Therapist giving presents to patients

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munshi
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Therapist giving presents to patients

Post by munshi » Wed Dec 25, 2013 11:48 am

Hi,

I was wondering what others felt about this situation that occured at my work. I currently work as a therapist in the private sector. At this time of year, a few clients have given the team / individual therapists Christmas presents such as cards, chocolates, biscuits etc. I was given (and accepted) a couple of small boxes of chocolate and have also in the past accepted gifts that clients have given as a thank you / goodbye at the end of therapy, as long as they were not of significant value.

Last week I noticed my colleague, a fellow therapist, was giving his clients Christmas presents and cards. I was quite taken aback by this and my initial reaction was that this is highly inappropriate. Even if the gifts themselves were not of significant monetary value (they were chocolate), knowing some of his clients they would be of great personal significance.

A lot of this therapist's clients are young, vulnerable females who have interpersonal and relational problems. The therapist himself is a man in his mid-40s.

Other more senior members of staff stated they would not give gifts to clients however nobody else questioned it. When I did, I was basically told it was up to him to do what he felt was appropriate. It's been playing on my mind since :-/

fabio
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Re: Therapist giving presents to patients

Post by fabio » Wed Dec 25, 2013 12:40 pm

Merry Christmas everyone!

I think it is wrong to give or recieve presents from people in therapy.The exceptions are the one you already mentioned(gifts of small value and of symbolic nature and at the end of therapy).
Especially in the situation you describe,I believe that he has not taken into consideration the implication such a gesture has!

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miriam
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Re: Therapist giving presents to patients

Post by miriam » Wed Dec 25, 2013 3:27 pm

I think accepting a small gift that is ephemeral or for the team/venue (a picture, chocolates, flowers) is fine for special occasions or the end of therapy. Giving a card would also be fine.

Different therapists would vary in their views about giving a gift, but I've got no objection in principle to bringing cake on a client's birthday or giving a chocolate bunny for xmas. We are human beings first and foremost, and provided that its not something inappropriate or of high value I don't object to gifts per se.

For example, after a long period of therapy a client can feel very reassured to have something to symbolise the therapist with them, and I've seen a friendship bracelet used like this with good effect.
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msrisotto
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Re: Therapist giving presents to patients

Post by msrisotto » Wed Dec 25, 2013 8:31 pm

Munshi, in the circumstance you describe, what negative impact do you think the gifts will have?

It wouldn't occur to me to give my clients gifts but I don't see the harm in these little chocolate bunnies. As Miriam said, we are human and I like the gesture. Obviously gifts for valentines day would be out of order! Or these Xmas gifts as a precursor to some kind of relationship would be inappropriate, is that what you think this is about?

munshi
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Therapist giving presents to patients

Post by munshi » Wed Dec 25, 2013 8:58 pm

Thinking more about this, I don't think it is so much about this incident than about my feelings about this colleague and this being the latest in a line of things that have raised questions in my mind about his motives.

I will take to supervision as my supervisor is aware of the context of my concerns. However, thank you to those who helped put this event into perspective, perhaps I had a bit of an overreaction.

Alex
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Re: Therapist giving presents to patients

Post by Alex » Thu Dec 26, 2013 12:04 am

I think that it depends on the client, therapist, the relationship, service and therapy context to whether a small gift would be appropriate to give to a client.

A small gift can have a powerful and significant positive impact on the client and research shows that therapists going beyond what is expect of them (extra mile) is related to positive outcomes. This is why I think a blanket ban on such gifts would be a shame.

Like self-disclosure, a therapist can never know for certain a gift is welcome and positive for the client. The client may interpret the significance of the gift in a different way, for example for a narcissistic client it may symbolize how special you both are and different from others which would probably be counter therapeutic or for a client with low self-esteem and social anxiety it may mean that someone has really thought about them and that they were worth giving a present which could be a turning point in therapy.

However, your last post indicate that it it is not the act of a giving gift that has concerned you but the colleague in question. I would not necessarily frame it as an overreaction but that you have concerns. I imagine it is an awkward situation, when you see you colleague doing things that do not appear right but maybe feeling that it is none of your business so cannot get involved. Definitely one for supervision!

lizzabadger
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Re: Therapist giving presents to patients

Post by lizzabadger » Fri Dec 27, 2013 9:01 pm

Well, going against the grain, I think it's overstepping the boundaries of the professional relationship.

You'd think it odd if your GP or dentist gave you a gift, wouldn't you?

And in a psychotherapeutic situation I think it's worse than just odd. I think there is a huge risk that potentially vulnerable patients attending therapy would read too much significance into the gift and start confusing the therapeutic relationship with friendship.

I'd react like you and I'd definitely discuss it with my supervisor/superiors.

