Here’s a dilemma — should you give your mental health therapist a gift? On the surface it sounds straightforward, but you probably already know therapy is often anything but straightforward.
Your therapist probably knows more about you than anybody else. They’ve seen you cry, can handle big emotions, are your biggest cheerleader and provide a safe space for you to explore just about anything. But the reason this relationship feels so supportive is because your therapist holds strict boundaries — you likely know little about their personal life and you can’t call them up on a whim like a friend, for example.
So what does this mean if you want to give your therapist a gift?
To find out, we went right to the source and asked 10 therapists what they think. It’s certainly not required or even expected you give your therapist a gift, but if you’re considering it, here’s what they told us about receiving gifts from clients:
1. Daniela Paolone, LMFT, Psychotherapist, Westlake Village Counseling
Accepting gifts is something I have to weigh with each specific client because their therapy goals, presenting concerns and cultural norms all need to be taken into consideration. If the client giving me a gift reflects a continuation of problematic behavior that they are wanting to address and manage in therapy, then me accepting the gift would not be clinically appropriate.
I am more likely to accept an inexpensive gift since the gesture hopefully reflects the great therapeutic relationship we have. Also with certain cultures and traditions, not accepting a gift can be interpreted as a deep insult to the client and can actually negatively impact the therapeutic relationship. Regardless of the relationship and therapy goals with a client, the act of gift giving can also lead to greater and deeper conversations in therapy.
I personally do not feel comfortable receiving money or gift cards from clients as that for me feels like it could complicate the therapy work and our working relationship during sessions. I will not accept expensive gifts for the same reason. I also worry that accepting these types of gifts may been seen as a possible gray area when thinking about the ethical guidelines outlined by my licensing board.
Related: 9 Mental Health Inspired Holiday Gifts
2. Annie Wright, LMFT, Psychotherapist, Founder of Evergreen Counseling
Rule of thumb: It’s totally fine as long as the value of the gift is less than the cost of a therapy session. Ethically, a therapist can accept a gift from a client if, say, the client gives the therapist a book or homemade painting or even a Christmas ornament (all of which would, presumably, be less than the average cost of a therapy session).
But if a client tries to gift the therapist a weekend at their Tahoe timeshare or a rare, vintage bottle of wine or front-row tickets to “Hamilton,” ethically the therapist can’t accept a gift of that much value due to the limitations of our licensing laws and ethics.
And also be prepared to talk with your therapist about how it feels and what it brings up for you to give your therapist that gift because many therapists will likely try to encourage that dialogue as part of your clinical work together.
3. April Foreman, Ph.D., Psychologist
In my experience, you can’t go wrong with a holiday card, one in which you write about the work that you are doing and your therapist’s importance to you in your life. I have carefully removed or blanked names in cards so that I could keep them, and on hard days at work I’ve looked back at cards from my clients over the years and gotten a real lift.
The truth is that my clients mean a lot to me, and these are important relationships that I must keep private and secret, so a card is a nice way to remember. They are also easy to keep, and if the cards do not leave your office, easy to store in HIPAA-approved ways. I have received poems, essays, funny jokes or little drawings in cards. They have so much meaning for me. Cards are, by far, the most appreciated thing someone could share with a therapist (if you feel so inclined).
4. Lacrisha Holcomb, MA, LCASA, NCC, Psychotherapist, Founder of Therapy Is Light
From an ethical perspective, gift exchanges are permitted under appropriate conditions such as the client (and therapist) having healthy boundaries and the gift being a genuine display of professional appreciation with just a sprinkle of, “We’re both human beings figuring this life thing out.” Of course, clinical discernment must be used to make sure that the therapeutic relationship is not compromised, and motivation for giving or receiving a gift is sincere. It is important to ensure that we do not exploit the client’s emotional state or misuse power.
A good rule of thumb that I’ve frequently heard (and it may fluctuate from state to state or by agency) is that a gift either to or from a client should be between $5-$15 (with anything over $25 pushing it). One of my clients actually got me a simple Christmas card and it was perfect! There wasn’t much written in it, and it was truly the thought that counted. She wrote, “Merry Christmas and thank you for the wise counsel.”
In my personal opinion, gifts such as a card, coffee mug, journal, pen — anything that could be used for professional or therapeutic purposes/reinforcement — are safely considerate!
5. Robert Vore, MS, APC, NCC, Psychotherapist
I’d consider the following if a client offered me a present:
1. Is it of substantial value? If so, I’d have to decline to make sure there wasn’t any ethical questions about payment, feelings of resentment or other things like that.
2. How would it impact the relationship? Given how important the therapeutic relationship is, this is super important. For example, is it someone who struggles a lot with feelings of rejection? How could it be taken if I turn it down (obviously as politely as I can)?
