Is It Ever Okay to Give or Accept a Gift in Therapy?

Exchanging gifts is a fairly common practice between people who come to care for each other. Much like any other human relationship, care is also exercised in a therapeutic relationship. 

To express your appreciation for others, to show that you hold them in high regard, people often give each other things. Someone remembering what you like, or making a concentrated effort to think what you will like and gifting it to you is such an expression of care and thoughtfulness.

However, this expression when made between a client and therapist can jeopardise the therapeutic relationship. In fact some may argue that it is, often mandated, rule of thumb in place restricting the exchange of gifts that maintains the integrity of a therapeutic relationship. 

The answer to whether you should exchange gifts in a therapeutic relationship however is not as straightforward. We cannot give a simple yes or no answer to this question because the answer to this depends on the context, on people, on the situation at hand. 

The relationship between the client and their therapist, the gift, the purpose, the occasion, the reason behind the gift, all of these elements come together to ascertain an answer to this question. 

In this article we will explore when is it okay to accept or give gifts to your client, when should you refrain from it and what does the law in place say about it. 

Why Should You Refrain from Accepting Gifts from Your Client?

Refraining accepting gifts from clients in a therapeutic setting is mandated due to ethical consideration and the need to maintain integrity of the therapeutic relationship. 

Following are several reasons why therapists may choose to decline gifts:

1. Maintaining Therapeutic Neutrality:

Accepting gifts can potentially compromise the therapist’s ability to remain neutral and unbiased. Therapists aim to create a space where their clients feel safe expressing themselves without concerns about favouritism or influence.

However when some clients start giving gifts, and other clients come to learn of it, they may come to believe that they are required to do the same. They also may believe that to receive fair treatment they are required to give gifts to their therapist. 

This severely jeopardises the opportunity to create a safe, judgement free zone, with gifts expectations becoming attached, bias is engendered. A therapist may try to maintain neutrality and remain bias free, however at the end of the day they are human and may end up giving preferential treatment, or reacting negatively to their client who has gifted them something. 

2. Avoiding Influence on Objectivity:

When neutrality is compromised, gifts, even well-intentioned ones, may unconsciously influence the therapist's perceptions and objectivity over time. This can potentially impact the therapist's ability to provide objective and unbiased guidance to their client. The integrity of the therapeutic relationship is compromised, rendering it susceptible to the limitations inherent in other human connections.

3. Preventing Boundary Blurring:

Accepting gifts can consequently blur professional boundaries, making it challenging to distinguish between the therapeutic relationship and personal connections. Maintaining clear boundaries is crucial for the effectiveness of the therapeutic process. 

4. Minimising Potential Exploitation:

Accepting gifts, especially those of significant value, can create a risk of exploitation. Therapists may feel indebted to the client or vice versa, potentially compromising the power dynamics within the therapeutic relationship.

5. Ensuring Consistency and Fairness:

Establishing a policy of not accepting gifts helps maintain consistency in therapeutic practices. If therapists were to accept gifts from some clients and not others, it could be perceived as unfair or biased, potentially impacting the therapeutic alliance.

6. Sending the Right Message:

Accepting tips or gifts may inadvertently send the wrong message about the therapist's financial motives. It's essential for clients to perceive the therapeutic relationship as driven by their well-being rather than financial gain.

Well-being of the client should be the main focus of a therapeutic relationship, their well-being risks being de-centered with giving and receiving of gifts. Some clients, with a tendency of pleasing people, may engage in similar harmful behaviour in therapy. 

A space which is meant to engender positive behaviour and mental state may end up enforcing negative behavioural patterns and thought process. 

7. Protection Against Manipulation:

Gifts with strings attached can manipulate the therapeutic process. Clients may unconsciously or consciously expect preferential treatment in return for their generosity, creating an imbalance in the therapeutic dynamic.

When Is It Okay to Accept Gifts From Clients?

As highlighted by Jenny Newsome in her insightful post titled "The Necklace: When Does a Rule Become a Straightjacket," declining a gift from a client can be construed as dehumanising them. In fact, the repercussions may extend beyond initial impressions. 

Refusing a gift could inadvertently undermine the progress achieved in the therapeutic journey or introduce new challenges. Within the sacred realm of the therapist-client relationship, the act of declining a gift may be perceived as a form of rejection, fostering distrust and creating rifts in the therapeutic bond. This rejection may trigger negative sentiments in the client, ultimately jeopardising the therapeutic process.