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Borrowed Cone
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Re: Therapist giving presents to patients

Post by Borrowed Cone » Sat Dec 28, 2013 12:22 am

lizzabadger wrote:Well, going against the grain, I think it's overstepping the boundaries of the professional relationship.

You'd think it odd if your GP or dentist gave you a gift, wouldn't you?

And in a psychotherapeutic situation I think it's worse than just odd. I think there is a huge risk that potentially vulnerable patients attending therapy would read too much significance into the gift and start confusing the therapeutic relationship with friendship.

I'd react like you and I'd definitely discuss it with my supervisor/superiors.
I always think it is interesting when therapists take such rigid positions with regard to therapist and/or client behaviours, especially as psychological flexibility is something therapists are ultimately trying to promote... ;)

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sarahg
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Re: Therapist giving presents to patients

Post by sarahg » Sat Dec 28, 2013 12:52 am

lizzabadger wrote:Well, going against the grain, I think it's overstepping the boundaries of the professional relationship.

You'd think it odd if your GP or dentist gave you a gift, wouldn't you?

And in a psychotherapeutic situation I think it's worse than just odd. I think there is a huge risk that potentially vulnerable patients attending therapy would read too much significance into the gift and start confusing the therapeutic relationship with friendship.

I'd react like you and I'd definitely discuss it with my supervisor/superiors.
The relationships formed with your GP/dentist tends not to be at the same psychological depth as with a therapist though! So I don't really think you can make that comparison.

I would also hope that a good therapist who has spent time with their client would be able to effectively assess how their client would view and process the receiving of a gift.

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miriam
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Re: Therapist giving presents to patients

Post by miriam » Sat Dec 28, 2013 3:05 am

I respect the difference of opinion, and its always good to hear different perspectives in discussions.

However, I do think the relationship with a therapist is different to a doctor or dentist due to quantity/frequency and the intensity - you don't tell your dentist your life story and the ins and outs of your feelings and relationships for an hour a week for months or even years. But I don't think being given chocolate in a physical health setting would be odd. In fact the Round Table used to donate hundreds of selection packs of chocolates to be given to patients with appointments in the xmas week when I worked in a hospital paediatrics department and no-one reacted as if that was weird at all.
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lizzabadger
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Re: Therapist giving presents to patients

Post by lizzabadger » Sat Dec 28, 2013 10:07 am

Seems a bit different with children, though? And not a personal gift from the clinician, just something generic from the Round Table so not much room for misinterpreting.

msrisotto
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Re: Therapist giving presents to patients

Post by msrisotto » Sat Dec 28, 2013 2:05 pm

It would depend on the individual client and surely if you knew them well enough to be thinking of giving them a gift, then you would already have assessed whether it would be well received.

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miriam
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Re: Therapist giving presents to patients

Post by miriam » Sat Dec 28, 2013 8:58 pm

lizzabadger wrote:Seems a bit different with children, though? And not a personal gift from the clinician, just something generic from the Round Table so not much room for misinterpreting.
So, if a therapist gives a lindt chocolate bunny to each person, that is different in meaning than if the therapist hands over a selection box paid for by the round table? Surely that difference only rests in any explanation given. If both were given with a "happy christmas, see you next time" they'd be the same thing :?
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workingmama
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Re: Therapist giving presents to patients

Post by workingmama » Mon Dec 30, 2013 1:14 pm

As folks are debating above, it dependes very much on the individual relationships and the context, and the consideration that has been put into the meaning etc of the gift giving etc.

It links to thinking I've been doing this last 6 months about 'what kind of CP might I be', and thinking about where I'm similar/different in how I'd like to practice compared to supervisors/colleagues. I think I'm probably more 'blunt' (can't think of the right word right now - I mean that I'm quite open in sharing my process whilst thinking/working compared to some colleagues that I talk to), but I'm probably more open to the idea of being open in other ways, like gift giving, or touching (this would need a longer explanation before someone calls the HCPC! :lol: ). I don't at the moment, because I'm too new to training to feel that I'm able to think through all the permutations and consequences, but I know that I'd like to sometimes.
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lakeland
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Re: Therapist giving presents to patients

Post by lakeland » Mon Dec 30, 2013 1:43 pm

I've found this thread really timely for me, as a couple of the young people I work with have given me presents and cards for Christmas. It feels a bit awful not getting them something in return, but I have so many children on my caseload that I wouldn't be able to get them all something, and wouldn't want to pick favourites. Similarly, I'd worry that if I gave everyone a gift (even a small one), they might feel obliged to reciprocate, and it might seem like I'm soliciting for presents.

However, I have given birthday cards out in this job, particularly to children who I've been discharging because they are 18, and have often enclosed a therapeutic goodbye letter within the card - so my rules are not fixed!

I do think, for me, there is a difference between a gift donated by charity and a gift paid for from the therapist's own pocket, the latter seems much more personal to me, and therefore perhaps more likely to be misinterpreted (by the client or other professionals)?

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