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Can Healthcare Workers Accept Gifts?

Can Healthcare Workers Accept Gifts
Even though patients often want to give healthcare workers gifts to make them happy and as a way to say thank you, workers are not allowed to accept most gifts. Little things such as homemade cookies, handcrafted items, chocolate Santas or a box of chocolates can be accepted without a problem.

Is it OK to accept gifts from patients?

Should Physicians Accept Gifts from Their Patients?: Yes: If they are given out of beneficence or appreciation The practice of patients giving gifts to their physicians is as longstanding as medicine itself. But the giving of gifts to those in positions of authority has recently come under scrutiny.

Bill and Hilary Clinton, for example, have come under attack for accepting gifts from admirers during the last year of their White House stay. Medicine involves a fiduciary relationship, with patients relying on physicians’ advice and expertise. If they present physicians unsolicited gifts, is it ethical to accept them? I believe it is, with a few important caveats.

First, let me distinguish clearly between gifts from individual patients and those offered by drug companies, device manufacturers, and other commercial ventures. There is a wealth of evidence that such corporate gifts can influence the behavior of health care providers, often in ways that run counter to good patient care.

  1. A patient’s intent in giving a physician a gift is relevant.
  2. There may be 3 possible motives for gift giving: influence, pure beneficence, and appreciation.
  3. No one can ever know with certainty the motive behind any action, but subsequent behavior after the gift has been given may provide a clue.
  4. Giving a gift to influence an outcome is a bribe, and as such, it is unethical.

The increasing tendency of hospitals to attract donor money with promises such as “access to the best” is disturbing. The implication here is that a sizable donation will result in special attention or the ability to “jump the queue.” Some institutions even distribute “donor cards” to give patients tangible evidence of their special status.

Individual physicians have also been involved in this practice, which cheapens the physician and destroys the trust inherent in a healthy doctor-patient relationship. But some people are simply generous by nature. Gifts to the mail carrier, the newspaper carrier, the hairdresser, the physician, and others in their lives are just a part of their personality.

They derive pleasure from the act of giving itself. Such behavior is inspirational and should not be thwarted. What about giving gifts in appreciation of a previous action or in celebration of a healthy relationship? Although this motive is more focused than pure beneficence, it does not aim to change future behavior.

To understand the appropriateness of gift giving in this situation, we need to consider the nature of the doctor-patient relationship. Some people hold that the degree of involvement between a physician and patient should be a purely neutral and objective one. Such pure objectivity would preclude acts of sentiment—such as giving a gift out of appreciation—as irrelevant and damaging to the neutrality of the association.

But an alternative school of thought imbues the doctor-patient relationship with attributes such as compassion and trust. These qualities stretch the relationship beyond a strictly neutral and impersonal one. Pellegrino and Thomasma have described the bond between a physician and individual patient using the concept of a special type of friendship.

  • Pp51-60) This involves recognizing personal values and the provision of information and access to treatment.
  • Friends recognize the special nature of their relationship, and in this context, presenting gifts is both natural and honorable.
  • Provided that patients are not trying to influence their relationship with their physician, the doctors should accept the gift with a smile, send a thank-you note, and move on.

Competing interests: None declared 1. Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CMA J 1993; 149 : 1401-1407.2. Pellegrino ED, Thomasma DC. For the Patient’s Good: The Restoration of Beneficence in Healthcare,

Can nurses accept giftcards?

My client overheard my colleagues talking about my upcoming birthday. On the day of my birthday he gave me a gift card for a local restaurant. Can I accept the gift? – To maintain appropriate professional boundaries in your therapeutic relationship with the client, you should not accept the gift.

  1. Nurses are responsible for effectively establishing and maintaining professional boundaries with clients.
  2. A boundary is crossed when the professional and therapeutic relationship between a nurse and client becomes unprofessional and personal in nature.
  3. This can happen unintentionally, but it is still considered a misuse of the relationship.

The client’s needs should be your priority. However, if you are faced with a very rare situation where you believe that refusing would harm the therapeutic relationship, page 8 of the Therapeutic Nurse-Client Relationship practice standard provides information about CNO’s expectations.

Are you allowed to accept gifts from employees?

What Is a Gift? – 5 C.F.R. § 2635.203(b) and (c) A gift is anything that has monetary value that you obtain for less than “market value.” The gift might be tangible or intangible. A gift may include, but is not limited to, a gratuity, favor, discount, cash, gift certificate, gift card, entertainment, hospitality, loan, forbearance, or other item having monetary value.

It also applies to services, training, transportation, travel, lodging, and meals. See 5 C.F.R. § 2635.203(b). “Market value” is the retail price that you, the recipient of the gift, would have to pay to purchase it. If you cannot readily determine the retail value of a gift, you may estimate its value by reference to the retail cost of items of similar quality.

If a ticket entitles you to food, refreshments, entertainment, or any other benefit, the market value is the face value printed on the ticket. Gifts from Outside Sources – 5 C.F.R. § 2635.202 As a general rule, you may not, directly or indirectly, solicit or accept a gift: (1) From a prohibited source; or (2) Given because of your official position.

A prohibited source is any person, company, or organization that has business with your agency, is seeking to do business with your agency, conducts operations that are regulated by your agency, or has interests that might be affected by the performance or nonperformance of your official duties; or is an organization, a majority of whose members are described above.

Exclusions: Some Things Are Not Gifts Some items are excluded from the definition of gift, and you may accept them pursuant to certain specific regulatory exclusions.

Modest items of food and non-alcoholic refreshments such as soft drinks, coffee, and donuts, not offered as part of a meal. Greeting cards and items of little intrinsic value such as plaques, certificates, or trophies, which are intended primarily for presentation. Prizes in contests open to the general public. Commercial discounts available to the general public or to all Government employees. Commercial loans, pensions, and similar benefits on terms available to the general public. Anything for which you pay fair market value. Anything that is paid for by the Government. Free attendance provided by the sponsor of an event to which you have been assigned to present information on behalf of the agency.

1. If you are assigned to participate as a speaker or panel participant or otherwise to present information on behalf of DOI or your bureau at a conference or other event, you may accept free attendance at the event on the day of your presentation if it is provided by the sponsor of the event.

This is not considered a gift to the employee or the agency. For speaking engagements, free attendance has the same meaning as for widely attended gatherings. As with a widely attended gathering, you must receive approval prior to the event.2. If the event is longer than one day, and you are offered free attendance for any day(s) on which you are not assigned to present information on behalf of DOI or your bureau, free attendance for those non- speaking days may be acceptable under the widely attended gathering exception to the gift rules.

You still must seek approval from your ethics counselor. Pursuant to DOI Supplemental Regulations, the Department is broken down into separate “agencies” for purposes of identifying “prohibited sources.” Please see 5 C.F.R. Part 3501 for a list of the current designation of separate agency components.

For example, a company that is only involved with the Department and its employees through activities regulated by BLM would only constitute a prohibited source for BLM employees – not the employees of any other listed “agency.” For employees not employed by a specific “designated agency component” (e.g., Office of the Solicitor employees), all prohibited sources of any “agency” of DOI constitute a prohibited source.

A gift is solicited or accepted because of “official position” if it would not have been solicited, offered, or given had the employee not held the status, authority, or duties associated with his or her Federal position. Considerations in Declining an Otherwise Permissible Gift You should consider declining an otherwise permissible gift if you believe that a reasonable person would question your impartiality or integrity as a result of accepting the gift.

Does the gift have a high market value? Does the timing of the gift create an appearance that the donor is attempting to influence an official action? Is the donor someone whose interests may be affected by the performance of your duties? Will acceptance of the gift provide the donor with dis- proportionate access to the employee or the agency?

Remember, it is never inappropriate, and frequently prudent, to decline a gift. Exceptions to the Gift Prohibition – 5 C.F.R. § 2635.204 There are some limited circumstances when you can accept gifts given because of your official position or from prohibited sources.

  1. Even where a gift exception is applicable, you should always consider whether it is appropriate to decline the gift.
  2. Gifts valued at $20 or less (retail market value), per occasion from a single source.
  3. You may accept unsolicited gifts that do not exceed $20 per occasion, up to $50 aggregated from a single source in any given calendar year.

You may not accept cash or checks made out to you under any circumstance. Gift cards valued at $20 or less for specific vendors/restaurants are permissible. If the gift is valued over $20 you may not pay the difference in order to accept the gift. If the aggregate value of gifts from the same source on a given occasion exceeds $20, you may decline any distinct and separate item in order to accept those items aggregating $20 or less.

  • Widely attended gatherings.
  • Acceptance of free attendance from the sponsor of a widely attended gathering is permissible as long as certain prior approval requirements are met.
  • Employees must receive written approval prior to the event using form DI-1958.
  • An event is widely attended if it is expected that a large number of persons will attend and that persons with a diversity of views or interests will be present.

For example, an event may be considered a widely attended gathering if it is open to members from throughout the interested industry or profession or if those in attendance represent a range of persons interested in a given matter. Attendance at such an event will be in the employee’s personal capacity, i.e., on the employee’s own time, or if authorized by the agency, on excused absence.

There is an additional restriction on accepting free attendance to a widely attended gathering if someone other than the sponsor of the event invited you and is paying for your attendance (such as if a corporation or friends group invited you to sit at their table). In that case, you may accept free attendance only if more than 100 persons are expected to attend, the gift of your attendance has a market value of $415 or less (as of January 2020, but this amount is revised every three years) and your attendance is approved as being in the interest of DOI or your bureau.

This dollar figure may change periodically. Please verify the current allowance with your ethics official. Free attendance may include waiver of all or part of a conference or other fee or the provision of food, refreshments, entertainment, instruction, and materials furnished to all attendees as an integral part of the event.

  • It does not include travel expenses, lodging, entertainment collateral to the event, or meals taken other than in a group setting with all other attendees.
  • Under certain circumstances, DOI or your bureau may be able to accept travel expenses from outside sources to attend these events as described below in the “Traveling on Official Business” section of this website.

Discounts and similar benefits that are offered to the public, other groups that you belong to, or to all Government employees. This exception includes favorable rates offered to all Federal employees even when you are off duty. It also includes favorable rates and commercial discounts offered to members of a group or class in which membership is unrelated to Federal employment.

  • Gifts based on outside business or employment relationships.
  • This exception permits you to accept gifts that result from your outside affiliations, outside work, or other relationships and those of your spouse, or customarily provided in connection with bona fide employment discussions, provided the gift is not offered or enhanced due to your official position.

Lastly, you may accept gifts provided by a former employer to attend a reception or similar event when other former employees have been invited to attend, the invitation is based on the former employment benefits have not been offered or enhanced because of your official position.

Awards and honorary degrees. You may accept awards with an aggregate value of $200 or less given as a bona fide award for meritorious public service by a person or organization who does not have interests affected by the performance or nonperformance of your official duties. Awards valued at more than $200, or that include cash or an investment interest of any amount, require prior written approval from an ethics counselor.

You may also accept honorary degrees upon written approval from your ethics counselor. Gifts from a political organization. You may accept a gift given by a political organization in connection with political activities permitted by the Hatch Act, as amended, 5 U.S.C.

  • §§ 7321-7326,
  • Gifts based on a personal relationship.
  • You may accept a gift given under circumstances that make it clear that the gift is motivated by a family relationship or personal friendship rather than your official position.
  • If the gift is given for business reasons or is not personally paid for by the family member or friend, it is not covered under this exception.

Social invitations. You may accept a gift of food, refreshments, and entertainment (not including travel or lodgings) at a social event attended by several persons where no fee is charged to anyone in attendance and the invitation is not from a prohibited source.

  • A written determination from the agency designee is required if either the sponsor of the event or the person extending the invitation is not an individual.
  • Gifts of informational materials.
  • You may accept unsolicited gifts of informational materials, provided that the aggregate market value of all informational materials received from any one person does not exceed $100 in a calendar year (if the value exceeds this amount, seek guidance from your ethics official).

Informational materials are writings, recordings, documents, records, or other items that: are educational or instructive in nature; are not primarily created for entertainment, display, or decoration; and contain information that relates in whole or in part to the following categories: 1.

The employee’s official duties or position, profession, or field of study; 2. A general subject matter area, industry, or economic sector affected by or involved in the programs or operations of the agency; or 3. Another topic of interest to the agency or its mission. Disposition of a Prohibited Gift You must promptly return the gift or pay the donor for its market value.

If the gift is a tangible item valued at $100 or less, you may destroy the item. If the gift is perishable, such as food or flowers, it may be shared within your office, donated to charity, or destroyed, as long as an ethics official or your supervisor grants approval.

