Accepting Gifts from Clients: What do Research & Ethics say?

Exchange of any kind of gifts between a therapist and their client can be tricky to navigate especially considering the ethical consequences of the act. There are varying opinions in the field on whether a therapist should accept or give gifts. Here are some points to consider before making a decision!

The American Counseling Association (ACA) Code of Ethics advises therapists to be cautious, consider the circumstances, and what the gift might signify before accepting presents. Maintaining professional boundaries ensures that both the therapist and the client are safe. Accepting or giving presents might cause these boundaries to become hazy, which could cause dual relationships or conflicts of interest.

Another ethical consideration is to be multiculturally informed. In many cultures, gift giving is often viewed as a token of appreciation and gratitude for the services one has received. Thus, declining a present is impolite or offensive. Counselors have to be culturally conscious and mindful of these nuances when they choose whether to accept presents.

Research suggests that the exchange of gifts might influence the therapeutic relationship and healing process. Clients who give presents attempt to express gratitude and increase meaning in their therapy journey. When a therapist accepts their gifts, it has the chance to enhance the therapeutic bond. At the same time, giving and receiving gifts can alter the perceived power dynamics between the therapist and the client. Clients may feel that they will get preferential treatment due to the ‘enhanced and deeper’ therapeutic connection as compared to other clients who do not give gifts. At the same time therapists may develop a sense of indebtedness of obligation to repay with service; thus removing objectivity from the treatment and hindering development. Counselors must consider if accepting a gift might compromise their neutrality and impede their ability to assist their clients impartially. Additionally, rationale behind the gift and the client's expectations is crucial in determining its impact on the therapeutic relationship. The timing and value of a gift are also significant considerations. While it is encouraged that each therapist communicates their personal policies on gift giving during treatment, it is imperative to consider whether the client’s gift signifies respect for the therapy or is an effort to control the relationship and tip the power dynamics. Valuable gifts presented during significant moments in therapy, such as after termination, may have greater significance and potential impact on closure for the clients. 

Establishing universally understood guidelines about gift-giving will prevent sporadic decision making when presented with a gift from the client. It also allows the counselor to pre-inform their personal policies to their clients, set clear expectations and delineate acceptable or unacceptable practices. This transparency helps create norms and maintains clarity in the treatment. It is also important to treat each case independently, prioritizing the client’s welfare at the foremost. Consider the meaning of the gift for the client, their cultural and developmental background and its potential impact on their healing process.  In other words, consider if it is the client’s best interest to accept or decline the gift. Additionally, when therapists are uncertain about the appropriate course of action, they must seek assistance from a supervisor or the coordinated care team that may provide more insight on the client’s motivations for presenting the gift. 

Along with making a decision to accept or deny the gift, it is also vital to document the interaction. After all considerations, if the counselor accepts the gift, they must document the exchange in their clinical notes. Include details of the gift, client’s intentions behind offering it, and the counselor’s interaction in the session. If the counselor chooses to decline the gift, they should verbally provide a compassionate and professional explanation and document the same. 

To summarize, the exchange of gifts is a sensitive issue that requires meticulous consideration by the therapist. While gifts may enhance the therapeutic process, they can also complicate the therapeutic relationship from a legal and ethical lens. While making a decision to accept or deny the gift, therapists must consider and evaluate the client’s culture, establish explicit guidelines, and uphold their professional duties.