Similar to other aspects of the Counseling profession, the topic of accepting gifts as a therapist can be a tricky topic to navigate. At this time, there is no clear standard for professionals to follow. However, there are suggestions available for us to consider. As an example, the American Psychological Association does not provide guidance for accepting gifts from clients (Knox, S., et al, 2009). While the American Counseling Association (2014) provides limited guidance, they do encourage counselors to consider the following factors when navigating whether or not to accept gifts from clients:
The current therapeutic relationship
The monetary value of the gift
The client’s motivation behind giving the gift
Your motivation behind wanting to accept gifts from clients
Additionally, the American Counseling Association’s 2014 Code of Ethics discusses the importance of “recognize (ing) that in some cultures, small gifts are a token of respect and gratitude”. This is a key component that should be included in your decision-making process. For some, accepting gifts is determined on a case-by-case basis, whereas some professionals can have a strict policy regarding accepting gifts. Being mindful of the expectations of your work environment may be a contributing factor as well. Continue reading to learn more about whether mental health professionals can accept gifts from their clients.
What is Considered a Gift?
Before we get into the different ways that Counselors can navigate gifts, it is important to first understand what is considered a gift. Maybe you have found yourself thinking of a situation or experience where you have already received a gift from a client. If you are thinking of something, take a moment to think about the recommendations offered by the ACA Code of Ethics. Do you stand by your decision to accept or deny your client’s gift?
Gifts can be handmade items or notes, or purchased goods that can have a range in monetary value. You may experience a client bringing you a cup of coffee, giving you a gift card, making a picture, or knitting a scarf. Common times for clients to offer gifts include holidays and special occasions for the counselor such as getting married or having a baby.
A 2009 study investigated 9 situations where clients had given gifts to their counselors (Knox, D., et al, 2009). The results from this study showed that most of the gifts given were of little monetary value, or handmade. Additionally, these gifts were chosen and/or made because the client felt as though the counselor would appreciate or enjoy the item.
For this study, there was no evidence of malicious or manipulative intent behind giving a gift.
Can Therapists Accept Gifts from Patients?
If you find yourself wondering “can therapists accept gifts” remember that there is no direct guidance for Counselors when it comes to accepting a gift from a client. In the meantime, Counselors need to take time to investigate all the relevant information when deciding whether to accept a gift or not.
Historically, there have been three common responses when a client gives a gift to their counselor (Knox, S., et al, 2009). One option is to have a strict boundary where the therapist does not accept any gifts. This can be the result of an employer policy or personal boundary. Choosing not to accept any gifts can be done with the intent to maintain professional boundaries.
A second option is to determine how to respond to small gifts on a case-by-case basis. When this occurs, Counselors often take time to learn more about what led to the client getting the gift, and what giving the gift means to them. Giving a gift can be a client’s sincere way of showing that they are grateful for the work they have been able to do with a counselor. While there are some situations where gift-giving can have an alternative motive that could be damaging, this does not appear to be the common reason behind a client’s gift-giving. The bottom line is that while we may believe that we know the reason for the client offering the gift, the truth is that we are not in their mind to know their true motivation. This illustrates the importance of having an open and honest conversation with your client.
The third stance that clinicians can have been to accept gifts more often than others when the gift is appropriate. This means that the factors identified by the 2014 American Counseling Association’s code of ethics check out, and would not damage the therapeutic relationship. Accepting gifts from clients can enhance the client’s sense of self, and demonstrate the humanistic side of counseling.
What Impact Can Refusing a Gift Have?
Therapists not accepting gifts can have a negative impact on the therapeutic relationship. As an example, if you have a client who has a history of interpersonal challenges and a lack of healthy relationships in their lives, they may perceive this as an act of refusal and non-acceptance.
It is important to take into consideration other personal aspects of your client to determine if refusing the gift would cause more harm than good. If we look at Counselors who work with children and adolescents, you may be given a painting or drawing from your client. It would be important to think about how the child or adolescent would internalize this act and if they have the ability to understand your reasons for not accepting the gift.
If you are considering refusing a gift that a client is offering you, try to take a moment to explore the concerns that you are having. Does the gift have a high monetary value? Are you concerned about the motivation behind the client’s gift? Do you have an interest in the gift that you feel is inappropriate for the counseling relationship? Or are you simply uncomfortable accepting a gift in your role as a clinician?
If you do feel as though the best practice in your situation is to refuse a gift, it is important to discuss this with your client openly and honestly. We mentioned that this can damage the therapeutic relationship, so take care of the words you use and how you explain your decision. You can show appreciation and be thankful that they thought of you, and let them know how it makes you feel that they wanted to share a gift with you.
Understanding Your Personal Boundaries
If you like to be proactive, take time to think about how you would navigate a situation where a client is sharing a gift with you before you find yourself in that situation. You may find it helpful to talk to your colleagues and supervisor about their experiences and how they have navigated similar situations in the past.
Choosing to accept gifts from a client can sometimes feel like a tug of war in our minds. You may have been told at some point in your education or career that Clinicians shouldn’t accept gifts. However, you may be able to think of scenarios where accepting a gift could actually benefit the client. As the ACA code of ethics states, in some cultures, gifts are a sign of gratitude.
Once you have an idea of what you feel your boundaries are in regard to accepting a gift from a patient, you can begin thinking about how you can incorporate these boundaries into your work.
This can include working it into your professional disclosure that is reviewed during your first session, or having a conversation with your clients when you feel it would be relevant.
When the day comes that a client offers you a gift, it is necessary to include this in your documentation. Your notes can include what the gift was, how the client introduced the gift, your decision to accept or deny the gift, and any relevant conversation that occurred.
Final Thoughts on Accepting Gifts from Clients in Therapy
Since Counselors are working with little to no rules regarding accepting gifts, our professional judgment will be an invaluable tool when it comes to navigating this situation. When we look at the three approaches that counselors tend to take regarding accepting gifts, the common thread is having a discussion with your client about the gift.
You have likely learned, and perhaps experienced, that the therapeutic relationship has a vital role in our client’s progress in treatment. Their relationship with us fosters an environment where they feel safe to talk about their challenges and be vulnerable. Keeping this in the forefront of your mind will help you navigate your experience regarding accepting gifts.
As always, if you find yourself unsure of how you want to proceed, reach out for support from your supervisor or colleague. We can understand our boundaries before we find ourselves in this position, however, it may feel different when we are actually in this situation. Consulting with other professionals can help us balance our instinct and thoughts so that we can determine how we would like to move forward.
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Resources:
American Counseling Association (2014). 2014 ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Knox, S., DuBois, R., Smith, J., Hess, S. A., & Hill, C. E. (2009). Clients’ experiences giving gifts to therapists. Psychotherapy: Theory, Research, Practice, Training, 46(3), 350–361. https://doi.org/10.1037/a0017001
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