If you receive a gift that doesn’t fall within an exclusion or exception, the Department or bureau may be able to accept the item as a gift to the agency using its statutory gift acceptance authority. Employees should consult with the Office of the Solicitor and their ethics counselor in such cases, particularly if refusal to accept the gift would cause offense or embarrassment.

Gifts from Foreign Governments In accordance with the Emoluments Clause of the U.S. Constitution, you may not accept anything of value from a foreign government, unless specifically authorized by Congress. This rule applies whether you are on or off duty.

Any unit of a foreign government, whether it is national, state, local, or municipal level is covered. It also applies to gifts from international or multinational organizations composed of government representatives. It also may apply to gifts of honoraria, travel, salary, or per diem from foreign universities, which are often considered as part of the foreign government.

Spouses and dependent children of Federal employees are also banned from accepting gifts from foreign governments. The following gifts from foreign governments are authorized under the Foreign Gifts and Decorations Act, 5 U.S.C. § 7342 : Gifts of minimal value ($415 or less, as of January 2020, but this amount is revised every three years)

Travel expenses (including transportation, food, and lodging) for travel taking place entirely outside the U.S. that exceeds minimal value Educational scholarships Medical treatment

If the value of a gift exceeds minimal value and where refusal of a gift would cause embarrassment either to the United States or the foreign government offering the gift, the gift may be accepted on behalf of the Department. You should consult with the DEO or an ethics counselor from your bureau/office regarding such gifts.

These statutory foreign gift restrictions also apply to the spouses and dependent children of Federal employees. Gifts Between Employees – 5 C.F.R. § 2635 Part C General Rules: Generally, you can’t give a gift to a person above you in your supervisory chain. You can’t solicit donations to buy a gift for a superior.

You can’t accept a gift from an employee that receives less pay than yourself. However, there are some exceptions. Gifts are permissible if:

There is a personal relationship between you and the other employee that would justify the gift and there is no subordinate-official superior relationship. A personal hospitality gift provided at a residence, which is of a type and value you customarily provide to personal friends. A gift given in connection with the receipt of personal hospitality if of a type and value customarily given on such occasions (e.g., a bottle of wine or a bouquet of flowers). A gift (other than cash) that has an aggregate market value of $10 or less per occasion. A gift of leave transferred under an approved agency leave sharing plan (but not to your immediate supervisor). Items such as food and refreshments to be shared in the office among several employees. There is a special and infrequently occurring occasion of personal significance, such as marriage, illness, the birth or adoption of a child; or an occasion that terminates a subordinate-official superior relationship, such as retirement, resignation, or transfer. On such occasions, an employee may give an appropriate gift exceeding the $10 limit and may request donations of nominal amounts within the office for contributions toward an appropriate gift. Donations must be entirely voluntary. Employees must be free to contribute a suggested amount, a lesser amount, or nothing at all.

Is it ethical to accept gifts from employees?

What about gifts to the boss? With a few exceptions, the general rule is that you cannot give, make a donation to, or ask for contributions for a gift to your official superior. An official superior includes your immediate boss and anyone above your boss in the chain of command in the Department. Also, an employee cannot accept a gift from another employee who earns less pay, unless the person giving the gift is not a subordinate and the gift is based on a strictly personal relationship. When can I give my boss a gift? You may give your boss a gift on an occasion when gifts are traditionally given or exchanged, such as a birthday or Christmas, or after a vacation trip. At those times, gifts valued at $10 or less – but not cash – are permitted. You always may contribute a nominal amount for food that will be shared in the office among several employees including your boss and may bring food to share. You also can invite your boss to your home for a meal or a party. If your boss invites you to his or her home, you can take the same type of gift for your boss that you would normally take to anyone else’s home for a similar occasion. You also may give your boss a gift on a special, infrequent occasion of personal significance, such as marriage, illness, birth, or adoption. And you may give your boss a gift on an occasion that ends your employee-boss relationship, such as retirement, resignation, or transfer. Such gifts given on these occasions may exceed the $20 limitation, but should be reasonable in relation to the specific occasion. For these special, infrequent occasions, employees also are allowed to ask for contributions of nominal amounts from fellow employees on a strictly voluntary basis for a group gift. A boss may never pressure you to give a gift, or to contribute toward a gift, to anyone. Remember that gift giving is strictly voluntary. A boss may never pressure you to give a gift. Some Gifts Permitted Between Employees Nadia may collect small voluntary contributions from other persons in her office in order to buy a cake to celebrate the birthday of her supervisor or a co-worker. Clarissa may participate in the exchange of gifts in the office holiday grab bag by buying and contributing a tape cassette worth $10. Kailash may collect contributions to purchase a fishing rod and tackle box for his boss when his boss retires, and may suggest a specific, but nominal amount, provided that he makes it clear to his coworkers that they are free to contribute less or nothing at all. Upon returning from a trip to Hawaii, Ralph may bring a jar of macadamia nuts to his boss. Previous Page | Next Page >

Can you give gifts to hospital staff?

Even though patients often want to give healthcare workers gifts to make them happy and as a way to say thank you, workers are not allowed to accept most gifts. Little things such as homemade cookies, handcrafted items, chocolate Santas or a box of chocolates can be accepted without a problem.

Why can’t you take gifts from patients?

Gifts from Patients Opinion 1.2.8 Patients offer gifts to a physician for many reasons. Some gifts are offered as an expression of gratitude or a reflection of the patient’s cultural tradition. Accepting gifts offered for these reasons can enhance the patient-physician relationship.

  • Other gifts may signal psychological needs that require the physician’s attention.
  • Some patients may offer gifts or cash to secure or influence care or to secure preferential treatment.
  • Such gifts can undermine physicians’ obligation to provide services fairly to all patients; accepting them is likely to damage the patient-physician relationship.

The interaction of these factors is complex and physicians should consider them sensitively before accepting or declining a gift. Physicians to whom a patient offers a gift should:

Be sensitive to the gift’s value relative to the patient’s or physician’s means. Physicians should decline gifts that are disproportionately or inappropriately large, or when the physician would be uncomfortable to have colleagues know the gift had been accepted. Not allow the gift or offer of a gift to influence the patient’s medical care. Decline a bequest from a patient if the physician has reason to believe accepting the gift would present an emotional or financial hardship to the patient’s family. Physicians may wish to suggest that the patient or family make a charitable contribution in lieu of the bequest, in keeping with ethics guidance.

AMA Principles of Medical Ethics: I, II Opinion 2.3.5 To sustain the trust that is the foundation of the patient-physician relationship and to reassure patients that their welfare is the physician’s primary priority, physicians who participate in fundraising should: refrain from directly soliciting contributions from their own patients, Protect patient privacy and confidentiality and be sensitive to the likelihood that they may be perceived to be acting in their professional role when participating in fundraising activities.

Are NHS staff allowed to accept gifts?

In cases of doubt advice must be sought from your line manager and, in no case, must a gift be accepted without prior written approval of the Manager if the estimated value of the gift exceeds £25.00. Under no circumstances must staff accept personal gifts of cash, even below the £25.00 limit.

Can you give nurses thank you gifts?

Often, patients and families express their gratitude for a special nurse’s outstanding care with spoken thanks or heartfelt commendations written to a nursing supervisor. Some even offer a small gift, perhaps a box of chocolates or a fruit basket. Most nurses are skilled at accepting these tokens of appreciation with gracious responses like,It’s why I love my job, or It’s a pleasure to take care of patients like you.

Can I accept a gift from my boss?

You may generally receive any non-cash gifts or awards from your employer if their combined value is less than $500 in a year.

Is it OK to give my boss a gift?

Can Healthcare Workers Accept Gifts Photo-Illustration: by The Cut; Photos: Getty Images Every year around this time, my inbox fills up with questions about handling the holidays at work. Are you supposed to give your boss a gift ? What about your co-workers? How mandatory is the holiday party, really? The employee handbook rarely covers these questions, leaving everyone to figure it out for themselves.

  1. Fortunately, we’ve got answers to your questions below.
  2. Before my boss hired me back in February, I’d freelanced for years, so I’m out of touch with how offices handle holiday gifts.
  3. But I think she’s a great manager, and I’m grateful to her for taking a chance on me when I’d been out of this part of our field for so long.

She’s also been really accommodating about letting me stay remote even though she and some others have returned to the office a few days a week. Should I mail a gift for her to the office? And if so, what’s an appropriate boss gift? Or is that not a thing people do? It’s a thing some people do, but ideally they wouldn’t.

  • Etiquette says that gifts at work should flow downward, not upward (meaning that your boss can give you a gift, but employees shouldn’t be expected to give gifts to their managers).
  • That rule exists because of the power dynamics at play.
  • Otherwise an employee might feel pressured to purchase presents for a manager, and it’s not okay for managers to benefit from the relationship in that way.

A holiday card, though, is absolutely fine, and it would be lovely to include a note about how much you appreciate working for her. The company I work for has about 12 employees. The owner asks our manager to go around and collect $60 from each person to then get a present for her.

  1. Around this time, she always makes comments about the type of jewelry she likes, or a new watch she saw.
  2. I have kindly let them know that it is simply not in my budget this year as my spouse changed jobs a month ago and times are tight.
  3. When I told them that, they said that it’s mandatory and no one is allowed to not participate.

I simply don’t have the $60. My spouse and I aren’t even exchanging gifts this year. Am I causing drama for no reason, or is $60 a lot to ask of an employee? Your company owner is a terrible person, and whoever is trying to make this mandatory is out of their gourd.

  1. Frankly, even insisting on $5 donations for a gift for the boss would be out of line — but demanding $60 from someone who says it’s out of their budget is a whole new level of awful.
  2. How firmly have you said no? If you soft-pedaled it in an effort to be polite, be more direct: “I literally do not have the money to give.

I’m not even exchanging gifts with my spouse this year. It’s not possible for me to come up with money that I don’t have.” You might also consider seeing if some of your co-workers are annoyed by this, too, and if so, pushing back as a group. This kind of practice is harder to maintain when a bunch of employees speak up and say, “We’re not okay with this.” If all else fails, escalate the issue to HR.

My office is hybrid now, with each team in one day per week. I’m still being very vigilant about masking because my mom, who lives with me, is immunocompromised and undergoing chemo. So on the days I’m in the office, I’m careful to eat in my office with my door closed so that I’m not around anyone while I’m unmasked.

However, we’re having a holiday party and we’ve been told that everyone will be required to come into the office that day. There will be eating and drinking, so people will definitely be unmasked — indoors, for several hours, without great ventilation, during a period when COVID cases are supposed to be surging.

The idea of a mandatory party is weird enough already, but throw in the health risk and I’m really unhappy to be required to be there. What do I do? Even “mandatory” work events aren’t always mandatory when people have valid reasons for missing them — like if they’re sick or traveling. Keeping your mom safe will qualify with any reasonable manager.

So the most straightforward option is to simply say to your boss, “I can’t safely attend the holiday party because my mother, who lives with me, is immunocompromised. I can’t risk bringing something back home to her from an unmasked gathering.” Note that that’s not asking for permission to skip it; it’s letting her know you’ll need to.

  • If she objects to that, she can say so, but if you frame it this way, she’s unlikely to.
  • If for some reason you think that won’t go over well (like if your boss is wildly unreasonable), you always have the option of waking up “sick” that day and having to send your regrets “so I don’t spread this to the whole office.” Alternatively, if you think there are professional disadvantages to not attending, you could go and keep an N95 or KN95 mask on the whole time.

That means you wouldn’t be able to eat or drink — which won’t make for a particularly enjoyable party experience — but you could put in an appearance, get the points for being there, and then leave after an hour or so, having stayed masked the whole time.

  1. Every year, my company (with around 70 employees) picks out one corporate gift and sends it to all of us.
  2. Every year, it is terrible.
  3. One year they delivered hams to our homes, despite us having a fair number of vegetarians and Muslims on staff.
  4. One year they sent us all branded hoodies, which would have been fine except that they seem to have just guessed at people’s sizes (which is already weird, right?) and got them really wrong in a lot of cases.

Mine would probably fit my toddler, but it doesn’t fit me. In 2020 (when no one was dining out because of COVID) they sent us all gift certificates for a restaurant that was far away from where most of us live. I’d rather receive nothing than these vaguely insulting gifts that seem to indicate no care went into picking them.

Is it worth saying something, or is it rude to complain? It’s rude to complain about a gift given in a social situation, but this is work, and the rules are different. Your company is sending gifts in the hope that it will increase staff morale and make people feel more connected to the company. If they’re failing at that (or, as is the case here, achieving the opposite), it’s useful for them to know.

