Psychotherapy Blog

 

Receiving Gifts in Psychotherapy

What does your ethical code say about accepting gifts from clients? Is it ethical to do so? If you’re a psychologist, social worker, or marriage and family therapist, you’re probably not sure. That’s because your official code doesn’t address it. Surprisingly, there’s not a word about gifts in any of the codes pertaining to those disciplines. And yet, virtually every mental health practitioner has, or will, face a situation where some client offers a gift of some sort at some time in the course of their treatment. So what do you do? Do you have a well thought out approach or policy to guide you when a client is standing in front of you with an offer of a gift?
 
The truth is that most practitioners don’t have a clear idea of what type of gift would be acceptable, if any. Those who work in an agency or hospital setting might simply adopt the policy their employer already has in place, but those in private practice need to develop their own guidelines or they might find themselves one day standing face to face with a smiling client who is offering a small, or large, token of their appreciation, and who is wondering why there is a such a long pause going on.
 
Would you accept a poinsettia plant at Christmas time that your client brought as a gift for your office waiting room? How about a plate of cookies at Easter for you and/or your staff? Or a packet of special seeds for your garden since you once talked about growing and nurturing in an earlier session? Or a picture a child client drew for you, or a lanyard she made for you in her crafts class? How about frequent flyer miles? Or cologne? Or an item of clothing for your birthday? Or underclothing?
 
Surely you drew a line somewhere along that list of choices. Maybe right at the beginning or maybe at some point along the way. But why? What went into your decision to say, “That one’s not acceptable”? Why did you reject it? What factors did you consider?
 
The one major code that addresses the issue is the American Counselor Association Code of Ethics. It advises counselors to consider the therapeutic relationship, the cultural context, the value of the item and the motive of both the client and the counselor involved in the transaction when dealing with the issue of the appropriateness of the gift (ACA Code Section A.10(e)). Those are all excellent considerations that should bear on your decision of whether to accept or reject the offer.
 
We might, however, add to those factors at least three more: age and gender of the client, and the timing of the offer. For example, if a six year old boy brings a bouquet of flowers he’s picked for his 40 year old female therapist the situation is markedly different from the same bouquet coming in the hands of a 45 year old male client. Motive and intent would not appear to be the same in those two instances.
 
Also, the timing of the offer can be critical. Is it at the end of a successful treatment regimen, or is it at the outset? Saying goodbye with a token of appreciation would seem more straightforward at the end than at the beginning treatment in terms of motive, intent and the therapeutic relationship.
 
So putting together the ACA list of factors of therapeutic relationship, cultural context, value and motive, and adding the age and gender of the client along with the consideration of timing, should give you enough to think about when deciding whether a gift is appropriate or not. But it would be wise to do your thinking before you hear your client say, “Here, I brought this for you”.
Filed under: Law & Ethics
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