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Summary
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A reader wants to give a handmade quilt to a long-term therapist who has provided free sessions for two years. They ask whether a gift is an appropriate way to express gratitude.
The response treats the wish to express appreciation as understandable and distinguishes offering a gift from the therapist’s responsibility to decide whether accepting it fits the therapeutic relationship.
It discusses how free treatment and gifts can create feelings of obligation, and encourages an open conversation about the gift, gratitude, and the reader’s ability to express all feelings in therapy.
Question
Reader · Identity withheldI have had the same therapist for more than 15 years, on and off. This therapist has recently been seeing me for free, well, not recently, rather for the past 2 years. I want to do something to show her how thankful I am. My mother made a quilt for her, and I’m just about to give it to her, but I’d like to know is it appropriate for me to do this?
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Answer
Allan Schwartz, Ph.D.That is a wonderful question and I am so pleased that you wrote to us so that we may discuss the issue.
\nFirst, the question is never if it is OK for the patient to give a gift but, rather, is it OK for a therapist to accept a gift. Well, like so many things in life, the answer is complicated. There is nothing wrong with a patient giving a gift to a therapist so long as it is nothing sexual or harmful in nature. From what you have written you want to give a gift as a way of expressing your appreciation for your long time therapist seeing you for free. It is certainly understandable that you want to express your gratitude and appreciation. It seems that your mother made a quilt and that makes the gift extra special because of the work it took to produce this quilt.
\nShould a therapist accept a gift? I believe that most of us in the field of providing psychotherapy services would accept a gift for the first time it is offered but discourage it thereafter. It would be rude and hurtful to refuse a gift, especially in this case.
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What is particularly difficult is that your therapist, out of compassion for you, offered free psychotherapy.
\nShould a Therapist offer free psychotherapy?
\nWhile it seems to be the charitable thing to do to offer free psychotherapy it creates difficult situations for therapist and patient. How can patients not feel indebted to a therapist for free services? As a result, can a patient feel that he or she has the right to express anger at the therapist when issues come up? It is hard enough for many people to express anger without the complication of feeling indebted. In your case, the offer of a gift to the therapist has to do with feeling you owe her something.
\nOf course, patients offer gifts for many reasons that have nothing to do with the cost of therapy.
\nI subscribe to the idea that therapy has as its purpose putting things into words. This includes all types of feelings and fantasies about the therapist. The therapist must be able to listen to and accept the patient whether they are expressing loving or hateful feelings.
\nConclusion:
\nYes, I believe there is nothing wrong with you offering this lovely gift to your therapist. I do hope that the two of you are able to discuss the gift as well as the free therapy in a way that is open and honest.
\nRemember, the method of therapy, of whatever type or variety it is, is to talk and not to enact or \"do.\" So, enjoy giving the gift but talk it over or, at least, I hope your therapist talks it over.
\nBut, no, you are doing nothing inappropriate.
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