So yes, if you have some political capital to spend, speak up to whoever coordinates the gifts! You’d be doing the company a favor, and you could probably find co-workers who would be happy to speak up with you. Start by acknowledging that it’s hard, if not impossible, to find a gift that 70 people will all love.

Then let them know that they’ve been sending gifts that are unused by a disproportionate number of your staff, and ask if they’d take feedback about what gifts would be most appreciated this year. (But if they don’t budge, please write back and share what they end up sending this year, because I am eager to know what they come up with next.) I work on a small team where everyone is pretty friendly.

Usually for the holidays, my co-workers and I exchange cards or leave baked goods in the kitchen for people to share. But one of my co-workers gives me a gift every year. It’s nothing extravagant — a candle one year, a book she thought I’d like another, and so forth.

But I’m feeling awkward that I’ve never reciprocated. Honestly, I’d prefer not to! I have a small gift-buying budget that I’d rather spend on my family, and I don’t want to encourage the expectation that we’ll all give each other gifts. But now that it’s clear she’s going to give me something every year, am I being rude by not returning the gesture? Some people give gifts to co-workers and some people don’t, and you don’t need to feel obligated to cross over to the gifting side if you don’t want to.

It sounds like this has gone on for long enough for her to see the pattern and stop if she objects to being the only one offering a gift; she hasn’t, so I’d assume she simply derives joy from continuing to do it. A sincere “thank you” is all that’s required.

That said, if you feel awkward about not reciprocating with something, a card with a warm note inside is a good middle ground. I have a graduate-level intern whose placement is required for her degree. She works directly with me. When I did required internships at both the BA and MA level, I received anything from small gift cards ($5 to $10) to the same holiday bonus as the full-time staff (a $100 check from the company).

Is gifting to someone who is technically your “student” appropriate? I’m thinking about going the $5 to $10 Amazon, Starbucks, or Target gift-card route, but what are your thoughts? A small gift card is a great gift if you make sure you know she likes the place it’s for.

  1. Every year I get letters from people who are mildly annoyed at receiving gift cards to restaurants that only exist two states away from where they live, or for coffee when they only drink tea, or other evidence that a gift was given without much personal thought.
  2. Also, keep in mind that the $100 check you received was a bonus that came from the company, not from your manager personally.

People don’t expect extravagant gifts from their managers, even if the company itself goes a more luxe route. And frankly, managers don’t need to give their staff gifts at all, though it’s a thoughtful gesture if you choose to. Order Alison Green’s book Ask a Manager: How to Navigate Clueless Colleagues, Lunch-Stealing Bosses, and the Rest of Your Life at Work here,

Is receiving gifts in the workplace as an unethical practice?

Company policy – Companies help prevent their employees giving or accepting inappropriate gifts/hospitality by providing guidance, usually in the company code of ethics (or equivalent document). The code will outline the company’s position on gifts and hospitality and set out good practice for employees.

Codes of ethics will often reference a gifts and hospitality policy which expands on the guidance in the code. Box 2 sets out some examples of guidance on gifts and hospitality in company codes and policies. A gifts and hospitality policy needs to be consistent with all other aspects of an organisation’s ethics programme in encouraging high standards of honesty and integrity in decision-making and behaviour.

It would be inappropriate, for example, to give or accept corporate hospitality which would discriminate or cause offence on the basis of gender or religion, as this would violate the ethical values of the giver’s/recipient’s company. Corporate gifts and hospitality policies typically set out:

Clear definitions of what constitutes ‘gift giving’ or ‘hospitality’ What type of gift/hospitality can and cannot be given or accepted The financial value of gifts/hospitality that can be given or accepted without disclosure How and where gifts/hospitality should be recorded when given or accepted i.e. on a gifts and hospitality register How employees can refuse gifts or hospitality without causing offence How staff can seek further guidance Standards for the giving and accepting of gifts and hospitality in the markets the company operates in and how the company responds to cultural differences in these markets. Companies may need to adapt their policy on gifts and hospitality in some localities so it is aligned with cultural beliefs and practice in these areas. However, it is important not to contravene the ‘spirit’ of the policy when accommodating cross-cultural differences.

Principles for what can and cannot be given or accepted There are a number of principles for organisations to consider when developing guidance for employees on giving and accepting gifts/hospitality. Though no principle alone is sufficient to decide whether the gift/hospitality is legitimate, each principle can be used to help identify potential ethical issues (‘red flags’).

When a gift is not a gift : One principle to consider is whether there is an expectation that the business relationship will be influenced. If so, this is a bribe, not a gift and is covered under Section One of the UK Bribery Act (2010) as ‘intent to induce improper conduct’ (see Box 1). The timing of gifts/hospitality is also relevant.

An offer shortly before or after, or during a tendering process for example, is inappropriate as it can be construed as a bribe, offered with the intention of ‘closing the deal’. It is not advisable to accept gifts/hospitality at any point in the time surrounding a tendering process or a contract renewal.

See also:  What Is A Root Cause Analysis In Healthcare?

Who the gift is for : Giving gifts or hospitality to certain persons, for example public officials, can be more inappropriate than when given to others. Gifts, particularly monetary gifts, to public officials can be construed as a facilitation payment to speed up a normally legal service and is illegal under UK law anywhere in the world.

Many companies prohibit gift giving/hospitality of any kind to public officials. Some may put additional controls in place, such as lowering the value limit on gifts/hospitality for public officials or requiring employees to obtain management approval, regardless of the value.

  1. Organisations, particularly those operating cross-culturally, may wish to provide specific guidance to employees to help identify public officials.
  2. In China for example, a significant proportion of companies are state-owned enterprises, and it can be difficult to clearly differentiate between public and private organisations.

Inappropriate scale (principle of proportionality) : What constitutes a ‘lavish’ gift or hospitality? Some companies adopt a ‘no to all’ gifts/hospitality approach. Others put a monetary limit on the value of gifts/hospitality that can be given or accepted.

It is worth noting that different monetary value limits may be set for gifts and for hospitality. Gifts/hospitality that is offered to an employee and is above the stated value will usually need line managers’ approval before the gifts/hospitality can be accepted. This can be difficult to judge. For example, the duties of senior staff may require them to attend or sponsor events where hospitality is generous.

What may seem minor to a senior manager could be significantly more valuable to a junior employee. Stipulating different monetary values for different management levels can become complicated to justify. Also, the exact value of an event package, for example a trip to watch the tennis at Wimbledon, is hard to determine.

  1. The UK Bribery Act (see Box 1) provides some guidance on how to judge whether a gift or hospitality is proportionate or not.
  2. In addition, multinational companies need to consider relative monetary values and cultural practice in the different countries in which they operate.
  3. A £25 limit on gifts in the UK may be considered lavish to some employees in poorer economies.

In some companies, gifts that exceed the value limit but are impossible to decline without causing offence or putting business relationships at risk may be accepted on behalf of the organisation. Gifts of high value can then be auctioned at the end of the year to raise funds for charity, for instance.

Box 2: Example corporate gifts and hospitality guidance in codes/policies

Codes It’s a Question of Ethics – Borealis (p16 -17) Our Code of Conduct – BP (p42 –45) Integrity – The Spirit and Letter of Our Commitment (Guide to Our Policies) – GE (p19 –20) Employee Guide to Business Conduct – GSK (p10) Our Values and Standards – Merck (p9 –11) How we Work, What we Value: Our Code of Conduct – Balfour Beatty (p19) Policies Code of Conduct: Supplier Relations and Third Party Hospitality and Gifts in Kind – Whitbread Gifts and Hospitality Policy – Cable & Wireless Worldwide Business Ethics, Gift and Hospitality Policy – WSP Group Gifts, Corporate Hospitality and Promotional Expenditure Policy – Berkeley Group Holdings

Reciprocity : Another principle sometimes applied to determine what is an appropriate level of gift giving or hospitality is that of reciprocity, i.e. if I accept an offer, am I able to offer the equivalent in value in return? For example, “If my supplier offers me tickets to the theatre, would I be able to reciprocate?”.

If the answer is “No”, then it may be seen as an attempt to ‘buy favour’ and it may be advisable not to accept. Cash : Giving or accepting cash gifts is rarely appropriate. Being easier to conceal, there is more risk that it will be viewed as bribery than a fair business practice. In some cultures however, giving cash in certain circumstances is acceptable or may even be part of cultural tradition, such as the giving of red envelopes for Chinese New Year.

The policy should advise staff on how to handle these cross-cultural challenges by establishing a protocol. Who does a policy cover? The policy should extend to all employees at all levels in the organisation. Additional guidance may be provided for employees working in ‘high risk’ business functions, such as procurement or sales.

  1. Besides employees, corporate gifts and hospitality policies may need to provide guidance on the inclusion of employees’ family members.
  2. For instance, a corporate invitation to a conference in the Bahamas may be legitimate for business reasons, but if spouses are invited and paid for, it may be misconstrued as a holiday.

The key principle is that hospitality received has to have a clear business reason and not just be for the employee’s or their family’s personal enjoyment. The gifts and hospitality policy should also extend to any third parties such as agents, that the company employs.

Is accepting a gift a form of corruption?

Gift giving and bribery, two sides of the same coin? Who doesn’t enjoy receiving a gift? And how often have we found ourselves fretting over what kind of gift to present to a friend, to a family member or even to a child? Gift giving is a universal phenomenon that has deep anthropological and sociological roots throughout history.

It is so ingrained in our interactions from a young age that we rarely stop to examine what the significance of gift giving is and why it is often intertwined with more nefarious intentions. On a very basic level, we give or exchange gifts with individuals or groups of individuals with whom we want to have some form of social relationship (not necessarily romantic).

People see no harm in gift giving and it is generally viewed as something positive. It is associated with kindness and selflessness. Giving or receiving a gift is legal. Bribery, on the other hand, is almost universally condemned, and its practice is considered undesirable, harmful and destructive.

How much money can you accept as a gift?

Gift Tax: How It Works, Who Pays and Rates

The gift tax limit was $16,000 in 2022 and is $17,000 in 2023. The gift tax rates range from 18% to 40%. The gift giver is the one who generally pays the tax, not the receiver.

Sending a $50 bill with your niece’s graduation card? No need to sweat the federal gift tax. But if you’re dispersing millions worth of gifts over the course of your lifetime, you may have to cut a few extra checks to the IRS. The gift tax is a federal tax on transfers of money or property to other people who are getting nothing (or less than full value) in return.

  • It is typically paid by the giver, not the recipient.
  • The IRS places limits on how much you can gift someone each year.
  • If you exceed the annual limit, you must report it on a tax return, and the excess of your contribution will be added toward your lifetime gift limit.
  • Once you exhaust your lifetime exclusion, you may begin to owe gift taxes.

The gift tax limit for 2022 was $16,000. This amount, formally called the gift tax exclusion, is the maximum amount you can give a single person without reporting it to the IRS. Keep in mind that even if you exceeded the exclusion and have to notify the IRS, you might not have to pay any taxes unless you have also gone beyond the additional lifetime gift tax exclusion.

That limit was set at $12.09 million for 2022. The 2023 gift tax limit is $17,000. If you gift more than this amount during the year, you must file a federal gift tax return in 2024. The lifetime limit rises to $12.92 million in 2023. Two things keep the IRS’s hands out of most people’s candy dish: the annual gift tax exclusion, and the lifetime exclusion.

Stay below the annual threshold, and you can be generous under the radar. Go above, and you’ll have to fill out a gift tax form when you file returns — but you still might avoid having to pay any gift tax. The annual exclusion is a set amount that you may gift someone without having to report it to the IRS on a gift tax return.

If you give away more than the annual exclusion amount in cash or assets (for example, stocks, land, a new car) to any one person during the tax year, you will need to file a gift tax return in addition to your federal tax return the following year. That doesn’t mean you have to pay a gift tax; it just means you need to submit IRS Form 709 to disclose the gift. The annual exclusion is per recipient ; it isn’t the sum total of all your gifts. That means, for example, that you can give $17,000 to your cousin, another $17,000 to a friend, another $17,000 to a neighbor, and so on in 2023 without having to file a gift tax return in 2024. If you’re married, you and your spouse could give away $17,000 each in 2023 without needing to file a gift tax return in 2024. If you want to combine your annual exclusions in order to give someone a combined $34,000, you can choose to take advantage of “gift splitting”, Gifts to qualified nonprofits are charitable donations, not gifts. The person receiving the gift usually doesn’t need to report the gift.

Can Healthcare Workers Accept Gifts There’s still time to get your taxes done right with Harness Tax. Can Healthcare Workers Accept Gifts On top of the $17,000 annual exclusion in 2023, you get a $12.92 million lifetime exclusion in 2023. And because it’s per person, married couples can exclude double that in lifetime gifts. That comes in handy when you’re giving away more than the annual exclusion amount.

