Patients giving gifts

[Doctor Eliza]

This was posted on medscape about patients giving gifts to their physicians. I found the differing attitudes between physicians and psychologists very interesting. Has anyone on here been given (and perhaps accepted?) a house in California by a patient? A hand tailored suit? An M-16?

http://www.medscape.com/viewarticle/774703?src=mp

Best,
Dr. E

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[weeblewobble]

Wow, I felt really special when a client baked me cookies... Clearly have been aiming too low.😉

 

[AcronymAllergy]

I've been given small gifts by therapy patients. I'm inclined to accept small one-time things, but would not accept anything expensive or repeated gifting.

+1. I stick to a ~$10 upper-limit, and ensure that the patient knows it's a one-time deal (and of course that the gift, although appreciated, is completely unnecessary).

I personally just don't see how I could ethically accept something like a house or tailored suit.

 

[sandy1]

I have never seen the patients offering such expensive gifts!!

 

[bmedclinic]

I've been given cards, asked on a date twice (by the same woman!) and been given coffee. The coffee one is because I had built rapport with that client by disucssing their love of coffee with mine (I roast my own coffee and am somewhat of a coffee snob).

 

[weeblewobble]

The policy at the clinic I'm at now is to accept the gift if it's not extravagant (and I've never seen anything excessive) and say something like, "Thanks! Everyone at the clinic will be so happy to see/share this." The point being to defuse the possible intimacy or boundary crossing of the situation, while still being grateful for the client's thoughtfulness. Also, then everyone gets delicious cookies.

I can't imagine accepting anything beyond a card/baked good/tiny trinket. For many clients even $10 is significant.

 

[Doctor Eliza]

The policy at the clinic I'm at now is to accept the gift if it's not extravagant (and I've never seen anything excessive) and say something like, "Thanks! Everyone at the clinic will be so happy to see/share this." The point being to defuse the possible intimacy or boundary crossing of the situation, while still being grateful for the client's thoughtfulness. Also, then everyone gets delicious cookies.

I can't imagine accepting anything beyond a card/baked good/tiny trinket. For many clients even $10 is significant.

I went to an ethics seminar where they suggested the same sort of statement about sharing the gift with others. I don't like that at all. I think that would feel really rejecting and insulting to the client (unless some sort of letter is sent out to everyone ahead of time stating clinic policy). Those cookies weren't for the secretary. They were an expression of graditude toward the therapist.

I think blanket policies on this topic (apart from a dollar limit, maybe) are tricky because so much depends on the relationship with the individual client. There are also cultural issues in some cases. While there are cases where it makes sense to diffuse intimacy, there are others where it is important to foster connection.

Best,
Dr. E

 

[weeblewobble]

I went to an ethics seminar where they suggested the same sort of statement about sharing the gift with others. I don't like that at all. I think that would feel really rejecting and insulting to the client (unless some sort of letter is sent out to everyone ahead of time stating clinic policy). Those cookies weren't for the secretary. They were an expression of graditude toward the therapist.

I think blanket policies on this topic (apart from a dollar limit, maybe) are tricky because so much depends on the relationship with the individual client. There are also cultural issues in some cases. While there are cases where it makes sense to diffuse intimacy, there are others where it is important to foster connection.

Best,
Dr. E

Yeah, I can see where responding this way could be offensive to the client and harm the therapeutic relationship. I haven't had a client respond that way or heard of a client responding that way (yet 🙂). I think you're right that having a universal way of responding probably isn't the way to go. There are some clients I can't imagine using that kind of phrasing with (ones with BPD traits are coming to mind) because of the possible harm. This is probably where clinical expertise comes in.

 

[cara susanna]

I've been told that it's okay to accept food and cards, but nothing expensive. We have clients bring food or cards all of the time at our dept clinic.

My undergrad mentor once had a client give her a big screen TV. She's a DBT therapist. 😉

 

[Therapist4Chnge]

Depending on the culture, rejecting food or personally chosen/made gifts can be viewed as highly insulting. It is always a balance of wanting to be aware of cultural implications, while also ensuring that you act ethically and within the policy of your employer.

When I did therapy, I usually started the conversation about discharge with at least a couple of sessions buffer so I could address things like common transition challenges, relapse prevention (if applicable), and also termination of the therapeutic relationship. If/When the topic of "thanks/appreciation" came up, I'd usually try and validate the feelings and desire to show thankfulness (if presented). I'd often encourage them to write a note/letter or draw/create something instead of buying me/treatment team something. The results were often more meaningful to them and often provided a natural end to the work.

Ironically, today while sorting through old forms/paperwork I found a "thank you" note of sorts that my last group of residential patients made for me at the end of my intern year. The fact a group of mostly rough and tumble Veterans in the middle of their treatment decided to organize it before my last group was pretty special. They called it an "After Action Review", which for active duty personnel was standard protocol following the completion of a mission. It was rather fitting in retrospect.

 

[Maedothin]

Similar to the above, I have never been given anything extravagant, nor would I accept such. When therapy has gone on long enough or had sufficient intimacy that a strong attachment has formed, I do believe that a symbolic gift (e.g., meaningful card or item with low monetary value) is a good way of allowing the client to grieve termination.

