In the category of Professional Orientation & Ethical Practice on the National Counselor Examination (NCE), the Counselor Preparation Comprehensive Examination (CPCE), or another counseling exam, you might come across the ethical dilemma of accepting gifts.
Whether a therapist can accept gifts from a client might not be as straightforward as one would hope. The cost, setting, and intent must all be considered. Therapists also need to understand their drive for accepting the gift. We explore all of these in this video.
There is not an easy yes or no answer to whether a therapist can accept a gift from a client. Below, you’ll find various points to help you make this decision. Importantly, you’ll want to consider all of the points below (and likely some others) before you decide whether to accept a gift or not.
What does the ACA Code of Ethics says? In code A.10.f., the ACA Code of Ethics states “Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift.”
Consider Costs – We must consider the cost of the gift that a client is attempting to give us. If they’re giving us something small, like a Christmas card, the cost incurred by the client for this is likely minimal. However, if they’re wanting to give us a new car as a token of their appreciation, this would represent a significant expense for the client. As far as I am aware, there is no specific dollar amount that classifies a gift as “small”. However, most will consider a cut off of somewhere around $20 dollars.
Site Policy – Some sites may say that therapists cannot accept a gift from a client. Under no circumstances would it be allowed. It won’t matter whether they’re wanting to give you a card or a car, the answer will have to be no. Other sites may say that it’s acceptable if the gift is under a specific dollar amount. Whereas some locations might state that it’s left up to the therapists discretion. Either way, it’s important to be aware of your site’s policies related to gifts.
Sharing Gifts – At some sites, the therapists will share the gifts with all the therapists at the site. For example, they may place a book in the site’s library or put baked goods out where other staff can enjoy it.
Consider Confidentiality – Keep in mind, a gift may inadvertently breach confidentiality. Therefore, if you accept a gift from a client, they should not be kept where other clients or people can see them. In some cases, a gift (such as a card) may be able to be placed somewhere that other therapists can view it, but any identifying information should be obscured. In other cases, such as if a client sends flowers, we may remove the card with the client’s name entirely before placing it where others can see them. We should also keep in mind that things such as cards or letters from clients should also be stored or destroyed according to the site’s policies as to not expose personally identifiable information.
Consider Client Intent – As the ACA’s code states, a client’s intent may be cultural. Clients may bring a gift as a token of appreciation or respect. However, some clients may bring gifts to attempt to reduce feelings of guilt they feel for accepting your help, or to try to compensate for feeling they have burdened you with their problems. Other clients may bring gifts as a means of manipulation—perhaps to feel they will be in your good graces, or to encourage you to have more positive thoughts related to them.
Personal Motivations – As the therapist, we might also have our own motivations for accepting or declining gifts. This could include feeling awkward accepting or declining a gift. Meaning, we might not want to accept or decline a gift to avoid the discomfort of that conversation. I think most would say that our personal feelings of discomfort in accepting or declining a gift should be put to the side and not influence our decision.
Additionally, we have to recognize that we might be called to accept gifts because of what the gift is. Of course, that new car would be fantastic. Or maybe the client is wanting to give us a book we’ve really been wanting to read. Additionally, we might also want to decline a gift because it’s not something we like or are interested in. Whether it’s that we want to accept or decline the gift because of our own personal feelings, these again should be put to the side. Remember, as the therapist, we’re there for the client. We are the professional in the room, which will often require us to set our own personal feelings aside.
Therapeutic Reasoning – That brings us to therapeutic or clinical reasons for accepting or declining a gift. This is an important area to pay attention to. Combined with the other areas we’ve discussed, we’re going to be able to make more informed decisions through the lens of therapeutic reasoning. For example, let’s say a client wants to give us a greeting card for the holidays. Assuming there is no site policy against prohibiting this, and because the cost is minimal, in most cases it would be a good idea to accept this. To not accept this could negatively impact the therapeutic relationship. However, let’s say you have a client who keeps bringing letters and cards expressing their gratitude for your help. In this case, it might be good to explore their motivation for the card or letter. Many would likely also set a boundary around this and why they can’t accept them.
When we reason the gift through our therapeutic reasoning, this means that we’ll be looking at the pros and cons of accepting the gift. Not only that, but we’re doing so in the context of what we know about the client. This might be a good time to consider that it’s often safe to assume that what a client does in our office is also what they’re doing outside of it.
Consider the Influence – Earlier, I brought up the example of a wealthy client wanting to give a car to the therapist. Let’s say that in this case, the client is so wealthy this would not be a financial impact for them in any way. Does that mean we should accept the gift? Well, probably not. Remember, by us accepting the gift, it might shift our feelings about the client. It might make us feel we have to be more gracious or accommodating, and result in us treating the client differently than others.
Show Appreciation – If you decline a gift from a client, expressing appreciation for the gesture might be helpful. Let them know that it means a lot to you that they thought of you and went out of their way to get the gift.
Suggest an Alternative – If you have to decline a gift from a client, you might suggest an alternative. Maybe you can’t accept the letter they want to give you, but maybe you can discuss what they were wanting to tell you in the letter, or perhaps you can read it in session and give it back to them. Or, maybe they could donate the book they were wanting to give you to the local library.
Explain Why – In some cases, it could be helpful for the client to know why you can’t accept the gift. This might be a good time to discuss the ethics of accepting gifts. For example, you might explain that you aren’t able to accept gifts in all situations, so to be fair to all your clients, you can’t accept gifts from any.
Reference Site Policies – Similarly, you may blame or reference the site policy. For example, you might let the client know you appreciate the gift and gesture, but that, unfortunately, the site policy prohibits accepting gifts from clients.
Discuss Consequences – Related to both the ethics and policy, it can be helpful (in some situations) to discuss with your clients the possible consequences of you accepting the gift. For example, you may explain that if you were to go against these, it would risk your license or job. In that case, if you were to lose your license or job, you would not be able to be their therapist any longer.
Process the Experience – It’s often a good idea to process this experience with the client. Allow them the space to discuss what it’s like for them to have their gift declined. You might explore what feelings come up for them, and validate their experience.
