As a general rule, therapists should not accept gifts from their clients. While the therapeutic relationship is special, it is still a professional one, and the practice of accepting presents starts to blur the boundaries of the work clients and therapists do together. While not inherently a dual relationship, gift-giving does make the relationship more personal, and should generally be avoided so that the professional relationship remains unadulterated.
Sometimes, however, a client would like to show that the help a therapist provides goes beyond the check that the client writes for the service. For me, this has happened most often at the end of therapy, when the client has improved and it’s time for us to go our separate ways. Is it wrong to accept a small token of a client’s appreciation? Not necessarily, as the therapeutic relationship does not exist in a vacuum. The office is still the real world. A therapist cannot simply deny a gift from a client. That would just be rude.
While not a Therapist Rule per se, my professional stance is that I will accept a small gift, provided that the item is not particularly expensive or suggestive of anything other than thanks for services rendered. A common example might be a small plant, a picture frame, or a coffee table book. There are also less common examples:
Jim and I worked together for six months on depression and low self-esteem. Jim was a mid-20’s man and college graduate, and his depression didn’t have a clear trigger or starting point. At the beginning of his depression, Jim wasn’t eating or socializing, and couldn’t get himself out of bed to go to work. He described himself as worthless and that he would never bring anything of value to a relationship, which was particularly troublesome to him since he wanted to start a family in the near future. An anti-depressant from his family doctor helped Jim to regain his appetite and get to work. But psychologically Jim was still miserable, and saw that medicine in and of itself wouldn’t get him to like himself again. So he turned to Rob Dobrenski: psychological guide, attractive sage, and recent murder attempt survivor.
Jim was one of the more amazing clients I have worked with. A true therapy lover, he never missed a session, or even one minute of one session for that matter. He printed out articles on various therapeutic approaches to depression and we discussed them. He did any and all therapy homework that was asked of him. He learned how to think differently about himself and his world. And over time, he felt better about himself, which meant that he no longer needed to be in therapy.
A good rule of thumb is to plan a final session in advance, rather than simply deciding on the spot that a client will not return. This allows the therapist and client to talk about what the client has learned, what work he could continue to do on his own, potential pitfalls that could lead to relapse, and the like. It’s also a time to say good-bye and get closure, for both therapist and client.
“Rob, this is for you, for all of your help,” Jim said.
Jim handed to me a small, flat refrigerator magnet, about a 3 inch by 3 inch square.
“This is…lovely,” I said, wondering what would compel Jim to give me this.
Sensing something other than gratefulness and appreciation, Jim said “What’s wrong? You don’t like it?”
“No no, it’s not that” I said.
“You don’t like the slogan?”
“It says, ‘I Love My Penis.'” Actually, the word ‘love’ was symbolized via the commonly used red heart, making the statement a true double-organ sentence.
“Right! And you do…don’t you?”
“Sure. Of course. I’ve just never received a gift such as this.”
Therapist Rule: When given a gift that falls outside the lines of tradition, try to understand the meaning behind the gift.
“I very much appreciate that you’d give me a thank-you gift for our work together, I just don’t quite understand what made you choose this particular gift.”
“You’ve helped to get my self-esteem back. I didn’t like myself for a long time, but that’s changed now. I got myself a girlfriend, and she tells me to be proud of my penis, that’s it’s the gateway to my manliness. She’s right, and I am proud. Damn, I might even marry this woman. ‘I Love my Penis’ is my new mantra, and I wanted to share it with you as my way of saying thank you. It’s also to remind you to be proud. Of your penis. And your life. That’s what you helped me to be.”
Although an unusual moment in my professional life, these instances are what make a therapist’s career worthwhile. Knowing that I played a profound part in Jim’s transformation made it a wonderful time to be alive, and even though he had never once mentioned his penis in the sixth months prior to that day, I felt immersed in Jim’s newfound happiness.
“Thank you,” I said. “It’s a nice present, and I’m glad I helped you to be proud. Of your penis. And your life.”
“You’re proud too, right?”
“Right. We’re both…proud of our lives. And other things too.”
“Shout it with me before I go” he said.
“Shout it with me. To celebrate!”
“I love my penis,” Jim said.
“I don’t know if that’s…”
“I love my penis.”
“I love my penis!”
“I LOVE MY PENIS!” we screamed at the tops of our lungs. I’m sure my colleagues heard us from the nearby suites and questioned my therapeutic methods, but I didn’t care.
“Doesn’t that feel great, Dr. Rob?”
It did. When the echo from the screaming had died down, the session was over, and it was time for Jim to go on his way as a happier man. And I did feel proud of the work we had done. I keep the magnet on my refrigerator as a reminder of how great it was to work with Jim. And to remember to be proud.