How to Handle Gifts From Clients

As therapists we have the opportunity to help people make big changes in their lives, in both body and mind. Acting as a guide for someone at a difficult and vulnerable time can feel quite intense for both parties, and create a unique closeness that you generally don’t find in any other setting. When profound emotional and/or physical changes take place, it’s common to feel an overwhelming sense of gratitude for the person who has helped us, through whatever medium. Clients often want to express this in some way, to show how much the experience has meant to them, and this often leads to a gift.

While there is still some controversy around accepting gifts, there are
professional governing bodies that actually include in their ethical guidelines
that it’s not an acceptable practice.

The main and most important problem with accepting gifts from your clients is that gift-giving connotes intimacy. We give gifts to family, partners, friends and co-workers: people we’re on relatively even ground with. While we know a lot of really intimate details about our clients’ lives, it’s not reciprocal, and boundaries are an essential reminder of this. A gift (while not always, and certainly not always consciously) can be an attempt to circumvent some of those boundaries and feel closer to you, and that’s not safe for you or them.

Expensive gifts have the potential to confuse a therapeutic relationship in more ways than one. Gifts mean different things to different people, and this meaning can be influenced by a lot of things, including culture. What if the client expects something in return (gift or otherwise) for the gift received, or feels that an expensive gift should have some bearing on their next payment?

There are a lot of ways to acknowledge good work done together that don’t involve concert tickets or spa treatments. Gifts are usually just a result of clients wanting you to know that your service and expertise has had personal meaning for them. With a little creativity, we can accomplish this with boundaries intact.

Ways to cultivate non-material appreciation:

  • When we say things out loud, there’s less need to say them with a gift. If a client thanks you, be really engaged in the way you respond. Clearly acknowledge appreciation within the boundaries of what feels comfortable to you (some therapists do hugs, for instance, and others don’t- but that’s a topic for another post!). Statements like ‘I’m just doing my job’ or ‘it was nothing’ may be well meant, but can diminish the importance of what’s happened between you, or how big a deal it has been for your client.
     
  • Encourage small but meaningful offerings. If people really want to give you something, what about a homemade card or small piece of artwork that could bring colour to the office for everyone to enjoy?
     
  • It’s always easier to reinforce boundaries that have already been set. A small notice in your waiting room or a line in your counselling contract is a great way to let clients know your guidelines about accepting gifts. It’s much harder for folks to feel personally rejected by a policy that applies to everyone.
     
  • Plan your last session ahead of time - this way clients can think about what they might want to say to you before you finish, and will have the opportunity to do so. Setting some time aside for closure can provide space for acknowledging gratitude out loud.
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Comments

Heather - I am glad you addressed this topic. I think your most important point - putting your gift-accepting policy in writing, in the contract and with short visual reminders in your office/meeting space - is well taken. I am, however, glad you mentioned the differences that exist between cultures. I once worked with some Buddhist Vietnamese nuns - tutoring ESL. Every week they would insist that I take home a bag of hand-picked fresh fruit that they had gotten at their market - just for me. When I showed them the agency's policy (I was volunteering for a larger area agency) - the head nun; who did speak and understand English - took me aside and explained that it was "rude" for me not to accept this offering - BUT that it was mine, and I was free to share it with whomever I pleased; so maybe I would like to donate it to "less fortunate" if I didn't need it. I decided to circumvent the agency policy - with the head instructor being fully aware of what was going on - and enjoyed some of the fruit for my family, but passed most of it on. Therefore "serving" many. It only enhanced the provider (me) - client (them, through the agency) relationship. You are right, creative thinking is the way to go. Personally, I give my therapists - on occasion - holidays and the like, and if I know them well - small hand-made gifts like the linen room sprays I make, or coasters I crochet - things appropriate for their work or home environment - or FOOD! Can't go wrong there; food can be shared!

Gift giving in a professional relation applies to a lot of careers. It is an interesting discussion. As a university teacher, I often have students bringing me gifts (sometime I like to call them offering to appease the God). Here the intention varies: they want me to like them, they want to apologize, or, like your clients, they want to say thanks.
Although there is no guidelines in most universities about accepting gifts, it creates an obvious discomfort and creates ambiguities. I created some guidelines for myself; some could be modified for therapists.

Of course when I see people showing up with something, I stop them and ask them "lets do that after class."That doesn't apply to you guys, but in my case, this kind of display can create some ambiguities with other students or start an epidemic of gift giving.

The next rule could be translated to you. I accept only 3 types of gifts:
1- food; because I also bring health food for them to share and keep telling them that they need to eat well and stop passing me their diseases (I had a mono and 5 varieties of flu last year). They hate bran muffins, but none are left at the end of class.
2- stuff related to the class or the field of study. They sometimes pass on books they read that discuss similar subjects or give copy of artworks (I teach digital art, photography and screen printing, it is easy to give a copy. I would never accept an original, especially with a frame. When a student really want to give it to me, I flip it and buy it from them for a very low price. It keeps us in a friendly professional relationship.) They also sometimes buy me pens, so far it has never been a fancy one so I go for it.
3- gifts for my dogs. (they come to class once and a while). I am not sure I am right, but I trust that their gifting intentions are truly for the dog.

I usually refuse other gifts and pretend that there is a university rule. The one thing that happens often and makes me uncomfortable are flowers. It is hard to return and usually is only a couple of stolen flowers from gardens not a store bought bouquet. I usually joke and say "I only accept monetary bribes of a million or more for better grades" or "I am sorry honey I'm happily married with a crazy artist like me, we pair up you know like parrots". Both somehow inappropriate ways to say: gifting me will not change their class status and I am not a potential date (they have hormones and do try to flirt). Hopefully it doesn't hurt anyone's feeling to much.
I usually leave flowers in the department office they have an empty vase sitting there that gets flowers once in a while, so I must not be the only one.

leigh's picture

Actually, this point does apply to therapist run groups - thanks for mentioning it :)

"Of course when I see people showing up with something, I stop them and ask them "lets do that after class."That doesn't apply to you guys, but in my case, this kind of display can create some ambiguities with other students or start an epidemic of gift giving."

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