 

[Sanman]

This was posted on medscape about patients giving gifts to their physicians. I found the differing attitudes between physicians and psychologists very interesting. Has anyone on here been given (and perhaps accepted?) a house in California by a patient? A hand tailored suit? An M-16?

http://www.medscape.com/viewarticle/774703?src=mp

Best,
Dr. E

In general, I follow the 'Godfather' rule; so, leave the gun and take the cannoli. Then again, my co-worker got chocolate covered strawberries from her client last week and all I got in my mailbox was a note from my patient that she was taking one of the magazines from the waiting room.

 

[Rainyday19]

Well from the other side perspective, of a patient to therapist, when I was younger I once gave my therapist a birthday present. However, this is a therapist who I have seen for over 5 years, since I was a teen, and whom I feel extremely grateful to. I think had she refused the present, as I’ve heard some therapists do, I know I would have been crushed and it definitely would have damaged the relationship. She still keeps the present in her office and it feels good to see this reminder of our work and connection every time I go there! She also gave me a small present when I started college, which meant so much to me and is still one of my most valued possessions. 🙄

 

[Maedothin]

I think Rainyday19 has a great point. I haven't heard it discussed explicitly, but it would seem to me that short-term therapies tend to have less attachment and depend less on the therapeutic relationship, thus they can hold a higher bar on gift giving. Longer term modalities of therapy depend heavily on relationship and gifts, both given and received, taken on a different value.

I would imagine that Dr. E's "Godfather rule" is still a good measure, but I would think that long-term therapists would be more inclined to consider more deeply what the intrinsic value of the gift is and the meaning that either receiving or rejecting the gift would have. I have a professor who conveyed a case example where rejecting the gift, and the feelings generated there, became an important vehicle in client growth. I don't think this could be the case in briefer therapy.

 

[Doctor Eliza]

I think Rainyday19 has a great point. I haven't heard it discussed explicitly, but it would seem to me that short-term therapies tend to have less attachment and depend less on the therapeutic relationship, thus they can hold a higher bar on gift giving. Longer term modalities of therapy depend heavily on relationship and gifts, both given and received, taken on a different value.

I would imagine that Dr. E's "Godfather rule" is still a good measure, but I would think that long-term therapists would be more inclined to consider more deeply what the intrinsic value of the gift is and the meaning that either receiving or rejecting the gift would have. I have a professor who conveyed a case example where rejecting the gift, and the feelings generated there, became an important vehicle in client growth. I don't think this could be the case in briefer therapy.

Wish I could take credit for the Godfather rule, but that was Sanman's phrase. 😉

Dr. E

 

[PsychPhDone]

Nobody's given me anything. 🙁 Makes it easy on the ethics, though!

We were told if you can eat it, you can keep it.

 

[DoctorLion]

My friend sculpted a statue of her therapist and gave it to him. It was very beautiful and I can't help but think that her therapist must have walked away with a pretty inflated ego lol

 

[Shatani]

Wow, I felt really special when a client baked me cookies... Clearly have been aiming too low.😉

lmao! i had a client who shared my affinity for pottery and gave me a tiny little lidded bowl. i, too, have been aiming far too low!

 

[thewesternsky]

My friend sculpted a statue of her therapist and gave it to him. It was very beautiful and I can't help but think that her therapist must have walked away with a pretty inflated ego lol

... A statue? Was it just the face, or more? This is potentially kind of creepy.

We are permitted to keep gifts of "token" value, including baked goods and other small gifts (typically pens, journals, little knick-knacks). We are NEVER permitted to keep cash at all. Gift cards are also tricky... I once had a long conversation with my supervisor about whether a $10 gift card to a coffee shop constituted token value. We ultimately decided that I would keep it because this particular client would have been offended, but in other circumstances we would have considered that to be too much.

 

[wigflip]

She still keeps the present in her office

I've thought about this because of my chiropractor. Walking past my chiropractor's business office on the way to the treatment room, one can't help but notice the dozens and dozens of bobblehead figures.

ME: So how long have you been collecting bobbleheads?

CHIRO: I don't collect bobbleheads.

ME: 🙂confused🙂 Huh. I could have sworn I saw bobbleheads in your office.

CHIRO: Yeah, it started because one of my patients gave me a bobblehead for the holidays. Then another patient saw that one and brought me another one. It kind of took off from there.

So...what if you get a small, inexpensive gift that is a) obviously meant to be displayed and b) dreadfully tacky? Do you display it until the patient terminates and risk eventually being buried under a mountain of bobbleheads?!?

P.S. I bet the gentleman pictured in my current avatar is responsible for at least one of those bobbleheads. His cat too.

 

[Rainyday19]

So...what if you get a small, inexpensive gift that is a) obviously meant to be displayed and b) dreadfully tacky? Do you display it until the patient terminates and risk eventually being buried under a mountain of bobbleheads?!?

