Gifts, Therapy, and Actions @ “The Boundary”


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In my opinion, gift giving within the context of the therapeutic relationship is an exercise in common sense.  None of the ethics codes specifically declare gift exchange as unethical, although it can certainly be unethical if taken to extremes.  I view “appropriate” gift giving as a tool to show appreciation and to advance the therapeutic alliance.  In his analysis of the “spectrum of boundary interventions,” Glass (2003) suggested we use the neutral term “actions at the boundary” instead of “boundary violation or transgression,” thereby designating that no boundary was crossed.  The most appropriate gifts in my opinion are “symbolic” and relatively inexpensive, although I can certainly see situations where even inexpensive gifts are wholly inappropriate (especially if they have sexual connotations).  If I was to give a gift, I would probably lean toward therapy-related educational materials (books, etc).

If presented with a gift, I would likely accept it depending on the situation.  I would take the size and the content of the gift into consideration, never accepting gifts that are too expensive, personal, or provocative.  I would also examine the kind of patient presenting the gift, and make as assessment as to whether they would benefit from its acceptance.  I would also be very cognizant of the context… is it early in treatment, around the holidays, or at the time of termination?  The dynamic meaning of the gift is also a consideration, although it is beyond the scope of this essay.  I would guide the interested reader to the Smolar (2002) article for in depth analysis of dynamic meanings of gifts.

In the case of a child giving a hand-made gift, I would generally speaking accept it and proudly display it.  If it advances the therapeutic alliance, I am all for it!

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References

Glass, L. L. (2003). The gray areas of boundary crossings and violations. American Journal of Psychotherapy, 57(4), 429-444. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=525045091&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Smolar, A. I. (2002). Reflections on gifts in the therapeutic setting: The gift from patient to therapist. American Journal of Psychotherapy, 56(1), 27-45. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=115179463&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

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About Kent Brooks

try-therapy.com is a group of helping professionals collaborating to bring you information about mental health, counseling, and therapy! We provide therapy and mental health services throughout the entire state of Nebraska via a hybrid delivery system. You choose the solution that is right for you - in person, online, or a combination of both! I WORK ON A SLIDING SCALE!! If you do not have insurance, ask me for more info!

4 thoughts on “Gifts, Therapy, and Actions @ “The Boundary”

  1. Lola Snow

    I think this is a tough area. It’s not the physical exchange of the gift in a monetary sense so much as the symbolism, and the reasoning behind the gift. If I was a therapist (and I’m not, much to the relief of the general public) I’d be wary of someone who tried to present me with a gift no matter what the value, because giving a gift seems to have very different meanings to different people. Mostly it seems slightly at odds with what therapy is supposed to be about. Like words are not enough, when the “gift” of the relationship should be the emotional connection. I’d interpret one possible reason for the gift as the client feeling their input into the relationship is not sufficient, or that they cannot express what they are trying to say with words. That seems dodgy territory for a talking treatment.

    Lola x

    Reply
    1. brookskent Post author

      Lola,

      I really like that you tee’ed off on the motive part… because it seems next to impossible to guess what the motive of the gift is. I appears to be the best course of action is the find out before you (the therapist) accepts it.

      Honestly, I wonder if clients even consider that we have to think about this stuff… I know I didn’t. Honestly, I give small gifts to show appreciation… no underlying motive involved (usually).

      Of course, it is the nature of the therapist to over-analyze… therapists in general seem to try “connecting the dots” even if they may or may not be there. Maybe it’s our problem solving nature, or our inquisitive minds… it’s hard to tell. The safest best for a therapist (and a client) is to politely refuse all gifts regardless of value. Eh, I dunno about that… I’ve never been the “stay safe type.” (One could argue that even having a blog and using your real identity is a significant risk in this profession, God forbid someone wander on here and realize I am actually human).

      I really enjoy reading your writing Lola. Your a very talented writer!

      Cheers,

      ^CKB

      Reply
  2. Bobby

    I give my therapist drawings to express feelings about our therapy relationship. I explain with words the symbols in my drawings.

    I use pictures as another kind of language to express myself in therapy. I would be hurt and frustrated if not allowed to do so. Luckily my therapist is flexible and open-minded, she appreciates the way I choose to communicate.

    Reply
    1. Kent Brooks Post author

      Thank you very much for sharing, Bobby! I’m not sure I had considered drawings, etc as therapeutic in nature… but now that you mention it, I think this is something I need to consider and investigate more. Great comment!

      Reply

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