, 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)

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

“Clinically appropriate gift-giving is ethical and clearly falls within the standard of care,” says Dr. Zur. “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.”

Dr. Zur also notes that while therapists should pay attention to the meaning of clients’ gifts, they must handle interpretation with clinical sensitivity, weighing the benefit of interpretation (rather than a simple “thank you”) against the clients’ potential feelings of rejection, shame or insult.

People who are in psychotherapy should be aware that gift exchanges with their therapist are often documented within their clinical therapy record. Dr. Zur notes, “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.”

It’s often okay to exchange a present or gift with your therapist during the holiday season. But first talk with your therapist to understand whether they accept such gifts, and what limitations they place on such exchanges.

Inexpensive CE credits are available for this course at the Zur Institute website: Gifts in Psychotherapy: Ethical and Clinical Considerations.

Do you exchange gifts in therapy?
What are your experiences with gift exchanging in psychotherapy?