Please Don't Give Me a Gift for the Holidays

Source: Jan Vašek/Pixabay

I am a therapist, and I love expressions of gratitude. A heartfelt card, a meaningful verbal thank you—these mean a lot to me. Therapists work hard, and while we make a decent living, we do not generally do it for the money. We honestly like to help others to improve their lives. I know this gives me great pleasure personally and professionally.

I also love the holidays, including giving and receiving gifts. When it comes to my patients, however, this is where it gets awkward. As a therapist, I am trained to consider multiple motivations behind my patients’ actions, not to judge but to better understand them. A gift can mean a lot of different things, which is why they can become more complicated than they seem at first glance.

Here are some considerations about what a gift from a patient might mean:

Honest and genuine gratitude. This is the least controversial motivation and a common reason why patients might give their therapist a gift. In this way, it can be a harmless, thoughtful gesture.

A defense against aggression. The often unconscious motivation here is that a patient wishes to “make nice” with their therapist. It can be a preemptive gesture to reduce any tension or aggression that might exist in the therapeutic relationship.

Manipulation. This reason for gift giving is more problematic, and it involves an attempt to make the therapist feel or act a certain way. The true motivation may be complex, but it could potentially include a sense of the therapist “owing” the patient, giving them special considerations, or attempting to push therapeutic boundaries.

Equalize the relationship. Different from above, some patients have difficulty with the power differential in therapy. This is both understandable and potentially problematic. The power differential is real and can be scary. However, it can also get in the way of the therapeutic process. A gift given for this reason attempts to level the playing field.

The American Psychological Association (APA) does not expressly forbid acceptance of gifts from patients, although it does urge caution. Gifts can put therapists in an awkward position because they may contribute to concerns related to APA Ethics Principles that are strictly prohibited. These include: Conflicts of Interest, Boundary Violations, and Exploitation. This is why many therapists are uncomfortable with gifts, because we take our ethical principles very seriously. Any breach of these principles can be harmful for patients and put therapists at risk for licensing or ethical complaints. So, please do not underestimate what a heartfelt verbal “thank you” will mean to your therapist, without the emotional ties that may come with a physical gift.

Finally, if a gift is given, whatever the motivation, exploration of the gesture can actually improve the therapeutic relationship. Both patient and therapist may learn about their own underlying psychological dynamics brought about by the exchange.