Of course just because refusing gifts can potentially jeopardise client-therapist relationships and even disrupt the progress made, does not mean that therapists should start accepting all kinds of gifts. Unreasonable and expensive gifts will always need to be declined to maintain the integrity of the therapeutic process. However, there are some gifts, which are likely to facilitate the therapeutic journey rather than take away from it. 

Dr. Sheldon (2020) has suggested the following gifts that could facilitate the therapeutic process and strengthen the client-therapist relationship. 

1. Symbolic or Token Gifts

Small, symbolic gifts that hold personal meaning for the client and reflect their journey or progress in therapy are often considered acceptable. A gift like this will not just convey the client's appreciation and acknowledgement of their progress but also that of their therapist who has facilitated it. Exchanging such a gift can be good for the therapist and their client.

2. Handmade or Personalised Items

Handcrafted or personalised items that demonstrate thoughtfulness and a personal connection may be appropriate. They often carry and convey emotional significance.

3. Culturally Significant Gifts

Gifts that align with and reflect the client’s cultural practices or rituals, given the therapist is aware of and respectful towards these traditions, may be acceptable. 

4. Books, Art, or Resources

Gifts such as books, artwork, or resources that are relevant to the therapeutic process and contribute to personal growth may be considered appropriate and are acceptable.

5. Letters or Notes

Thoughtful letters or notes expressing gratitude or reflections on the therapeutic journey are generally acceptable and can enhance and strengthen the therapeutic relationship.

6. Occasional Celebratory Gifts

Gifts presented on special occasions, such as the completion of therapy or significant milestones, can be acceptable and may be viewed as celebratory expressions.

7. Clinical or Therapeutic Materials

Gifts that have clinical or therapeutic value, such as relevant therapeutic materials or tools, may be acceptable if they align with the therapeutic process.

Rejecting them, particularly if they become a blockade to improvement of the client would not be the smartest decision. 

However, before deciding to accept or reject a gift it is also important to see what the ethical codes in place have to say about exchange of gifts in therapy. 

It is best to make your policies after a careful assessment of jurisdiction to place to ensure that the two align. 

Following are some of the professional codes of ethics on this topic:

The American Mental Health Counsellors Association (AMHCA)

The organisation’s code of ethics advises counsellors to make sure that they are aware of as well as understand the cultural norms of each patient in relation to their fee arrangements, bartering and gifts. 

It is recommended that therapists clearly explain all financial arrangements related to counselling, including gift giving, early on in the therapeutic relationship. 

The American Counseling Association (ACA)

ACA’s code of ethics notes that small gifts from a patient are an expression of respect and gratitude. These guidelines go on to say that when determining whether to accept a gift from a client, counsellors should take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counsellor’s motivation for wanting to accept or decline the gift. 

The American Association for Marriage and Family (AAMF)

Section 3.9 of the AAMF’s ethics code states that Therapy Marriage and family therapists attend to cultural norms when considering whether to accept gifts from or give gifts to clients. Marriage and family therapists consider the potential effects that receiving or giving gifts may have on clients and on the integrity and efficacy of the therapeutic relationship.

National Association for Addiction Professionals (NAADAC)

NAADAC’s stance when it comes to accepting gifts in therapy is that mental health providers should make every effort to avoid creating multiple relationships with a client, which becomes likely with exchange of gifts. 

However, when it becomes unavoidable to create a dual relationship the professional shall take extra care so that professional judgement is not impaired and there is no risk of client exploitation.” 

When a therapist does accept a gift they should make sure to document the transaction in the patient’s records along with any resulting outcomes, the association suggests. 

The National Board of Certified Counsellors (NBCC)

NBCC remains the singular major mental health organisation that appears to have explicit guidelines on receiving patient gifts. It warns against the practice of exchanging gifts. However, the board does go on to say that small tokens of appreciation are acceptable if the exchange fits within a patient’s cultural norms or has therapeutic relevance. 

The board asserts that the value of the gift and its effect on the therapeutic relationship when contemplating acceptance should be considered. Their guidelines advise that consideration shall be documented in the client’s records. 

American Psychological Association (APA)

APA does not offer specific advice on whether or not gift giving by clients is acceptable, it asks the therapist to consider whether accepting a gift could potentially harm the patient or their therapeutic progress.

Thus, APA is suggesting to make your decision based on the present case and context.  

Conclusion

In therapeutic relationships, the exchange of gifts demands careful consideration within ethical bounds. Refusing gifts helps maintain professional neutrality and prevent boundary blurring, protecting against pitfalls like exploitation. However, the decision is nuanced, with symbolic and culturally respectful gifts potentially enhancing the therapeutic process.

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