Thinking Outside the Gift

A Story of Navigating a Tricky Ethical Issue Creatively

Lisa Ferentz

What do you do when a client you’ve worked with for years shows up with a holiday gift that’s inside a beautiful, light-blue Tiffany box? And as she hands you the gift, what if she says—without a hint of manipulation—“I know that you’ll tell me that you can’t accept this, but it will break my heart if you don’t keep it.”

Most therapists have a policy about receiving gifts. Some will accept a gift if it’s under a certain dollar amount. Some won’t accept a gift under any circumstances. Some will accept a gift but make it clear that it’ll be put in the waiting room and shared with everyone. Up to this point in my career, I’d been confronted only with a small candle and a few homemade cards. In each case, it seemed appropriate to accept the offering graciously and move on with the session.

I was completely caught off guard by the Tiffany box that my client, Dawn, had handed to me. But I knew two things: I couldn’t keep whatever was in it, and I couldn’t simply hand it back to her unopened, either. After she’d done so much work in therapy over so many years, resolving a lot of childhood trauma, I didn’t want to rekindle old feelings of rejection and shame. Yet as we sat down together and I lifted the lid, my eyes grew wide.

Inside was an exquisite, heart-shaped gold pin studded with diamonds—real diamonds. Once again, I had two thoughts: I have a dress that would go perfectly with this, and How the hell am I going to navigate this one? I want to emphasize that if she’d handed me a chocolate-chip cookie or a loaf of zucchini bread, I wouldn’t have had an issue. But this was an elegant and expensive piece of jewelry.

“You’ve been so kind to me for so long,” Dawn said, leaning forward. “You never judge me, always support me. I feel like you’ve given me a piece of your heart, and I wanted to give you a small piece of mine.” Dawn had been horribly emotionally and physically abused by her father throughout childhood and never protected by her mother. Throughout her 20’s, feeling invisible and worthless, she landed in several emotionally abusive relationships and silently struggled with depression and anxiety. I’d been working with her for eight years, and she’d been making great progress. She was managing her depression well, feeling confident living on her own, and volunteering at a local elementary school. She was unhappy in her job at a science lab, but was beginning to pursue an advanced degree, hoping to change jobs in the near future.

I was genuinely moved by her gift—and genuinely at a loss. Picking it out clearly demonstrated tremendous thought, and even love, on her part. “Thank you, Dawn. I’m so touched,” I said sincerely. She beamed, sitting up straighter on the couch. Taking a deep breath, I continued, “But you know that I can’t keep it.”

At this, Dawn’s body slumped. A look of pain set in around her eyes, reaffirming my fear that refusing her gift would be devastating for her. I could feel my palms getting moist as I held onto the box. I was flying by the seat of my pants, with no strategy or precedent to work from. “Dawn,” I said, hoping to find a way forward, “would you be willing to share with me why you thought I was worthy of such a beautiful gift?”

Without missing a beat, she rattled off a long list of loving qualities she felt I possessed and had shared with her, so many that I began to blush. What now? Where could we possibly go with this? Then, watching this client I’d known for such a long time, who’d done such powerful trauma work with me and had such a gentle, fragile heart, I had an epiphany. I put my hand up, pausing her in mid-sentence, and asked, “Would it be okay if we wrote some of those qualities down?”

With this request, she looked at me strangely, but given our safe and trusting relationship, she went along with it, perhaps thinking I was in need of some extra affirmation that day. I handed her a large sheet of white paper and with great speed and alacrity, she wrote down phrases like never judgmental, always unconditionally kind, makes negative thoughts more positive, tells me I have worth. I remained silent as she wrote. After she’d scribbled about 10 phrases, I told her that was plenty.

“Here’s what I’d like to do,” I said, sounding more confident than I felt. “I can’t take this gift home with me, but I’m going to lock it in the bottom drawer of my filing cabinet here in the office. And then I’d like to propose that you and I work together, for however long it takes, to help get you to a place where you believe that everything on that list describes you. Then, you’ll be ready to claim this gorgeous pin.” It seemed like a pretty good idea, considering I was thinking on my feet.