“Think about buckets or cups,” says Christopher Picciurro, a certified public accountant and co-founder of accounting and advisory firm Integrated Financial Group in Michigan. Any excess “spills over” into the lifetime exclusion bucket. For example, if you give your brother $50,000 in 2023, you’ll use up your $17,000 annual exclusion.

The bad news is that you’ll need to file a gift tax return, but the good news is that you probably won’t pay a gift tax. Why? Because the extra $33,000 ($50,000 – $17,000) simply counts against your lifetime exclusion. Next year, if you give your brother another $50,000, the same thing happens: you use up your annual exclusion and whittle away another portion of your lifetime exclusion.

The gift tax return keeps track of that lifetime exclusion. So if you don’t gift anything during your life, then you have your whole lifetime exclusion to use against your estate when you die. Learn more about how works. Another trick that can help you avoid an unwanted surprise is simply keeping an eye on the calendar.

In 2026, the lifetime exclusion amount will revert back to its pre-2018 level of about $5 million (as adjusted for inflation) per individual. » MORE: Learn, In most cases, no. Assets you receive as a gift or inheritance typically aren’t taxable income at the federal level.

  • However, if the assets later produce income (perhaps they earn interest or dividends, or you collect rent), that income is probably taxable.
  • IRS Publication 525 has the details.
  • Also keep in mind that while there is no federal, some states may impose their own.
  • Caring is sharing, but some situations often inadvertently trigger the need to file a gift tax return, pros say.

» MORE: Lending money to friends and family can be tricky, and the IRS can make it even worse. It considers interest-free loans as gifts. Or, if you lend them money and later decide they don’t need to repay you, that’s also a gift. “Let’s say you live by Grandma, so for convenience, we’re going to put you on Grandma’s bank account.

Guess what just happened?” Picciurro says. “If you’re put as a joint on a bank account with somebody and you have the right to take the money out at any time, essentially Grandma is giving you a gift.” This applies to joint accounts when the other owner is not your spouse. Frequently asked questions According to the IRS, money or property that is transferred to another person without receiving anything in exchange is a gift.

Gifts that exceed a certain value may be subject to a tax. The donor, not the recipient, typically pays the gift tax. What are the gifting rules in 2023? In 2023, taxpayers can gift up to $17,000 to a person without reporting it to the IRS on a federal gift tax return.

  1. Anything that exceeds the annual threshold counts toward the lifetime exclusion.
  2. The lifetime exclusion for 2023 is $12.92 million.
  3. According to the IRS, money or property that is transferred to another person without receiving anything in exchange is a gift.
  4. Gifts that exceed a certain value may be subject to a tax.

The donor, not the recipient, typically pays the gift tax. What are the gifting rules in 2023? In 2023, taxpayers can gift up to $17,000 to a person without reporting it to the IRS on a federal gift tax return. Anything that exceeds the annual threshold counts toward the lifetime exclusion.

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Can you send thank you gifts to hospital staff?

Q: Can healthcare workers accept gifts? –

A: In the healthcare industry, there is a lot of debate about whether or not healthcare workers can accept gifts. On one hand, it can be seen as a way to show appreciation for the care that they provide. On the other hand, some people feel that it could create a conflict of interest. So, what is the answer? The truth is, it depends on the situation. In general, healthcare workers should avoid accepting gifts that are excessive or lavish. If a patient or family member wants to give a small gift, such as flowers or a thank you card, that is usually acceptable. However, if the gift is something expensive or would be considered a bribe, then it is probably best to decline.

Can you give a hospice nurse a gift?

Bring Them Treats – As a token of your appreciation, you can bake them some cookies or bring them a basket of mini muffins, or perhaps pick up an extra coffee on your way in every morning. Often times, hospice workers have little time for a rest or break.

  • A little treat in the middle of their day offers a much-needed pick me up and shows you are thinking of them.
  • You may also consider including a small gift card in a greeting card, perhaps to their favorite coffee shop or movie theater.
  • Eep in mind, though, some hospice care organizations have limitations and restrictions on what hospice care workers can accept as gifts.

It’s a good idea to check with the administrator of the facility before giving gift cards or cash to an individual. However, a nice box of chocolates or fruit basket are always nice sights in the break room for tired workers.

Should I give my midwife a gift?

If you’re at a loss for ideas, here are some special ways to say ‘thank you’ to your midwife for caring for you, your pēpi, and your whānau. – A thank you present for your LMC is certainly not required nor expected, however many whānau do like to give their midwife a meaningful gift after their baby is born, often at their final postnatal visit,

A card with a photo of your baby. Many midwives like to display these in their clinic. Filling the page with words from the heart will mean more than anything money can buy. A voucher for some pampering. As we’re sure you know, your midwife works incredibly hard so the opportunity for a massage, pedicure or facial will allow them to have a moment of being looked after in return. A coffee voucher for the cafe nearest their clinic or the maternity unit/hospital/birthing centre. A restaurant or movie voucher for your midwife to spend some quality time with their other half or their children on their next weekend off. A bouquet of dried flowers, an orchid, or a houseplant. A bottle of wine or champagne. A pregnancy female form candle, mug or vase. A gift box filled with treats that you know they’ll love like chocolate, and a bath soak or soap. Pounamu or another taonga of meaning and significance to your whānau. Providing feedback to the New Zealand College of Midwives about your care. This feedback is essential to your midwife’s Midwifery Standards Review Process.

Can Healthcare Workers Accept Gifts

How do you reject a gift from a patient?

When is it ethical to accept gifts from patients? Some believe that accepting gifts from patients can influence a physician’s clinical judgment, while others believe that accepting such gifts can enhance the patient-physician relationship. Because there are no clear-cut guidelines, physicians are often uncertain about how to address the issue.

Consider the motive behind the gift, Consider the cost or value of the gift, Consider whether you would be comfortable if colleagues knew about the gift.

If you decide not to accept the gift, thank the patient, politely communicate the reasons you cannot accept it, and then assure the patient that this does not change your relationship in any way. Rejecting a gift is never easy, but most patients will understand. Adapted from “” Posted on Feb 08, 2018 by FPM Editors : When is it ethical to accept gifts from patients?

Why is it wrong to accept gifts from clients?

Ethics Alive – Gifts From Clients: The Good, the Bad, and the Ethically Ugly by Allan Barsky, J.D., MSW, Ph.D. Everyone loves gifts, don’t they? Well, maybe it depends on who is giving the gift and under what circumstances. For social workers, being offered a gift from clients may be cause for celebration, cause for concern, or both.

  • Assume you have been working with Cleo, a client experiencing high levels of social anxiety.
  • Over the past few months, you have helped her reduce her levels of anxiety to the point that she now enjoys personal and work relationships that she once dreaded.
  • In your final session with Cleo, she offers you a present.

Your first instinct may be to tell yourself, “Accepting gifts from clients is unethical. I need to find a polite way to decline.” But is accepting gifts truly unethical, and if so, why? Under what circumstances might accepting gifts be ethically justifiable, or even desirable? Some people may assume the NASW Code of Ethics (2008) specifically prohibits accepting gifts.

  1. It does not.
  2. It doesn’t even mention gifts, per se.
  3. The NASW Code does have provisions related to gifts.
  4. Standard 1.06(a) advises social workers to “avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment.” Standard 1.06(b) instructs social workers not to “take unfair advantage of any professional relationship.” Standard 1.06(c) says that social workers should set “clear, appropriate, and culturally sensitive boundaries” with clients.

Taken together, these standards certainly put social workers on notice that there are risks related to accepting gifts from clients. Thus, there are some situations in which accepting gifts would be clearly unethical:

if accepting a gift biases a social worker’s judgment (e.g., if you were tempted to give Cleo favored treatment because she gave you a gift) if the social worker manipulates clients into thinking that providing gifts is necessary to obtain services that they are already entitled to receive (e.g., if you indicate to Cleo that she needs to provide a gift to receive counseling) if the social worker has not established appropriate professional boundaries with the client and the gift-giving reflects this lack of appropriate boundaries (e.g., if you befriend Cleo and she gives you a gift as if you were her friend )if you are in a position of authority over the client and the client is vulnerable to your decisions (e.g., if you are a child protection worker deciding whether to remove a child from Cleo’s home) if the gift has a deep emotional meaning to the client, and the client may later regret giving the gift (e.g., if Cleo gives you a home-made vase that has minimal market value but is deeply meaningful because it was a gift from her dearly departed brother) if the nature of the gift is inappropriate given the nature of the services and/or your professional role (e.g., if Cleo gives you a sample of drugs that she found helpful in reducing her anxiety)

As a social worker, your primary commitment is to your client (Standard 1.01). The main interest to consider is the impact of gift-giving on the client. If gift-giving is an authentic expression of the client’s gratitude, then the principle of self-determination suggests that social workers should honor the client’s wishes.

The client may feel a sense of pride and satisfaction from being able to thank the worker with a gift. However, if the client feels exploited or manipulated—or if the client receives inappropriate services as a result of gift-giving—then encouraging or accepting the gift would be unethical. So, under what circumstances might accepting gifts be ethically justifiable? In broad terms, accepting gifts may be justifiable when they promote the principles of beneficence (doing good, particularly for the client) and nonmaleficence (avoiding harm, particularly to the client).

Assume that Cleo comes from a culture in which gift-giving is appropriate and perhaps culturally expected, even in professional relationships. Assume, further, that Cleo may feel rejected or disrespected if you do not accept her gift as a gesture of thanks.

  • Rejecting the gift could also have a negative impact on her progress in counseling.
  • To accept the gift would do more good than harm—particularly if there are no risks or perceptions of exploitation, inappropriate boundaries, or biases in your professional decision making.
  • Along these lines, Standard A.10.f of the Code of Ethics (2014) of the American Counseling Association 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.

  1. Rather than having a blanket rule about accepting gifts, this standard invites counselors to assess each situation, including the client’s and counselor’s motivations for accepting the gifts.
  2. If a client feels pressured into providing a gift or if the counselor is motivated by greed to accept the gift, then accepting the gift would be unethical.

Note also that this standard asks counselors to take the therapeutic relationship into account. If Cleo offers you a gift because she has a low level of trust in the relationship and wants to ensure your support, then accepting the gift may be tantamount to exploiting her vulnerability.

  • If Cleo and you have an egalitarian relationship, then the risks of exploitation are lower.
  • In terms of the monetary value of gifts, social workers should consider the value in relation to the client’s level of wealth and income.
  • If a client is living in poverty, then a gift worth $20 may be significant.

If the client is wealthy, then a gift worth $20 may be perceived by the client as a small token of appreciation. Some agencies put specific values on what types of gifts may be accepted. Some agencies prohibit gifts of any value. Some agencies allow gifts to the agency (as a whole), but not to individual social workers.

Remember that even if an agency has a policy prohibiting acceptance of gifts, it may be ethical to accept them. You may need to advocate with the agency to change the policy, or to grant exceptions on a case-by-case basis. The question of accepting gifts is not simply an either/or issue. When and how are also important considerations.

To pre-empt problems, it would be helpful for clients to know the social worker’s or agency’s policy on gift-giving from the outset of the helping process. Informing clients up front allows the parties to avoid that ugly moment when a client has made the effort to make or purchase a gift, only to have it rejected.

If a client offers a gift during the middle stages of work, then the worker may remind the client of the policy. If a client provides a gift at the termination stage of services, then the risk of exploitation may be lower. Because the client has already received services, it is less likely that the client is providing the gift to sway how the social worker provides services or other benefits.

Still, there are concerns about professional boundaries and whether the client may want the professional relationship to transition into a personal or romantic one. If you decide it is inappropriate to accept a particular gift, then consider how you can inform the client in a respectful manner.

Thank you for this beautiful gift. Although our agency does not allow workers to accept gifts, I appreciate your gratitude and want you to know that I’ve valued the opportunity to work with you. Your Christmas gift is very generous. Thank you. Would it be okay with you if I shared this gift with the rest of the agency?

Clearly, it is helpful to individualize your response so the client knows your gratitude is genuine. You may also need to explain the reasons that you cannot accept a gift. A final guideline on accepting gifts is transparency. If Cleo offers you a gift and you are concerned about telling your supervisor or co-workers, this raises a warning flag about accepting gifts.

  • If you do accept the gift, then you should be prepared to let your colleagues know about the gift, without fear of condemnation.
  • You might ask yourself, “How would I feel if I checked my favorite social networking site one day and saw a story about my receiving this gift, for all the world to see?” Further, as a matter of risk management, you should document a client’s offer to give you a gift, how you responded to the offer, and your justification for responding in that manner.

