Jan 31 2009

Ethics and gift-giving to the therapist

Published by at 10:51 am under Counseling & Psychotherapy

Therapists usually have many diverse opinions about whether it is ethical to accept gifts from clients. We are all pretty much agreed that it is wrong to accept a new car, but what about a box of cookies during the holidays?

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What is missing most in these discussions is the fact that the idea of giving gifts to the therapist is counter-therapeutic.

There is a large disparity in the power dimension of the therapist-client relationship and gift giving is only one way for the client to try to create a better power balance.

So, the early message clients need to receive about gifts is the same as whether the therapist and client will get together after the session and have a beer.

Friends and relatives give gifts. A therapist is not the “friend” of the client and as such there is NO NEED for the client to worry about giving the therapist a gift. On the contrary, the therapist in the beginning of therapy should explain the significance of the therapist-client relationship, including the intense feelings that can result from the therapy. Clients must never be led to believe that the therapist is the reason why the client makes progress or becomes stuck in the same place.

To help the client see that their progress comes from some place deep inside themselves is not only appropriate, it is true. The therapist is professionally trained to facilitate this change, but it most certainly comes from within the client.

Likewise, when clients are stuck, and keep making the same mistake over and over, it is essential for the therapist to help the client understand their beliefs about themselves, their relationships and the world that may keep them stuck.

I heard a story recently of a client who needed to make many changes for the health of her marriage. After a few sessions, one of which the therapist merely helped the client slow their thoughts, use silence, relax and follow their breathing into their heart. The client began sobbing and cried for most of the session.

The client kept joking, asking the therapist, “hey, what did you do to me?!” The therapist did some softpedaling of the reality that they had done very little. The therapist told the client, “I guess your psyche decided that you were ready to relieve yourself of the burdens you have been carrying.”

When the client came in a few weeks later, proud of the progress they had made, the therapist said, “hey, awesome, congratulations! When you write your book, make sure you give me all the credit!”

The client laughed and talked about how much easier it was than she thought. She talked about how relieved she was that she could do it and that she could feel the progress she was making from a deep place within.

How is this related to whether or not we accept gifts from clients? As therapists, we are conduits for something very sacred.

Doing anything that somehow conveys the client “needs” to give us anything, degrades the process.

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