“Well, that sounds like a pretty stupid idea,” Dawn quickly said, with more anger than I’d seen from her in a long time. She sighed in frustration, broke eye contact, and slowly shook her head. “It’s certainly not what I was hoping for,” she added. I anxiously waited out this reaction, hoping she’d soften to the idea. Finally, given that we had such a safe and trusting relationship, she begrudgingly agreed.

So we locked the pin away and got to work on developing greater self-compassion and a stronger ego. Over the next several months, we reframed her self-criticisms to reflect the strengths that others saw in her. We chipped away at the shame and self-blame that were byproducts of her trauma. It was hard work, and sometimes her determination flagged. But she kept at it. After a few months, she even managed to extricate herself from her toxic workplace and was surprised by the quiet pride that opened up inside her. We moved on to help her set better boundaries with dysfunctional family members, and l gave her lots of homework assignments that focused on self-care.

There were still many times when Dawn struggled with self-confidence, particularly as she approached the work required for her master’s degree. Despite her great intelligence, she questioned her abilities, didn’t believe she had anything worthwhile to contribute in class, and felt too anxious to ask her professors for help when she needed it. This added layers of unnecessary stress and often impacted her sleep. Several times I felt the potential setback coming as she contemplated leaving the program, but she stayed with it.

Then a particularly pivotal moment occurred one day when I congratulated Dawn on her ability to speak up and set limits with a friend who was regularly taking advantage of her. For the first time ever, she maintained eye contact with me as I pointed out her success. She made none of her customary attempts to minimize, rationalize, or deny the compliment. She even nodded her head, ever so slightly, in agreement. It was a giant step in her ability to embrace an expanded and more loving narrative about herself.

Almost a year later, Dawn sat down in my office one day and asked, “Can I see that thing in the bottom drawer?” If I’d had a soundtrack playing in my office, this was the point where the strings would’ve swelled and a dramatic drumroll would’ve rumbled through the air. It had been an arduous journey to get to this point, full of ups and downs. I tried to act as nonchalant as she did, but my heart was pounding with excitement.

As calmly as I could, I took the Tiffany box out of the drawer and ceremoniously placed it in her hands. Dawn opened it slowly, with great care, and looked at the pin for a long time. She even picked it up and gently traced the outline of the heart with her finger. Then, she closed the box and handed it back to me. And that’s when the soundtrack would’ve gone wah-wah-wah.

A few weeks later, Dawn came to our session clad in an elegant, stylishly cut red dress. Beyond the dress and the artful upsweep of her hair that showed off the soft features of her face, there was something new, even fresh, about her. Maybe it was the heels, I thought, but even sitting on the edge of the couch, she appeared taller, the usual hunch in her shoulders momentarily gone. Since it was mid-December, I asked if she were going to a holiday party.

“No,” she said, a small smile playing at the corners of her mouth. “I just thought this dress would look nice with my pin.”

This time, I helped Dawn fasten it on, and it sparkled and glowed, just as she did.

So here’s what I’ve learned: sometimes, clients give us the gifts they want for themselves but don’t feel worthy of receiving. And sometimes, by helping them see the attributes in themselves that they admire in us, we can help them reconnect with those qualities. And I also learned that sometimes, making a difference means thinking outside the box—especially if it’s a beautiful, light-blue one from Tiffany.


This blog is excerpted from "Thinking Outside the Gift" by Lisa Ferentz. The full version is available in the May/June 2017 issue, What Now? Five Therapists Face the Limits of What They Know.

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Topic: Creativity | Ethics

Tags: 2017 | Challenging Cases & Treatment Populations | ethical | ethical and legal issues | ethical boundaries | ethical issues | ethical professional | ethical therapist | Ethics | gift giving | gifts | Lisa Ferentz | Networker Symposium

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1 Comment

Monday, July 10, 2017 5:08:27 AM | posted by jennifer
Thank you a lot! Very useful article and good tips.