Decisions about whether and how to accept gifts can be complex. When in doubt, ask your supervisor or other professional colleagues for assistance. Explore the context of the decision, including the client’s and your motivations, as well as options, risks, and potential benefits.

Is accepting gifts from a client unethical?

Main content – Full Text: The ethical and therapeutic implications of receiving gifts from clients are explored. The importance of the issue is noted, and relevant ethical considerations are discussed. Therapeutic meanings that underlie client gift-giving are explored.

By integrating the ethical and therapeutic considerations, four general categories of gifts are identified. Specific therapeutic responses to each category are identified and briefly discussed. ********** It is not unusual for clients to bestow gifts upon their mental health counselors who, as a consequence, experience positive, negative, and mixed emotions (Spandler, Burman, Goldberg, Margison, & Amos, 2000).

In such situations, mental health professionals must manage personal emotions and behavior adequately in order to respond therapeutically. However, little attention is given to such therapeutic events in graduate training. In addition, few guidelines on appropriate therapeutic responses to client gift-giving have been developed.

Such client behavior can have important ethical and therapeutic implications (Beier & Young, 1998; Cappa, 2001; Dodds, 1985; Gartrell, 1992; Kritzberg, 1980; Spandler et al.). Yet, there is frequently professional ambivalence toward this topic that is, perhaps, reflected in the dearth of existent professional literature on gift-giving.

As Spangler et al. note, although “there is a vast general literature on ‘gifts,’ this is not the case in psychotherapy where an intriguing silence predominates” (p.80). The purpose of this article is to explore ethical and therapeutic issues that are relevant in client gift-giving situations.

  • First, the extent and nature of client gift-giving are discussed.
  • Second, relevant ethical and therapeutic issues are identified.
  • A scheme for categorizing and assessing gift-giving behavior is developed.
  • Finally, several general suggestions are given for handling these incidents.
  • THE EXTENT AND NATURE OF CLIENT GIFT-GIVING IN COUNSELING Webster’s Third New International Dictionary (Gove, 1993) defines a gift as “something that is voluntarily transferred by one person to another without compensation” (p.953).

The inherent value of the gift might be monetary, but can also be psychological and symbolic. The recipient knowingly recognizes its gift status and accepts it as such. There is no prior claim upon the gift by the recipient. In addition, the recipient is under no obligation to pay for it in the future.

  • It is not unusual for mental health counselors to receive gifts from clients, although few studies have been conducted to investigate this phenomenon.
  • In a review of the professional literature, only one empirical investigation on the gift-giving behavior of clients was found (Spandler et al., 2000).

Another investigation examined the gifts received by physicians from their patients (Drew, Stoeckle, & Billings, 1983). Anecdotal evidence accrues from informal discussion with colleagues, who reveal numerous occasions of gift-giving. For example, one female client, who was typically scheduled at the dinner hour, frequently brought in food items such as strawberry pie or pizza to share with her mental health counselor.

Another client, whose spouse worked for a snack distributor, would bring in bags of chips or pretzels that had reached their shelf life expiration date. Sometimes, the practice of gift-giving does not take place in such a straightforward manner. One client gave her mental health counselor a large photo album containing a number of family pictures.

Another mental health practitioner, working for a nonprofit agency, reported that a client donated a large quilt for an agency fund-raiser and had attached to it a poster-sized note thanking the mental health professional for her excellent service. In each case, the gift item was dropped off at a time when the mental health professionals were in session with other clients.

  • Drew et al.
  • 1983) identified three general categories of gifts.
  • First, gifts are often seen as a type of tip to the professional.
  • The underlying motive of the gift-giver in this case may be likened to the restaurant diner.
  • The client, who is pleased with the personalized service, degree of tolerance displayed, and timeliness of service seeks to compensate the mental health professional for providing service that is beyond the call of duty.

Second, gifts are given to address a perceived imbalance in the professional relationship. For example, a store manager, upon an improved level of functioning, might give her counselor a gift certificate that is redeemable at her store. Such a gift may help the client regain status that was temporarily lost during her increased sense of dependency during a major portion of her counseling.

Third, the gift might serve as a payment of homage or sacrifice to the mental health professional (Drew et al.). In such cases, the client sees the mental health counselor as using professional power on his or her behalf. For example, it might be through signing of appropriate forms by the mental health counselor that the client is entitled to specific benefits such as special housing, worker’s compensation, or Supplemental Security Income.

Gifts received in such circumstances can be viewed as the client giving thanks with a gift, similar to primitives paying homage to their god for a plentiful harvest. Sometimes, gifts offered by clients mark specific events or transitions (Spandler et al., 2000).

For example, a client may give the mental health counselor a gift at their last scheduled session. Or a gift and card might be given in relation to a holiday or birthday. Gifts of these types might be related to culture and the gender. In one study, it was reported that the majority of such gifts offered to counselors were given by female clients (Spandler et al.).

It is useful and appropriate to consider gift-giving as a form of communication. Spandler et al. (2000) speak of the meaning of gifts. For example, gifts come into being as a result of the will and intention of the gift-giver (Camenisch, 1981). And, in accepting the gift, mental health counselors implicitly acknowledge the giver’s will, intention, and reasons for giving it.

In addition, giving gifts is a common way of expressing and strengthening one’s social attachments (Schudson, 1986). It is a socially acceptable way of communicating gratitude and eliciting positive emotions from the receiver. Gifts are used to buy love and soothe feelings of guilt. Gifts are a way of restoring a balance of power within a relationship (Camenisch).

It is likely, though, that the client’s meanings and intentions are implicit and may even be beyond the awareness of the gift-giver. Gifts can also be distinguished by the depth of meaning attached to them. Thus, it is useful to view the various types of gifts as lying along a continuum.

At one end of the continuum, gifts received from clients can be considered as a form of ritualistic behavior. Wolin and Bennett (1984) distinguish between family celebrations and traditions. Although a party is a celebration, traditions include holidays, weddings, funerals, and other rites of passage.

Frequently, the giving of gifts by clients accompany occasions in the counselor-client relationship that can be construed as traditions. For example, Shapiro and Ginzberg (2002) describe the use of “parting gifts” as a termination ritual in group therapy.

Such gifts carry with them an intended meaning that is conveyed in an overt and intentional manner. The meaning and significance of the gift is readily perceived through an accurate perception of the situation and accompanying verbal behavior of the gift-giver. On the other end of the continuum, giving gifts serve as metaphors.

In these instances of metaphorical communication, it does not suffice to literally interpret the gift or the interactive process surrounding the giving and receiving, because as Searle (1993) notes, the literal meaning calls into mind another possible meaning.

  • Metaphors work by taking concepts that are not normally associated and juxtaposing them in a meaningful way that illuminates the similarity that exists in some way between them (MacCormac, 1985).
  • In the example of the client who gave her counselor a family photo album at the termination of treatment, a deeper meaning might be related to unresolved issues of transference.

ETHICAL AND THERAPEUTIC ISSUES The Code of Ethics of the American Mental Health Counselors Association (AMHCA, 2000) does not specifically address the topic of gift-giving by clients. It does, however, discuss the related issue of bartering. Bartering raises concerns about therapeutic boundaries and multiple relationships, as does the issue of clients’ gift-giving (Corey, Corey, & Callanan, 2003).

  • In contrast to gift-giving by clients, bartering is the exchange of goods or services without the exchange of money.
  • Like gift-giving, bartering is not prohibited by codes of ethics.
  • But mental health counselors ordinarily refrain from the practice because such arrangements create potential for conflicts, exploitation, and distortion of the professional relationship (AMHCA).

It is the potential for exploitation and distortion of the professional relationship that make the receiving of gifts from clients an ethical concern. Yet, a dilemma occurs as mental health counselors also are called upon to respect the dignity and worth of clients (AMHCA, 2000).

In addition, being a gracious receiver is an accepted social protocol. To do otherwise is to negate the giver’s experience of the “blessing” that supposedly comes with giving. And the refusal to accept a gift could communicate rejection of the client and that could result in a diminished view of self.

On the other hand, many examples can be noted where the act of giving gifts may not be in the best physical or psychological interest of the client. For example, gift-giving can, in fact, be a feature of the clinical picture for clients with dependent or borderline personality disorders.

The mental health counselor passively accepting a gift from such a client may reinforce patterns of manipulative or self-debasing behaviors that are symptomatic of the problematic levels of functioning. In such instances, mental health counselors must discern which course of action is truly in the client’s best interest.

Several principles of AMHCA’s Code of Ethics (AMHCA, 2000) have implications for mental health counselors in client gift-giving situations. First, Principle 1 states that the “primary responsibility of the mental health counselor is to respect the dignity and integrity of the client.

  1. Client growth and development are encouraged in ways that foster the client’s interest and promote welfare” (Principle 1.a.1).
  2. In addition, it warns that mental health counselors guard against the misuse of the influence they possess by virtue of role and position.
  3. To do so, mental health counselors must be aware of the degree of influence they have by virtue of their professional role (Principle 1.a.2).
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Thus, mental health counselors do well to recognize and respond to such underlying motives in ways that enhance the client’s dignity and self-respect rather than reinforce his or her sense of inferiority. The potential for exploitation exists when a real or perceived power differential exists in the therapeutic relationship.

The gift becomes a cue that increases the mental health counselor’s awareness of the power differential and can influence specific therapeutic decisions. For example, if I must adjust my schedule of appointments for a particular day, I might be more inclined to reschedule the client who has given me a gift.

Or the decision to reschedule the client may be founded upon the socially accepted meaning of a gift (e.g., a sign of liking and appreciation; a willingness to please). Thus, my decision to reschedule the gift-giving client, rather than another client, reflects my attempt at identifying the path of least resistance.

Because of having been offered a gift in the past, I assume that this specific client will not mind. On the other hand, mental health counselors may be more inclined to compromise agency policy related to no-shows and cancellations when the offending client happens to be one from whom the mental health counselor has received gifts in the past.

The motive for such a show of grace on the part of the mental health counselor, in this latter case, might be more out of reciprocity than client need. By being a gracious receiver of the gift, the accepting behavior of the mental health counselor can serve as a powerful reinforcer of the gift-giving behavior.

  • Thus, when in similar conditions, the client’s gift-giving behavior may tend to recur.
  • Such was the case when a clients brought in a number of packages of snack products.
  • The client’s partner worked for a food distributor, leaving the client with an abundance of these tasty morsels whose expiration date had just passed.

Staff fussed over the client’s thoughtfulness, and, consistent with operant principles, the client continued to bring cartons of snacks even when the mental health professional communicated that the behavior was not warranted or needed. By accepting gifts without question, mental health practitioners may or may not be acting in ways that are truly supportive of the client’s welfare.

  • It is clear that in many cases such determinations cannot be made without a consideration of the underlying intentions and motives of the client and counselor as well as the dynamics of the therapeutic relationship.
  • Therefore, constructive therapeutic responses can be identified only upon first considering the therapeutic implications of the gift alongside the ethical concerns.

ASSESSING AND RESPONDING IN GIFF-GIVING SITUATIONS Because gifts can mean so many things and fulfill social functions, the mental health counselor’s task is to identify the contextual meaning what the gift is and is not. Stated another way, the mental health counselor determines when the gift is not merely a gift.

  • To do so, the mental health counselor must “look the gift horse in the mouth” and draw out from the client information to discern the possibility of a metaphorical meaning for the gift-giving.
  • Clues come from client statements, the context, and the specific characteristics of the gift.
  • The degree of client awareness into the metaphorical nature of the gift-giving influences the extent to which the mental health counselor relies on client, contextual, or gift characteristics in formulating the therapeutic response.

In light of the discussion above, a model for assessing gift-giving situations can be put forth. Clients’ gift-giving behavior can be viewed as lying along two dimensions. The first dimension relates to the ethical implications of receiving the gift. On this dimension, gifts can range from having little or no ethical implications to being unethical.

Receiving gifts from clients can also be viewed as lying on a second dimension related to the therapeutic meaning of the gift. Gifts, on this second dimension, can range from possessing relatively low to high levels of therapeutic meaning. When viewed in this manner, gifts can be seen as falling into one of four categories (see Table 1).

Many gifts presented in the context of counseling fall in the category of carrying a low level of ethical concern and therapeutic meaning. Receiving cards (e.g., Christmas, Passover) and inexpensive gifts often fall into this category. For example, one client gave the mental health counselor a paperback book with a card at their final session.

On such occasions, the gift can be received with a brief collaborative exploration of the client intention and meaning followed by a genuine “thank you.” Little therapeutic gain is achieved by attempting to excavate a deeper meaning for the gift, and such explorations can, in fact, be seen as communicating disrespect to the client.