I suppose in that case a therapist could just thank the client and say something along the lines of "oh what a nice gift, I think I'll keep it in my home". Then they take the tacky gift back home and keep it there, maybe in the trashcan!

 

[SingingCow]

I suppose in that case a therapist could just thank the client and say something along the lines of "oh what a nice gift, I think I'll keep it in my home". Then they take the tacky gift back home and keep it there, maybe in the trashcan!

I learned to turn down gifts from patients the year I was being offered torn candy wrappers, empty kleenex boxes, and old magazines that probably survived a flood (in the bathroom?)

The "accept what can be eaten" rule is fine until you receive raw meat in a zipblog bag or cookies that look sort of green (and it's not the Christmas-themed frosting.)

The best gift is when a patient actually improves or does not decline as rapidly as everyone else has anticipated. I'll take that over a box of gold. 🙂

 

[Sanman]

Hey guys,

I remembered this thread and had my own conundrum come up a couple of weeks ago. I received a number of Christmas gifts from my private practice pts. Just before new years the parent of one of my pts (a teenager with significant issues, special needs schooling, multiple therapists for the family) mentioned she does something for all the therapists for the holidays (dinner gift cards and such). I told her it wasn't necessary, but mentioned I am not a fan od chain restaurants anyway. I figured a gift to panera, DD, etc for $20-25 like some pts have given. It ended up being a check for $100 with a request for me to spend it on a nice dinner out (in place of a gift card to a chain restaurant). The gift seems a bit excessive, but this is an upper middle class private practice with cash paying clients. So, any suggestions on what I should do. I have entertained the options of just not cashing the check or speaking to them about the gift. Then again this pt also tends to be a big hassle and cancel appts last minute, reschedule, etc. I could just put it toward their unpaid session bill in the future. Thoughts?

 

[Therapist4Chnge]

Does the owner of the practice have a policy about things like this? In the context of being an upper-middle class setting, the $ amount is somewhat relative, but it still is enough $ value to give me pause. The one alternative I thought of was to "pay it forward" and suggest the family donate to a cause that you/they support: animal shelter, food kitchen, etc. You could also put it toward a "office" gift...coffee maker, cater a lunch, etc. since it is often a team effort w. treatment.

 

[cara susanna]

I had this come up during the holidays, too. A client gave me not one gift but a bag full of gifts. My supervisor suggested that I should ask the client if they have any friends or family to whom they could give the gifts instead.

 

[Shoregirl]

I've been told that it's okay to accept food and cards, but nothing expensive. We have clients bring food or cards all of the time at our dept clinic.

My undergrad mentor once had a client give her a big screen TV. She's a DBT therapist. 😉

Being a DBT therapist, I can't imagine accepting something like that. (You didn't say whether or not she accepted it?) DBT, if anything, would be stricter about accepting gifts, because of the meaning that clients attach to it. I've had clients in my groups give small teddy bears and hot cocoa gifts, but they gave them to everyone and it was not specifically aimed at the therapist. Had it been aimed at me, I likely would not have accepted it because it would have set up a perceived favoritism in the group. Individually - I've had a client bake cookies, and others give me cards. I put the cards in the file, after I gratefully receive it and thank my client for it.

 

[Shoregirl]

Well from the other side perspective, of a patient to therapist, when I was younger I once gave my therapist a birthday present. However, this is a therapist who I have seen for over 5 years, since I was a teen, and whom I feel extremely grateful to. I think had she refused the present, as I’ve heard some therapists do, I know I would have been crushed and it definitely would have damaged the relationship. She still keeps the present in her office and it feels good to see this reminder of our work and connection every time I go there! She also gave me a small present when I started college, which meant so much to me and is still one of my most valued possessions. 🙄

I once gave a therapist I'd been working with for two years a small gift. At the time I was a doctoral candidate and she'd helped me through some very rough times with my program and my marriage. I gave her a shell from the beach of my favorite place on earth. Very inexpensive (I had a lot of them) but was a symbol of "coming out of my shell" - something we'd worked on. She kept it on a shelf with other natural objects. It meant a lot to me that she accepted it.

 

[Shoregirl]

Hey guys,

I remembered this thread and had my own conundrum come up a couple of weeks ago. I received a number of Christmas gifts from my private practice pts. Just before new years the parent of one of my pts (a teenager with significant issues, special needs schooling, multiple therapists for the family) mentioned she does something for all the therapists for the holidays (dinner gift cards and such). I told her it wasn't necessary, but mentioned I am not a fan od chain restaurants anyway. I figured a gift to panera, DD, etc for $20-25 like some pts have given. It ended up being a check for $100 with a request for me to spend it on a nice dinner out (in place of a gift card to a chain restaurant). The gift seems a bit excessive, but this is an upper middle class private practice with cash paying clients. So, any suggestions on what I should do. I have entertained the options of just not cashing the check or speaking to them about the gift. Then again this pt also tends to be a big hassle and cancel appts last minute, reschedule, etc. I could just put it toward their unpaid session bill in the future. Thoughts?

I would apply it toward a future session and let them know that. $100 seems excessive to accept, from the vantage point of the way I was trained. Good luck!