Academic journal article American Journal of Psychotherapy

Reflections on Gifts in the Therapeutic Setting: The Gift from Patient to Therapist

Academic journal article American Journal of Psychotherapy

Reflections on Gifts in the Therapeutic Setting: The Gift from Patient to Therapist

Article excerpt

Since Freud's time, psychoanalytically oriented therapists have been wary of accepting gifts from patients, although they have done so in some circumstances within the sanctum of their offices. After providing a working definition of the word "gift" for the purposes of this clinical discussion, the article reviews the relevant literature on the subject. The author presents clinical material in which he describes how gifts were presented by patients within the context of their treatment processes. The article concludes with the author's attempt to define some of the variables that affect the response of the therapist to a patient's gift, and expounds on those variables in terms of their influence on technique.


While explicitly warning against gift exchange, both from patient to analyst and vice versa, Freud often accepted gifts and special consideration from patients through all stages of treatment (1). For example, one patient presented him with an express letter from the Minister of Education, announcing Freud's appointment as professor (2); other patients gave Freud books (3). Subsequent analysts espoused the party line against the exchange of gifts, although within the confines of their offices, they probably allowed exceptions. The results of Glover's questionnaire document this ambivalence on the part of therapists (4). This paper aims to elucidate the complex feelings within the therapeutic dyad that often accompany the presentation of a gift, and aims to discuss some technical implications of the matter.

The Oxford English Dictionary defines the word "gift" as follows: "something, the possession of which is transferred to another without the expectation or receipt of an equivalent; a donation, present" (5). Stein outlines the derivation of the word in several different languages, pointing out that connotations of the words for "gift" in Spanish, German, and Greek range from generous giving to poisoning to a binding of the receiver. She also provides a cultural history of gifts, noting that exchanges have not been exclusively of tangible items, but also of rituals and courtesies, often with reciprocation. The American Indians, for example, practice a kind of obligatory gift-giving that requires a group to give and to receive (6).

Clearly, there are advantages to defining a "gift" narrowly, as a concrete object given voluntarily from one party to another, without expectation of compensation. However, on the shifting terrain between therapist and patient, a gift can be understood to be greater than the object itself, to exist metaphorically when there may not be a tangible object given at all, and to have reverberations long past the moment when it is given from one to the other. Such gifts may be accompanied by other communications from the patient, some of them stated explicitly, and some that remain to be discovered by patient and therapist. It is from this latter vantage point that I hope to explore the meaning of the gift from patient to therapist in the therapeutic setting.


The debate about gifts and technique has been conducted on several levels. Langs views gift acceptance of all kinds-with the exception of a gift given by a suicidal patient-as pathologic and indicative of partial gratification of the incest taboo (7). Others state it differently and emphasize that gift acceptance often represents a countertransference error on the part of the therapist (8-10). Still others have attempted to isolate variables that determine whether or not acceptance is of therapeutic advantage:

1. The Size and Content of the Gift

Some argue that accepting small, modest gifts, is benign (9, 11, 12). Almost all are in agreement that accepting large, costly gifts would be unethical, and would constitute improper technique (4, 9, 13). Many also point out that gifts that are too "personal" to the therapist, such as a piece of clothing, or gifts that are too provocative, such as a pornographic film, should be rejected (14). …

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