In contrast, a second category might be gifts characterized as relatively low in therapeutic significance, but the acceptance of them may border on unethical behavior. For example, as a genuine show of appreciation for services rendered, a client might attempt to give to the therapist a very expensive set of books at the final session.

  1. At some point, accepting such gifts can be construed as a tip, and so become exploitive.
  2. Although not desiring to be inappropriately confrontive, mental health counselors do well to take some time and process the behavior, feelings, and underlying meaning associated with the giving of such an expensive gift in order to avoid the potential for unprofessional or unethical behavior or for unintentional harm to be inflicted upon the client.

In the third category, gifts presented by clients may, on the surface, appear to raise few ethical issues. But, upon exploration of the client’s underlying intentions or motives, a deeper meaning is revealed. For example, a child may draw a picture and bring it in as a gift to the therapist.

  • It is a mistake to simply accept the drawing without considering underlying motives, thoughts, and feelings of the child.
  • Such events can be the occasions where the child is actually conveying important and powerful feelings that can be identified and related to other themes emerging in the treatment process.

As Beier and Young (1998) note, powerful social conventions associated with gift-giving and receiving can lead mental health professionals to choose paths that limit therapeutic effectiveness in such situations (e.g., routinely responding as a gracious receiver and, in doing so, relinquish the role of mental health counselor).

  • Finally, it may be unethical to accept a gift that also carries a high level of therapeutic meaning.
  • Take, as an example, a female client and male therapist.
  • The client stalked the mental health counselor to discover where he lived.
  • She, later, stopped by the house and attempted to initiate a personal relationship, stating that the therapist would be given “a night he would remember.” To accept this gift, of course, would be highly unethical.

Yet, it was vital that the counselor explore the deep meanings and motives beneath the client’s behavior in order to discern the significant therapeutic implications. Seeking supervision or consultation with an experienced colleague is an important way of maintaining objectivity and developing therapeutic responses in such situations.

MANAGING APPROPRIATE RESPONSES Mental health practitioners are divided on how to respond to clients’ gift-giving behavior. For example, Dodds (1985) suggested the following guidelines regarding gift-giving in child therapy: * If parents ask, you suggest to them that they not bother to have the child give you a gift unless the child really pushes for it.

* If the child insists and you have an opportunity for some input on gift selection, then urge something simple like a box of candy or something the child has made. * When the child gives you a gift, accept it graciously and gratefully, since he or she would be hurt by a refusal if the child made the present.

  1. If you can possibly display the gift over the next few weeks, the child will know that you really do appreciate and value the gift and the thought behind it.
  2. P.133) In contrast, Beier and Young (1998) express a different perspective.
  3. According to these authors, mental health professionals must necessarily move ahead with caution and good clinical judgment because very strong social conventions are called into play when a gift is received.

Mental health counselors can use gift-giving situations as opportunities to explore deeper feelings and motives that may lie beneath the safe structure of giving a gift. The following example clarifies their view: When a 7-year-old girl brings the therapist a bouquet of flowers she picked in the garden, the first impulse of any receiver is to say “thank you” and feel very pleased about this expression of gratitude and friendliness.

Yet within the therapeutic situation, nothing could be more wasteful. It is just because the gift is such a safe way of expressing feelings and setting up structures that some of the most therapeutically important feelings are likely to be hidden behind these expressions (Beier & Young, 1998, p.118).

It is suggested here that the clearest path for the mental health counselor to take is found at the intersection of the ethical implications and therapeutic meaning. Once these dimensions are clearly defined by the therapist, an appropriate course of action becomes more apparent.

  1. Thus, mental health counselors should, first, assess the nature of the specific gift-giving situation using, for instance, the questions below can clarify the situation and help point the mental health counselor toward constructive responses to the gift being offered.
  2. Decisions made on how to respond to gift-giving depend to a large extent on the specific classification of the gift offered.

* To what extent would acceptance of the gift be ethical? Will accepting this gift negatively affect the well-being of this client? Is there any potential for client exploitation due to counselor/client role or power differential? By accepting this gift, is there a potential for crossing boundaries (e.g., moving from the professional to a more personal role)? * What is the relationship of the gift-giving behavior to presenting clinical issues? Is the behavior a reflection of what occurs in the client’s other social relationships? Can the gift-giving be considered as part of this client’s self-defeating pattern of behavior that maintains his or her status quo? * What am I (the mental health counselor) experiencing in this specific situation? Do I detect any personal feelings of ambivalence or dissonance? To what extent am I experiencing an approach-avoidance conflict? What would be my motives for accepting this gift? It is imperative for the mental health counselor to go beyond the superficial level of awareness in answering these questions.

Does the gift carry both overt and covert meanings? What possible meanings may be assigned to the giving of the gift? Based on collaborative exploration, what meaning(s) can be attached to the giving of the gift? To what extent is the client aware of his or her motives for giving the gift and willing to take ownership for the behavior as well as the underlying motives? Seek clarification as necessary.

* How is the gift-giving situation best categorized (see Table 1)? Once the category of gift-giving has been assessed, appropriate responses can be determined. As can be noted (see Table 2), mental health counselors have the option to either accept or not accept gifts when assessed as ethical.

  • However, in such situations, the determining factor on deciding to accept the gift depends on the nature of therapeutic meaning assigned to the gift-giving situation.
  • In addition, it is never appropriate to accept a gift when to do so would be unethical.
  • The meaning of such a gift, though, should be processed in order to integrate its significance into the ongoing themes of counseling.

Mental health counselors should keep in mind the possible symbols and metaphors associated with the literal gift. Frequently, the best and most overlooked metaphors are those created by clients in the context of therapy. When properly constructed and invoked, metaphors enhance learning by creating a model or framework for supporting future learning of new concepts and skills.

That is, the metaphor serves as a bridge from the “known to the radically unknown” (Petrie, 1993, p.584). Being sensitive to the conditions surrounding the gift as well as background assumptions of the client, the literal meaning of the gift will tend to call a metaphorical meaning into the mind of the mental health counselor.

A provocative approach is to acknowledge or accept the gift and, then, utilize it as a metaphorical object. Occasionally, the gift or process in giving the gift symbolically represents another object, event, or process related to therapeutic issues. By playfully and respectfully focusing on, discussing aspects of, or manipulating the object in session, the mental health counselor is able to address significant therapeutic concerns through indirect communication.

  1. To effectively use gifts as metaphorical objects, mental health counselors need to be simultaneously supportive and provocative (Andolfi, Angelo, & de Nichilo, 1989).
  2. When used effectively, a therapeutic crisis, which can activate in the client’s search for alternative meanings, is created by questioning the client’s actions and motivations that have been typically taken for granted.

The gift can become a relational link between the known (i.e., the gift) and the unknown (i.e., deeper meanings associated with presenting problems, therapeutic process, and goals). Examining gifts in this manner becomes a tool that opens up conflicts, rejections, or resolutions that may otherwise remain unexplored or hidden.

Andolfi and his colleagues have found that “the images created in session and represented by metaphorical objects have a remarkable capacity to persist and reverberate that is clearly superior to those produced by verbal exchanges and interpretations” (p.74). CONCLUSIONS Receiving gifts from clients is a frequently occurring therapeutic event.

However, little has been written on its nature, significance, and therapeutic implications. Although several authors have commented on the significance of receiving gifts from clients, mental health counselors are offered few guidelines for such events.

  • In this article, I have attempted to identify relevant ethical and therapeutic issues related to client gift-giving, put forth a model for assessing gifts, and recommended several responsible and therapeutic courses of action.
  • However, a number of issues remain for further research.
  • First, there are no studies that systematically investigate the actual dimensions of gifts received.

Thus, the model presented in this article, which uses ethicality and level of therapeutic meaning as dimensions, requires empirical investigation. Second, future research is needed to systematically explore the experiences and practices of mental health counselors when interacting with clients who offer gifts to them.

For example, it would be worthwhile to investigate the extent to which gift-giving occurs and how it varies according to gender, age, and culture or ethnicity of the client or mental health counselor. Finally, future research should explore the extent to which therapeutic responses to gift-giving vary depending on the (a) practice setting (e.g., pastoral, agency, private), (b) phase of treatment in which the gift is given, and (c) personal characteristics of the counselor.

For instance, anecdotal evidence suggests that some therapists have numerous experiences with gift-giving clients whereas other counselors report few or no such experiences. Given that situations and attached meanings can be quite personal and idiosyncratic, case study or qualitative models might be well-suited to explore many of these identified research questions.

  • Clients’ welfare would be promoted as increased attention is given to these commonly occurring therapeutic events.
  • Table 1 Categories of Gifts LEVEL OF ETHICAL CONCERN Relatively Low Level of Ethical Concern Relatively Low Level * Minimal Ethical Risk of Therapeutic * Low Level of LEVEL OF Significance Therapeutic Meaning THERAPEUTIC and Significance MEANING & SIGNIFICANCE Relatively High Level * Minimal Level of of Therapeutic Ethical Concern Significance * High Level of Therapeutic Meaning and Significance LEVEL OF ETHICAL CONCERN Relatively High Level of Ethical Concern * High Level of Ethical Concern; Risk of LEVEL OF Ethical Violation THERAPEUTIC * Low Level of MEANING & Therapeutic Meaning SIGNIFICANCE and Significance * High Level of Ethical Concern; Risk of Ethical Violation * High Level of Therapeutic Meaning and Significance Table 2 Ethical and Therapeutic Responses Based on Categorization of Gift LEVEL OF ETHICAL CONCERN Relatively Low Level of Ethical Concern 1.

Reflect client affect, behavior, and situational content Relatively Low Level 2. Self-disclose of Therapeutic personal thoughts Significance and affect 3. Choose to accept or not accept LEVEL OF THERAPEUTIC MEANING & SIGNIFICANCE 1. Seek clarification through questioning 2.

  • Reflect client affect and behaviors 3.
  • Self-disclose thoughts and affect Relatively High Level 4.
  • Interpret meaning of Therapeutic and connect to thera- Significance peutic issues 5.
  • Integrate gift-giving into treatment process by using gift as symbol, metaphor, or metaphorical object 6.
  • Choose to accept or not accept LEVEL OF ETHICAL CONCERN Relatively High Level of Ethical Concern 1.

Seek clarification 2. Reflect client behavior, affect, and situational content 3. Self-disclose personal thoughts and affect 4. Provide information regarding ethics of accepting specific gift 5. Decline gift, while LEVEL OF exhibiting positive THERAPEUTIC regard and warmth MEANING & SIGNIFICANCE 1.

Seek clarification through questioning 2. Reflect clients affect and thoughts 3. Self-disclose thoughts, affect and rationale for not accepting gift 4. Reframe as and connect with therapeutic issues 5. Explore deeper meaning of gift using Socratic questioning 6. Process directly and metaphorically REFERENCES American Mental Health Counselors Association.

(2000). Code of ethics of the American Mental Health Counselors Association. Alexandria, VA: Author. Andolfi, M., Angelo, C., & de Nichilo, M. (1989). The myth of Atlas: Families and the therapeutic story. New York: Bruner/Mazel. Beier, E., & Young, D.M. (1998).

  1. The silent language of psychotherapy: Social reinforcement of unconscious processes (3rd ed.).
  2. New York: Aldine.
  3. Camenisch, P.F. (1981).
  4. Gift and gratitude in ethics.
  5. Journal of Religious Ethics, 9, 1-34.
  6. Cappa, S.A. (2001).
  7. They came bearing gifts:” A cast study of the manifestation of gift giving in psychotherapy.

Journal of Psychology and Christianity, 20, 287-292. Corey, G., Corey, M.S., & Callanan, P. (2003). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole. Dodds, J.B. (1985). The child psychotherapy primer: Suggestions for the beginning therapist.

New York: Human Sciences Press. Drew, J., Stoeckle, J.D., & Billings, J.A. (1983). Tips, status, and sacrifice: Gift-giving in the doctor-patient relationship. Social Science and Medicine, 17, 399-404. Gartrell, N.K. (1992). Boundaries in lesbian therapy relationships. Women and Therapy, 12, 29-50. Gove, P.B.

(1993). Webster’s third new international dictionary, unabridged. Springfield, MA: Merriam-Webster. Kritzberg, N.I. (1980). On patients’ gift-giving. Contemporary Psychoanalysis, 16, 98-118. MacCormac, E.R. (1985). A cognitive theory of metaphor. Cambridge: The MIT Press.

Petrie, H.G. (1993). Metaphor and learning. In A. Ortony (Ed.), Metaphor and thought (pp.342-356). New York: Cambridge University. Schudson, M. (1986, December). The giving of gifts. Psychology Today, 20, pp.27-29. Searle, J.R. (1993). Metaphor. In A. Ortony (Ed.), Metaphor and thought (pp.84-111). New York: Cambridge University.

