The Gift Dilemma: When Boundaries and Gratitude Collide in Therapy

Written by [Haythem Lafhaj]

A client offers you a small gift—perhaps a thank-you card, homemade cookies, or a cultural token of appreciation. Do you accept it? Ethical decision-making around gifts isn’t black and white. It’s situational, relational, and deeply cultural.

Knox (2008) emphasizes that rejecting a gift without context can damage rapport, while blind acceptance may blur boundaries. The therapist must assess: What does the gift represent? Is it part of a relational ritual? Is it tied to a cultural expectation?

Using the SLEEPP model, we can analyze the sociocultural meaning of the gesture, the ethical implications of acceptance, the power dynamic involved, and how we communicate around the decision. Ethical practice doesn’t require rejecting all gifts—it calls for thoughtful reflection and transparency.

As PLMFTs, we must develop a stance that honors gratitude while protecting the integrity of the therapeutic frame. That might mean accepting the gift and naming its significance—or respectfully declining while affirming the client’s generosity.

References:
Knox, S. (2008). Gifts in psychotherapy: Practice review and recommendations. Psychotherapy, 45(1), 103–110.https://doi.org/10.1037/0033-3204.45.1.103