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!
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