Shapiro, E.L., & Ginzberg, R. (2002). Parting gift: Termination rituals in group therapy. International Journal of Group Psychotherapy, 52, 319-335. Spandler, H., Burman, E., Goldberg, B., Margison, F., & Amos, T. (2000). ‘A double-edged sword:’ Understanding gifts in psychotherapy.

Is accepting gifts from a client unethical?

Main content – Full Text: The ethical and therapeutic implications of receiving gifts from clients are explored. The importance of the issue is noted, and relevant ethical considerations are discussed. Therapeutic meanings that underlie client gift-giving are explored.

By integrating the ethical and therapeutic considerations, four general categories of gifts are identified. Specific therapeutic responses to each category are identified and briefly discussed. ********** It is not unusual for clients to bestow gifts upon their mental health counselors who, as a consequence, experience positive, negative, and mixed emotions (Spandler, Burman, Goldberg, Margison, & Amos, 2000).

In such situations, mental health professionals must manage personal emotions and behavior adequately in order to respond therapeutically. However, little attention is given to such therapeutic events in graduate training. In addition, few guidelines on appropriate therapeutic responses to client gift-giving have been developed.

Such client behavior can have important ethical and therapeutic implications (Beier & Young, 1998; Cappa, 2001; Dodds, 1985; Gartrell, 1992; Kritzberg, 1980; Spandler et al.). Yet, there is frequently professional ambivalence toward this topic that is, perhaps, reflected in the dearth of existent professional literature on gift-giving.

As Spangler et al. note, although “there is a vast general literature on ‘gifts,’ this is not the case in psychotherapy where an intriguing silence predominates” (p.80). The purpose of this article is to explore ethical and therapeutic issues that are relevant in client gift-giving situations.

First, the extent and nature of client gift-giving are discussed. Second, relevant ethical and therapeutic issues are identified. A scheme for categorizing and assessing gift-giving behavior is developed. Finally, several general suggestions are given for handling these incidents. THE EXTENT AND NATURE OF CLIENT GIFT-GIVING IN COUNSELING Webster’s Third New International Dictionary (Gove, 1993) defines a gift as “something that is voluntarily transferred by one person to another without compensation” (p.953).

The inherent value of the gift might be monetary, but can also be psychological and symbolic. The recipient knowingly recognizes its gift status and accepts it as such. There is no prior claim upon the gift by the recipient. In addition, the recipient is under no obligation to pay for it in the future.

  1. It is not unusual for mental health counselors to receive gifts from clients, although few studies have been conducted to investigate this phenomenon.
  2. In a review of the professional literature, only one empirical investigation on the gift-giving behavior of clients was found (Spandler et al., 2000).

Another investigation examined the gifts received by physicians from their patients (Drew, Stoeckle, & Billings, 1983). Anecdotal evidence accrues from informal discussion with colleagues, who reveal numerous occasions of gift-giving. For example, one female client, who was typically scheduled at the dinner hour, frequently brought in food items such as strawberry pie or pizza to share with her mental health counselor.

  1. Another client, whose spouse worked for a snack distributor, would bring in bags of chips or pretzels that had reached their shelf life expiration date.
  2. Sometimes, the practice of gift-giving does not take place in such a straightforward manner.
  3. One client gave her mental health counselor a large photo album containing a number of family pictures.

Another mental health practitioner, working for a nonprofit agency, reported that a client donated a large quilt for an agency fund-raiser and had attached to it a poster-sized note thanking the mental health professional for her excellent service. In each case, the gift item was dropped off at a time when the mental health professionals were in session with other clients.

Drew et al. (1983) identified three general categories of gifts. First, gifts are often seen as a type of tip to the professional. The underlying motive of the gift-giver in this case may be likened to the restaurant diner. The client, who is pleased with the personalized service, degree of tolerance displayed, and timeliness of service seeks to compensate the mental health professional for providing service that is beyond the call of duty.

Second, gifts are given to address a perceived imbalance in the professional relationship. For example, a store manager, upon an improved level of functioning, might give her counselor a gift certificate that is redeemable at her store. Such a gift may help the client regain status that was temporarily lost during her increased sense of dependency during a major portion of her counseling.

Third, the gift might serve as a payment of homage or sacrifice to the mental health professional (Drew et al.). In such cases, the client sees the mental health counselor as using professional power on his or her behalf. For example, it might be through signing of appropriate forms by the mental health counselor that the client is entitled to specific benefits such as special housing, worker’s compensation, or Supplemental Security Income.

Gifts received in such circumstances can be viewed as the client giving thanks with a gift, similar to primitives paying homage to their god for a plentiful harvest. Sometimes, gifts offered by clients mark specific events or transitions (Spandler et al., 2000).

  • For example, a client may give the mental health counselor a gift at their last scheduled session.
  • Or a gift and card might be given in relation to a holiday or birthday.
  • Gifts of these types might be related to culture and the gender.
  • In one study, it was reported that the majority of such gifts offered to counselors were given by female clients (Spandler et al.).

It is useful and appropriate to consider gift-giving as a form of communication. Spandler et al. (2000) speak of the meaning of gifts. For example, gifts come into being as a result of the will and intention of the gift-giver (Camenisch, 1981). And, in accepting the gift, mental health counselors implicitly acknowledge the giver’s will, intention, and reasons for giving it.

  • In addition, giving gifts is a common way of expressing and strengthening one’s social attachments (Schudson, 1986).
  • It is a socially acceptable way of communicating gratitude and eliciting positive emotions from the receiver.
  • Gifts are used to buy love and soothe feelings of guilt.
  • Gifts are a way of restoring a balance of power within a relationship (Camenisch).

It is likely, though, that the client’s meanings and intentions are implicit and may even be beyond the awareness of the gift-giver. Gifts can also be distinguished by the depth of meaning attached to them. Thus, it is useful to view the various types of gifts as lying along a continuum.

At one end of the continuum, gifts received from clients can be considered as a form of ritualistic behavior. Wolin and Bennett (1984) distinguish between family celebrations and traditions. Although a party is a celebration, traditions include holidays, weddings, funerals, and other rites of passage.

Frequently, the giving of gifts by clients accompany occasions in the counselor-client relationship that can be construed as traditions. For example, Shapiro and Ginzberg (2002) describe the use of “parting gifts” as a termination ritual in group therapy.

Such gifts carry with them an intended meaning that is conveyed in an overt and intentional manner. The meaning and significance of the gift is readily perceived through an accurate perception of the situation and accompanying verbal behavior of the gift-giver. On the other end of the continuum, giving gifts serve as metaphors.

In these instances of metaphorical communication, it does not suffice to literally interpret the gift or the interactive process surrounding the giving and receiving, because as Searle (1993) notes, the literal meaning calls into mind another possible meaning.

Metaphors work by taking concepts that are not normally associated and juxtaposing them in a meaningful way that illuminates the similarity that exists in some way between them (MacCormac, 1985). In the example of the client who gave her counselor a family photo album at the termination of treatment, a deeper meaning might be related to unresolved issues of transference.

ETHICAL AND THERAPEUTIC ISSUES The Code of Ethics of the American Mental Health Counselors Association (AMHCA, 2000) does not specifically address the topic of gift-giving by clients. It does, however, discuss the related issue of bartering. Bartering raises concerns about therapeutic boundaries and multiple relationships, as does the issue of clients’ gift-giving (Corey, Corey, & Callanan, 2003).

  • In contrast to gift-giving by clients, bartering is the exchange of goods or services without the exchange of money.
  • Like gift-giving, bartering is not prohibited by codes of ethics.
  • But mental health counselors ordinarily refrain from the practice because such arrangements create potential for conflicts, exploitation, and distortion of the professional relationship (AMHCA).

It is the potential for exploitation and distortion of the professional relationship that make the receiving of gifts from clients an ethical concern. Yet, a dilemma occurs as mental health counselors also are called upon to respect the dignity and worth of clients (AMHCA, 2000).

  1. In addition, being a gracious receiver is an accepted social protocol.
  2. To do otherwise is to negate the giver’s experience of the “blessing” that supposedly comes with giving.
  3. And the refusal to accept a gift could communicate rejection of the client and that could result in a diminished view of self.

On the other hand, many examples can be noted where the act of giving gifts may not be in the best physical or psychological interest of the client. For example, gift-giving can, in fact, be a feature of the clinical picture for clients with dependent or borderline personality disorders.

The mental health counselor passively accepting a gift from such a client may reinforce patterns of manipulative or self-debasing behaviors that are symptomatic of the problematic levels of functioning. In such instances, mental health counselors must discern which course of action is truly in the client’s best interest.

Several principles of AMHCA’s Code of Ethics (AMHCA, 2000) have implications for mental health counselors in client gift-giving situations. First, Principle 1 states that the “primary responsibility of the mental health counselor is to respect the dignity and integrity of the client.

Client growth and development are encouraged in ways that foster the client’s interest and promote welfare” (Principle 1.a.1). In addition, it warns that mental health counselors guard against the misuse of the influence they possess by virtue of role and position. To do so, mental health counselors must be aware of the degree of influence they have by virtue of their professional role (Principle 1.a.2).

Thus, mental health counselors do well to recognize and respond to such underlying motives in ways that enhance the client’s dignity and self-respect rather than reinforce his or her sense of inferiority. The potential for exploitation exists when a real or perceived power differential exists in the therapeutic relationship.

The gift becomes a cue that increases the mental health counselor’s awareness of the power differential and can influence specific therapeutic decisions. For example, if I must adjust my schedule of appointments for a particular day, I might be more inclined to reschedule the client who has given me a gift.

Or the decision to reschedule the client may be founded upon the socially accepted meaning of a gift (e.g., a sign of liking and appreciation; a willingness to please). Thus, my decision to reschedule the gift-giving client, rather than another client, reflects my attempt at identifying the path of least resistance.

  • Because of having been offered a gift in the past, I assume that this specific client will not mind.
  • On the other hand, mental health counselors may be more inclined to compromise agency policy related to no-shows and cancellations when the offending client happens to be one from whom the mental health counselor has received gifts in the past.

The motive for such a show of grace on the part of the mental health counselor, in this latter case, might be more out of reciprocity than client need. By being a gracious receiver of the gift, the accepting behavior of the mental health counselor can serve as a powerful reinforcer of the gift-giving behavior.

  1. Thus, when in similar conditions, the client’s gift-giving behavior may tend to recur.
  2. Such was the case when a clients brought in a number of packages of snack products.
  3. The client’s partner worked for a food distributor, leaving the client with an abundance of these tasty morsels whose expiration date had just passed.

Staff fussed over the client’s thoughtfulness, and, consistent with operant principles, the client continued to bring cartons of snacks even when the mental health professional communicated that the behavior was not warranted or needed. By accepting gifts without question, mental health practitioners may or may not be acting in ways that are truly supportive of the client’s welfare.

  • It is clear that in many cases such determinations cannot be made without a consideration of the underlying intentions and motives of the client and counselor as well as the dynamics of the therapeutic relationship.
  • Therefore, constructive therapeutic responses can be identified only upon first considering the therapeutic implications of the gift alongside the ethical concerns.

ASSESSING AND RESPONDING IN GIFF-GIVING SITUATIONS Because gifts can mean so many things and fulfill social functions, the mental health counselor’s task is to identify the contextual meaning what the gift is and is not. Stated another way, the mental health counselor determines when the gift is not merely a gift.

  • To do so, the mental health counselor must “look the gift horse in the mouth” and draw out from the client information to discern the possibility of a metaphorical meaning for the gift-giving.
  • Clues come from client statements, the context, and the specific characteristics of the gift.
  • The degree of client awareness into the metaphorical nature of the gift-giving influences the extent to which the mental health counselor relies on client, contextual, or gift characteristics in formulating the therapeutic response.

In light of the discussion above, a model for assessing gift-giving situations can be put forth. Clients’ gift-giving behavior can be viewed as lying along two dimensions. The first dimension relates to the ethical implications of receiving the gift. On this dimension, gifts can range from having little or no ethical implications to being unethical.

Receiving gifts from clients can also be viewed as lying on a second dimension related to the therapeutic meaning of the gift. Gifts, on this second dimension, can range from possessing relatively low to high levels of therapeutic meaning. When viewed in this manner, gifts can be seen as falling into one of four categories (see Table 1).

Many gifts presented in the context of counseling fall in the category of carrying a low level of ethical concern and therapeutic meaning. Receiving cards (e.g., Christmas, Passover) and inexpensive gifts often fall into this category. For example, one client gave the mental health counselor a paperback book with a card at their final session.

