When (and When Not) to Give a Holiday Gift to Your Therapist

Few subjects seem to engender more controversy amongst mental health practitioners than that of accepting gifts from clients (except maybe hugging them). This time of year, social media and podcasts blow up with people asking what is or is not appropriate with respect to giving your therapist a gift and folks have very strong opinions on the matter. In the interest of continuing my dialogue about therapy and “good versus bad” therapy, I wanted to provide a few thoughts on this matter.

First, there is nothing explicitly stated within ethical codes for mental health practitioners banning accepting gifts. It is considered something of a gray area. I interviewed a therapist about the topic who teaches ethics in psychology at the college level and her reply was that it’s a nuanced subject which requires a therapist to have very good boundaries, clear with their stance and observant. Many therapists opt to not even open that can of worms because they would rather err on the side of caution, however if a therapist does decide not to accept gifts, this should be explicitly stated within any initial intake paperwork so a client is aware of it from the beginning and it doesn’t become a source of rupture in the therapeutic alliance later on.

That being said, the most important thing a therapist must consider is what is in the best interest of a client when it comes to gift giving. Giving a gift on a special occasion, like during the holidays, is a very human instinct and a way people show gratitude or affection toward those who mean something to them. Why should this instinct be any different when it comes to someone you spend a lot of time with talking about things you likely don’t share with anyone else?

This speaks to something I often lament as a critique of mental health — its lack of humanity. In its attempt at achieving legitimacy within the scientific community, mental health has successfully created a culture within which therapists can get hamstrung by rules, regulations, and fear of repercussion in the form of malpractice. These are legitimate considerations, but they can also inhibit something integral to what I think is the key to good therapy: the therapist’s humanity. If the therapeutic alliance is in fact the single greatest predictor of positive outcome in therapy, we cannot completely anesthetize the personality and vulnerability out of a therapist.

As such, gift giving and more importantly the acceptance of a gift from a client can be a powerful part of cultivating the therapeutic alliance. It could also backfire if a therapist hasn’t clearly stated their stance on gift giving and then rejects a gift from a client. This could easily be perceived as a rejection of the client themselves, something that for some clients could be devastating, particularly if there has been any kind of abandonment trauma in their history. That’s where the nuance and careful consideration of the therapist comes into play.

An example where a therapist might discourage gifts from a client that was described to me by the therapist I interviewed was when a client pathologically gives gifts, meaning it becomes a regular thing that clearly comes with some kind of transactional expectation of reciprocity. Another example would be a client with a shopping addiction that is well-documented. Again, in this case, the therapist would need to establish that boundary cautiously so as not to inadvertently harm the therapeutic alliance.

As a general rule of thumb, there are a few criteria to keep in mind if you do plan to give your therapist a gift this holiday season.

1. Don’t give a gift of great value.

It may seem obvious, but something like expensive jewelry, a trip, or a car are not acceptable.

2. Avoid gifts that are too personal.

Again, this may appear to be clear, but things like lingerie are off limits.

3. Don’t offer anything that might change the therapeutic relationship.

This may be subjective, but again it really encompasses things like alcohol, anything sexual or intimate, or anything that could otherwise shift the power dynamic.

4. Don’t expect anything in return.

Again, avoiding transactional expectation of reciprocity.

5. Something from the heart is always best.

Home-baked cookies, a nice card, or something you know is meaningful (like say, an ornament with a therapy quote on it you have discussed in sessions) is typically safe.

Ultimately it’s up to your therapist to determine whether or not they will or will not accept a gift. If you are unsure, bring it up in session. It may provide a great opportunity to discuss your need for or desire to give the gift and what it means to you. As for hugs? We shall save that discussion for another day.