In general, gift giving is somewhat discouraged in case it’s something valuable or could complicate things, but I think some things that are smaller or are important to the relationship are OK. It’s almost entirely up to the therapist if they want to accept it (or feel like they can ethically).
6. Crystal I. Lee, Psy.D., Psychologist and Owner of LA Concierge Psychologist
Many professional ethics codes discourage or outright ban therapists from accepting gifts from their clients. This is because gift-giving can blend the boundaries between a professional relationship and a personal relationship. Therapy is already such an intimate relationship with the client being very vulnerable and talking about difficult thoughts and feelings. Anything that blurs the boundaries can harm the therapeutic relationship. If a therapist doesn’t accept a gift from you, please don’t interpret it as a rejection.
That being said, many therapists will accept inexpensive gifts from clients (less than $20 monetary value) if they are given one. We may realize that, in your culture, it would be offensive for us to not accept a gift. Some therapists may feel that declining a gift would cause undue damage to the therapeutic relationship. Before going out and getting your therapist a gift, it’s probably best to ask them what their gift policy is. It would save you some guessing and allow the therapist to explain whether or not they can accept gifts from clients.
7. Joan Goodman, LCSW-C, BCD, Psychotherapist and Founder/President of Adolescent Self Injury Foundation
Let’s begin with my saying that I do not expect patients to give me gifts. Yet, there have been times when patients have given me a gift. On theses occasions I do accept their gifts, as I am concerned that not doing so would be counter-therapeutic. I believe saying no to the gift would be construed as a form of rejection, and could muddy the waters of the therapy and the therapeutic alliance.
If I am given a gift I will ask their permission to open it in front of them right at that moment. This allows me to express my joy in front of them. I will always make every effort possible to keep a gift given to me in my office on display, so that this patient can see it when they come to the office. It instantly becomes a positive “bonding” moment for the therapist and patient. It opens a door to learn more about the patient … as well as the meaning of the gift chosen by the patient to give the therapist.
8. Sari Skolnik, Ph.D., LCSW, PAT, Assistant Professor, Clinical Practice, Yeshiva University’s Wurzweiler School of Social Work
This is a complicated question with no definitive answer, but there are some things to take into consideration. Gift-giving blurs the lines of a therapeutic relationship by turning a professional relationship into a different type of relationship — one that is more similar to what you would do with a friend or family member.
What it comes down to is an issue about boundaries. Many agencies create policies that don’t allow therapists to accept gifts, but it is important that the therapist proactively address this dynamic by either stating in the beginning that it is their personal policy not to accept gifts or that it is agency policy. This prevents a potential issue later on. However, if there is no issue with giving your therapist a gift, baked goods, a card expressing your feelings and gratitude for your therapist or even a plant are all appropriate gifts to give.
9. Debra Kissen, Ph.D., MHSA, Executive Director of Light On Anxiety Treatment Center
Personally, I think there’s just something rude and disingenuine about not accepting a thoughtful gift and I think it can hurt. I think all of us can imagine how that feels if you put some thought and want to express your appreciation and someone does not accept your gesture.
I suppose if it were a love note that didn’t cost money but it hinted at a different kind of relationship, [I would not accept the gift]. It would not be about the gift as much as a lack of understanding of what the therapy relationship is about. That’s a bigger situation than just a gift.
If I knew something didn’t cost an excessive amount of money or was not a family heirloom but something that somebody put thought into, I have a hard time imagining it not doing more harm than good to turn away a gift of small monetary value based on my practice philosophy.
10. Sarah Schewitz, Psy.D., Psychologist at Couples Learn
If somebody wants to get their therapist a gift, something great is a plant for the office or even just a heartfelt card saying how much we’ve impacted you is the most meaningful. We love getting those. Little stuff maybe that’s related to office or something edible that’s not super expensive is great, or like a coffee mug. If it’s too large, it becomes we can’t accept it.
We’re human, you know? We want to have a good relationship. We like most of our clients a lot. We look forward to spending time with them. … Several clients gave me cards thanking me and it was so nice. I think that’s honestly the best thing you can do for your therapist. Most of us do what we do because we like making an impact on people’s lives, so getting that validation and feedback is worth millions of dollars to us just as far as how good it feels.
Also, it’s up to your therapist to keep the boundaries. I wouldn’t worry a ton as a client about, ‘Is this appropriate or [are they] going to be able to accept that?’ Let them worry about it and do what feels good for you. Your therapist will hold whatever healthy boundaries are necessary and do it in a loving way so you don’t feel rejected.
Additional reporting by Sarah Schuster, The Mighty’s mental health editor.