Thank you to everyone who responded to our December Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
December Quandary: I know that accepting gifts from clients is an ethical no-no, but when my client Asha recently gave me a homemade necklace (a shell she’d found on the beach and strung on a piece of leather), it seemed innocuous enough to thank her and keep it. Now she asks about it at almost every session, wondering why I’m not wearing it and if I still like it. Asha and I have been working on her attachment issues, a likely result of childhood neglect. I think I can turn my error into a therapeutic teaching moment, but I also worry that by offending her, I may lose her as a client. What are some ways I can best handle this?
1) Gifts Symbolize Different Things for Different People
Asha offered her therapist a small gift—the work of her hands. I would’ve accepted it as well. It’s clear that Asha cares a lot about her therapist, and this was her way of showing it. It feels good to give and show affection to those we care about: accepting the gift is a gift to Asha in itself.
If I was this therapist, I’d wonder if Asha’s repeated questioning about the necklace is her way of making sure I still accept her. After sharing their problems and foibles with us, it’s only natural for clients to wonder if they’re still loveable and acceptable human beings. Maybe this is Asha’s way of asking this question.
I might start our next session by reaffirming the importance of Asha’s gift before she brings it up, perhaps saying something like, “I wore your necklace the other day, and it made me smile. I really enjoy your beautiful handiwork. Gifts symbolize different things for different people, and I’m wondering what it meant for you to give me this gift?” After she answers, I might follow up by asking whether she gives gifts often, how others have responded when she’s given them gifts, and what her family’s experience with gift-giving has been. I’d also ask what these questions bring up for her. Hopefully, they’ll allow us to do some further exploration.
Jan Canniff, LMHC
Friday Harbor, WA
2) Be Grateful and Proud
If you accept a gift, then show the client that it’s important to you. It’s clearly a transitional object that Asha would want to see when she’s with her therapist. I’d proudly display the necklace in my office as a piece of art. I might hang it on my office wall, drape it over a picture frame, or hang it a doorknob. This way, Asha would know I care about it and that I’m keeping it in the space where it was given, not as something to be brought into my personal life, but as part of our shared space.
I wonder if it’s necessary to process Asha’s question therapeutically. If she asked about it, I’d let her know that other people comment on it (if they do) and that I admire it (if I did). If I thought it was lovely, I’d tell her. Her necklace is art, and I think displaying it is the equivalent of hanging a child's drawing on your refrigerator. I’d keep it displayed in my office where both of us can be proud of it.
Tammy Nelson, PhD
3) Help Asha Have a Conversation with Herself
In my opinion, accepting Asha’s necklace wasn’t a mistake. Rejecting a handmade gift like this could’ve been more injurious than her therapist’s decision not to wear it.
If Asha was my client, I’d first acknowledge the courage it took for her to speak for parts that are disappointed or hurt by me for not wearing the necklace, which isn’t an easy thing to do. I’d let her know that I’m touched by her thoughtfulness and sad that my actions have disappointed her. I’d ask what she’s noticing in her body as she talks about this, and ask how she’s reacting to my appreciation of her courage. I’d invite her to be curious about the part of her that decided to make and give me the necklace. What was this part hoping for? Does it want to say anything to me? What might Asha have believed about herself if I’d worn the necklace? What does she believe about herself now?
I’d also want to ask Asha about her earlier experiences with gift-giving, and whether this experience with me is similar to any of them. When I didn’t wear the necklace, were any of her beliefs reaffirmed or overturned? My hope would be to help Asha process this in a way that leaves her more mindful in the future when it comes to giving gifts and expressing tender feelings for others.
Tish Miller, LCSW
4) Don’t Be Overly Clinical
Personally, I don’t believe accepting gifts from clients is always a no-no. There are limits, of course, but I don’t think this is a case where the gift should be refused.
I also believe the quickest way to offend, if not lose, Asha is to take a “clinical” approach with her when she asks about the necklace by reflecting her question back to her, for instance, keeping the focus off myself. Maybe Asha doesn’t know how to articulate what she’s feeling when she asks about the necklace again and again. She does, however, trust her therapist enough to show through her behavior, This is how I’m hurting. This is how I’ve been forced to say, indirectly, what I need. A lack of secure attachment can manifest itself in all kinds of ways.
Instead of taking an impersonal, clinical approach, I’d suggest trying to be as genuine as possible, or what some person-centered therapists refer to as “meeting at relational depth.” In this case, I might say something like “Asha, your gift was thoughtful, and I deeply appreciate it. I think I know you well enough to know what giving me this gift might mean.” Next, I might tell her about something we’ve talked about that reminds me of her gift, including the deeper meaning that surrounds it.
Jeffrey Von Glahn, PhD
Ann Arbor, MI
5) Don’t Shy Away from Pointed Questions
I think it’s disrespectful to refuse small gifts from clients, especially if they’re handmade. Sometimes our emphasis on maintaining professional boundaries has more to do with the therapist’s discomfort and reinforces a hierarchy that’s detrimental to the therapeutic relationship. Accepting Asha’s gift and thanking her for it shouldn’t be viewed as an error, but an opportunity to explore an important issue in Asha’s life in real time. I might not give a full explanation the first or second time Asha asks about the necklace, but if she asked a third time, I’d want to address it.
There are several ways to do this. One way would be for me to say, “You know, Asha, this is the third time you’ve asked me about the necklace,” and see if she has some insight into why she’s asking about it. She might respond with something like, “I just wanted to know if you wore it,” which tells me she might be reluctant to look into the meaning of her behavior. I could also ask something like, “Do you think that me not wearing your necklace means you’re not important to me?” Asha could deny feeling this way, which might also show that she’s reluctant to examine things deeper, or she could acknowledge that she feels this way, which would give us an opportunity to explore further.
There are also more pointed ways to ask about Asha’s question by saying something like, “If told you I didn’t wear your necklace, what would that mean to you?” Or, since Asha’s attachment issues have been covered in therapy, something like, “Do you think your concern about my wearing the necklace has anything to do with the topics we’ve been discussing?”
Jessica Heriot, PhD
We'll post a new response to each Clinician's Quandary on the first Tuesday of every month! See how to submit to next month's Quandary here.
January Quandary: I’ve been seeing Mark and his wife, Nicole, for couples therapy for almost six months. Mark recently requested an individual session, during which he revealed he’s been chatting online with an old girlfriend and even met her for once drinks when Nicole was away on a work trip, at which point they’d shared a kiss. He says he’s still committed to doing couples work, regrets the kiss but not the rekindled friendship, and has asked me to keep the whole thing a secret. What should I do?
Photo © iStock/AaronAmat