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Article Excerpt
The ethical and therapeutic implications of receiving gifts from clients are explored. The importance of the issue is noted, and relevant ethical considerations are discussed. Therapeutic meanings that underlie client gift-giving are explored. By integrating the ethical and therapeutic considerations, four general categories of gifts are identified. Specific therapeutic responses to each category are identified and briefly discussed.
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It is not unusual for clients to bestow gifts upon their mental health counselors who, as a consequence, experience positive, negative, and mixed emotions (Spandler, Burman, Goldberg, Margison, & Amos, 2000). In such situations, mental health professionals must manage personal emotions and behavior adequately in order to respond therapeutically. However, little attention is given to such therapeutic events in graduate training. In addition, few guidelines on appropriate therapeutic responses to client gift-giving have been developed. Such client behavior can have important ethical and therapeutic implications (Beier & Young, 1998; Cappa, 2001; Dodds, 1985; Gartrell, 1992; Kritzberg, 1980; Spandler et al.). Yet, there is frequently professional ambivalence toward this topic that is, perhaps, reflected in the dearth of existent professional literature on gift-giving. As Spangler et al. note, although "there is a vast general literature on 'gifts,' this is not the case in psychotherapy where an intriguing silence predominates" (p. 80).
The purpose of this article is to explore ethical and therapeutic issues that are relevant in client gift-giving situations. First, the extent and nature of client gift-giving are discussed. Second, relevant ethical and therapeutic issues are identified. A scheme for categorizing and assessing gift-giving behavior is developed. Finally, several general suggestions are given for handling these incidents.
THE EXTENT AND NATURE OF CLIENT GIFT-GIVING IN COUNSELING
Webster's Third New International Dictionary (Gove, 1993) defines a gift as "something that is voluntarily transferred by one person to another without compensation" (p. 953). The inherent value of the gift might be monetary, but can also be psychological and symbolic. The recipient knowingly recognizes its gift status and accepts it as such. There is no prior claim upon the gift by the recipient. In addition, the recipient is under no obligation to pay for it in the future.
It is not unusual for mental health counselors to receive gifts from clients, although few studies have been conducted to investigate this phenomenon. In a review of the professional literature, only one empirical investigation on the gift-giving behavior of clients was found (Spandler et al., 2000). Another investigation examined the gifts received by physicians from their patients (Drew, Stoeckle, & Billings, 1983). Anecdotal evidence accrues from informal discussion with colleagues, who reveal numerous occasions of gift-giving. For example, one female client, who was typically scheduled at the dinner hour, frequently brought in food items such as strawberry pie or pizza to share with her mental health counselor. Another client, whose spouse worked for a snack distributor, would bring in bags of chips or pretzels that had reached their shelf life expiration date.
Sometimes, the practice of gift-giving does not take place in such a straightforward manner. One client gave her mental health counselor a large photo album containing a number of family pictures. Another mental health practitioner, working for a nonprofit agency, reported that a client donated a large quilt for an agency fund-raiser and had attached to it a poster-sized note thanking the mental health professional for her excellent service. In each case, the gift item was dropped off at a time when the mental health professionals were in session with other clients.
Drew et al. (1983) identified three general categories of gifts. First, gifts are often seen as a type of tip to the professional. The underlying motive of the gift-giver in this case may be likened to the restaurant diner. The client, who is pleased with the personalized service, degree of tolerance displayed, and timeliness of service seeks to compensate the mental health professional for providing service that is beyond the call of duty. Second, gifts are given to address a perceived imbalance in the professional relationship. For example, a store manager, upon an improved level of functioning, might give her counselor a gift certificate that is redeemable at her store. Such a gift may help the client regain status that was temporarily lost during her increased sense of dependency during a major portion of her counseling. Third, the gift might serve as a payment of homage or sacrifice to the mental health professional (Drew et al.). In such cases, the client sees the mental health counselor as using professional power...
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