I don’t remember the first time I gave a client a gift. I don’t remember who it was or what I chose, but years ago, I established a tradition of giving gifts at particular milestones. If gift-giving was mentioned at all during my training as a psychologist, it was solely in the context of how to manage receiving gifts from clients. Therapists might lend something from their office as a transitional object during a long separation or a particularly difficult time, but to give a gift was viewed as a breach of boundaries. Forty years later, I take a different perspective.

The Value and Challenges of Therapist Gift Giving

Giving a gift is an opportunity to acknowledge the special relationship between therapist and client. It has the power to reinforce the depth of closeness, of being known, that often only happens in the setting of a therapeutic alliance. Transference and countertransference are part of the connection between therapist and client, but not the sum total of the relationship. Showing our humanity can be a true gift to a client.

Over the years, I have settled on a few select items to give at times of major transition. I give a copy of Gift from the Sea, by Anne Morrow Lindbergh, to clients getting married; Make Way for Ducklings when a baby is born; and a stone coffee coaster with the town seal of Brookline, where my office was located, when clients move or end therapy. 

Additionally, I mail condolence cards when someone experiences a significant loss. Recently, one client who received a card from me on the occasion of his father’s death remarked that it felt so formal to get a card in the mail. In a sense, it seemed out of character to him for me to be that traditional. As generational and cultural norms shift, I may need to rethink my choices.

I don’t have a rule about who gets a gift or a card, and I don’t give them to everyone. I decide based on a gut feeling that this act will be well received, and that acknowledging our relationship as something that exists beyond the allotted sessions will be beneficial. There is a basic humanness that exists inside the professional alliance that I value expressing. It touches my sense of gratitude for the trust the client has placed in me. For certain clients, there also can be worth in modeling an act of kindness for them.

In preparing to write about this topic, I reached out to a dozen colleagues to inquire about their philosophy regarding gift-giving. I realized I had never talked with another clinician about my tradition, nor had I heard anyone else mention this subject. Although I was a bit nervous that I might be judged negatively for my behavior, I approached the conversations without bias about other clinicians’ practices. I am more curious about their thinking than the position they take.

I learned from these exploratory conversations that only one other colleague gives gifts regularly. She reported that the more trauma the client suffered, the greater the chance she would give them a gift to help with the healing. Others talked about calling clients or sending texts to acknowledge life events, which mirrors their behavior in their personal lives. Interestingly, one therapist talked about the significance of the gifts she had received from her therapist many years ago, mementos she still treasures, but she herself never adopted this practice because she struggled to find gifts that she deemed suitably meaningful.

Unanswered questions for me include whether the age of the patient population might impact giving gifts, whether the gender of the therapist and/or client influences the choice, and whether the type of training and years of experience are reflected in how one thinks about gift giving in therapy.

And finally, I am curious if doing remote versus in-person sessions will have any impact on this practice. With more therapists only doing remote therapy, I wonder if gift giving on either side of the equation might diminish. I know for myself that now having a fully remote practice, I receive fewer holiday gifts than when I was seeing clients in person. But, to date I have maintained my gift-giving practice even though it now requires more trips to the post office, and I miss the connection from handing the gift personally to a client.

Giving gifts has enriched my practice. Although I largely rely on my words to communicate in therapy, gift-giving is a tangible way to communicate that I value clients and care about them. It is a concrete representation of the very real relationship that is carved out of years of hard work together.


Questions for Thought and Discussion

What is your position on this practice of giving gifts to clients?

To what kinds of clients have you given gifts?

If you do give gifts, how do you choose them for specific clients?  


File under: A Day in the Life of a Therapist, Musings and Reflections