On such occasions, the gift can be received with a brief collaborative exploration of the client intention and meaning followed by a genuine “thank you.” Little therapeutic gain is achieved by attempting to excavate a deeper meaning for the gift, and such explorations can, in fact, be seen as communicating disrespect to the client.

In contrast, a second category might be gifts characterized as relatively low in therapeutic significance, but the acceptance of them may border on unethical behavior. For example, as a genuine show of appreciation for services rendered, a client might attempt to give to the therapist a very expensive set of books at the final session.

  • At some point, accepting such gifts can be construed as a tip, and so become exploitive.
  • Although not desiring to be inappropriately confrontive, mental health counselors do well to take some time and process the behavior, feelings, and underlying meaning associated with the giving of such an expensive gift in order to avoid the potential for unprofessional or unethical behavior or for unintentional harm to be inflicted upon the client.

In the third category, gifts presented by clients may, on the surface, appear to raise few ethical issues. But, upon exploration of the client’s underlying intentions or motives, a deeper meaning is revealed. For example, a child may draw a picture and bring it in as a gift to the therapist.

It is a mistake to simply accept the drawing without considering underlying motives, thoughts, and feelings of the child. Such events can be the occasions where the child is actually conveying important and powerful feelings that can be identified and related to other themes emerging in the treatment process.

As Beier and Young (1998) note, powerful social conventions associated with gift-giving and receiving can lead mental health professionals to choose paths that limit therapeutic effectiveness in such situations (e.g., routinely responding as a gracious receiver and, in doing so, relinquish the role of mental health counselor).

Finally, it may be unethical to accept a gift that also carries a high level of therapeutic meaning. Take, as an example, a female client and male therapist. The client stalked the mental health counselor to discover where he lived. She, later, stopped by the house and attempted to initiate a personal relationship, stating that the therapist would be given “a night he would remember.” To accept this gift, of course, would be highly unethical.

Yet, it was vital that the counselor explore the deep meanings and motives beneath the client’s behavior in order to discern the significant therapeutic implications. Seeking supervision or consultation with an experienced colleague is an important way of maintaining objectivity and developing therapeutic responses in such situations.

  1. MANAGING APPROPRIATE RESPONSES Mental health practitioners are divided on how to respond to clients’ gift-giving behavior.
  2. For example, Dodds (1985) suggested the following guidelines regarding gift-giving in child therapy: * If parents ask, you suggest to them that they not bother to have the child give you a gift unless the child really pushes for it.

* If the child insists and you have an opportunity for some input on gift selection, then urge something simple like a box of candy or something the child has made. * When the child gives you a gift, accept it graciously and gratefully, since he or she would be hurt by a refusal if the child made the present.

  1. If you can possibly display the gift over the next few weeks, the child will know that you really do appreciate and value the gift and the thought behind it.
  2. P.133) In contrast, Beier and Young (1998) express a different perspective.
  3. According to these authors, mental health professionals must necessarily move ahead with caution and good clinical judgment because very strong social conventions are called into play when a gift is received.

Mental health counselors can use gift-giving situations as opportunities to explore deeper feelings and motives that may lie beneath the safe structure of giving a gift. The following example clarifies their view: When a 7-year-old girl brings the therapist a bouquet of flowers she picked in the garden, the first impulse of any receiver is to say “thank you” and feel very pleased about this expression of gratitude and friendliness.

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Yet within the therapeutic situation, nothing could be more wasteful. It is just because the gift is such a safe way of expressing feelings and setting up structures that some of the most therapeutically important feelings are likely to be hidden behind these expressions (Beier & Young, 1998, p.118).

It is suggested here that the clearest path for the mental health counselor to take is found at the intersection of the ethical implications and therapeutic meaning. Once these dimensions are clearly defined by the therapist, an appropriate course of action becomes more apparent.

Thus, mental health counselors should, first, assess the nature of the specific gift-giving situation using, for instance, the questions below can clarify the situation and help point the mental health counselor toward constructive responses to the gift being offered. Decisions made on how to respond to gift-giving depend to a large extent on the specific classification of the gift offered.

* To what extent would acceptance of the gift be ethical? Will accepting this gift negatively affect the well-being of this client? Is there any potential for client exploitation due to counselor/client role or power differential? By accepting this gift, is there a potential for crossing boundaries (e.g., moving from the professional to a more personal role)? * What is the relationship of the gift-giving behavior to presenting clinical issues? Is the behavior a reflection of what occurs in the client’s other social relationships? Can the gift-giving be considered as part of this client’s self-defeating pattern of behavior that maintains his or her status quo? * What am I (the mental health counselor) experiencing in this specific situation? Do I detect any personal feelings of ambivalence or dissonance? To what extent am I experiencing an approach-avoidance conflict? What would be my motives for accepting this gift? It is imperative for the mental health counselor to go beyond the superficial level of awareness in answering these questions.

* Does the gift carry both overt and covert meanings? What possible meanings may be assigned to the giving of the gift? Based on collaborative exploration, what meaning(s) can be attached to the giving of the gift? To what extent is the client aware of his or her motives for giving the gift and willing to take ownership for the behavior as well as the underlying motives? Seek clarification as necessary.

* How is the gift-giving situation best categorized (see Table 1)? Once the category of gift-giving has been assessed, appropriate responses can be determined. As can be noted (see Table 2), mental health counselors have the option to either accept or not accept gifts when assessed as ethical.

However, in such situations, the determining factor on deciding to accept the gift depends on the nature of therapeutic meaning assigned to the gift-giving situation. In addition, it is never appropriate to accept a gift when to do so would be unethical. The meaning of such a gift, though, should be processed in order to integrate its significance into the ongoing themes of counseling.

Mental health counselors should keep in mind the possible symbols and metaphors associated with the literal gift. Frequently, the best and most overlooked metaphors are those created by clients in the context of therapy. When properly constructed and invoked, metaphors enhance learning by creating a model or framework for supporting future learning of new concepts and skills.

That is, the metaphor serves as a bridge from the “known to the radically unknown” (Petrie, 1993, p.584). Being sensitive to the conditions surrounding the gift as well as background assumptions of the client, the literal meaning of the gift will tend to call a metaphorical meaning into the mind of the mental health counselor.

A provocative approach is to acknowledge or accept the gift and, then, utilize it as a metaphorical object. Occasionally, the gift or process in giving the gift symbolically represents another object, event, or process related to therapeutic issues. By playfully and respectfully focusing on, discussing aspects of, or manipulating the object in session, the mental health counselor is able to address significant therapeutic concerns through indirect communication.

To effectively use gifts as metaphorical objects, mental health counselors need to be simultaneously supportive and provocative (Andolfi, Angelo, & de Nichilo, 1989). When used effectively, a therapeutic crisis, which can activate in the client’s search for alternative meanings, is created by questioning the client’s actions and motivations that have been typically taken for granted.

The gift can become a relational link between the known (i.e., the gift) and the unknown (i.e., deeper meanings associated with presenting problems, therapeutic process, and goals). Examining gifts in this manner becomes a tool that opens up conflicts, rejections, or resolutions that may otherwise remain unexplored or hidden.

  1. Andolfi and his colleagues have found that “the images created in session and represented by metaphorical objects have a remarkable capacity to persist and reverberate that is clearly superior to those produced by verbal exchanges and interpretations” (p.74).
  2. CONCLUSIONS Receiving gifts from clients is a frequently occurring therapeutic event.

However, little has been written on its nature, significance, and therapeutic implications. Although several authors have commented on the significance of receiving gifts from clients, mental health counselors are offered few guidelines for such events.

In this article, I have attempted to identify relevant ethical and therapeutic issues related to client gift-giving, put forth a model for assessing gifts, and recommended several responsible and therapeutic courses of action. However, a number of issues remain for further research. First, there are no studies that systematically investigate the actual dimensions of gifts received.

Thus, the model presented in this article, which uses ethicality and level of therapeutic meaning as dimensions, requires empirical investigation. Second, future research is needed to systematically explore the experiences and practices of mental health counselors when interacting with clients who offer gifts to them.

  1. For example, it would be worthwhile to investigate the extent to which gift-giving occurs and how it varies according to gender, age, and culture or ethnicity of the client or mental health counselor.
  2. Finally, future research should explore the extent to which therapeutic responses to gift-giving vary depending on the (a) practice setting (e.g., pastoral, agency, private), (b) phase of treatment in which the gift is given, and (c) personal characteristics of the counselor.

For instance, anecdotal evidence suggests that some therapists have numerous experiences with gift-giving clients whereas other counselors report few or no such experiences. Given that situations and attached meanings can be quite personal and idiosyncratic, case study or qualitative models might be well-suited to explore many of these identified research questions.

  1. Clients’ welfare would be promoted as increased attention is given to these commonly occurring therapeutic events.
  2. Table 1 Categories of Gifts LEVEL OF ETHICAL CONCERN Relatively Low Level of Ethical Concern Relatively Low Level * Minimal Ethical Risk of Therapeutic * Low Level of LEVEL OF Significance Therapeutic Meaning THERAPEUTIC and Significance MEANING & SIGNIFICANCE Relatively High Level * Minimal Level of of Therapeutic Ethical Concern Significance * High Level of Therapeutic Meaning and Significance LEVEL OF ETHICAL CONCERN Relatively High Level of Ethical Concern * High Level of Ethical Concern; Risk of LEVEL OF Ethical Violation THERAPEUTIC * Low Level of MEANING & Therapeutic Meaning SIGNIFICANCE and Significance * High Level of Ethical Concern; Risk of Ethical Violation * High Level of Therapeutic Meaning and Significance Table 2 Ethical and Therapeutic Responses Based on Categorization of Gift LEVEL OF ETHICAL CONCERN Relatively Low Level of Ethical Concern 1.

Reflect client affect, behavior, and situational content Relatively Low Level 2. Self-disclose of Therapeutic personal thoughts Significance and affect 3. Choose to accept or not accept LEVEL OF THERAPEUTIC MEANING & SIGNIFICANCE 1. Seek clarification through questioning 2.

  • Reflect client affect and behaviors 3.
  • Self-disclose thoughts and affect Relatively High Level 4.
  • Interpret meaning of Therapeutic and connect to thera- Significance peutic issues 5.
  • Integrate gift-giving into treatment process by using gift as symbol, metaphor, or metaphorical object 6.
  • Choose to accept or not accept LEVEL OF ETHICAL CONCERN Relatively High Level of Ethical Concern 1.

Seek clarification 2. Reflect client behavior, affect, and situational content 3. Self-disclose personal thoughts and affect 4. Provide information regarding ethics of accepting specific gift 5. Decline gift, while LEVEL OF exhibiting positive THERAPEUTIC regard and warmth MEANING & SIGNIFICANCE 1.

  1. Seek clarification through questioning 2.
  2. Reflect clients affect and thoughts 3.
  3. Self-disclose thoughts, affect and rationale for not accepting gift 4.
  4. Reframe as and connect with therapeutic issues 5.
  5. Explore deeper meaning of gift using Socratic questioning 6.
  6. Process directly and metaphorically REFERENCES American Mental Health Counselors Association.

(2000). Code of ethics of the American Mental Health Counselors Association. Alexandria, VA: Author. Andolfi, M., Angelo, C., & de Nichilo, M. (1989). The myth of Atlas: Families and the therapeutic story. New York: Bruner/Mazel. Beier, E., & Young, D.M. (1998).

The silent language of psychotherapy: Social reinforcement of unconscious processes (3rd ed.). New York: Aldine. Camenisch, P.F. (1981). Gift and gratitude in ethics. Journal of Religious Ethics, 9, 1-34. Cappa, S.A. (2001). “They came bearing gifts:” A cast study of the manifestation of gift giving in psychotherapy.

Journal of Psychology and Christianity, 20, 287-292. Corey, G., Corey, M.S., & Callanan, P. (2003). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole. Dodds, J.B. (1985). The child psychotherapy primer: Suggestions for the beginning therapist.

  • New York: Human Sciences Press.
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  • Tips, status, and sacrifice: Gift-giving in the doctor-patient relationship.
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(1993). Webster’s third new international dictionary, unabridged. Springfield, MA: Merriam-Webster. Kritzberg, N.I. (1980). On patients’ gift-giving. Contemporary Psychoanalysis, 16, 98-118. MacCormac, E.R. (1985). A cognitive theory of metaphor. Cambridge: The MIT Press.

Petrie, H.G. (1993). Metaphor and learning. In A. Ortony (Ed.), Metaphor and thought (pp.342-356). New York: Cambridge University. Schudson, M. (1986, December). The giving of gifts. Psychology Today, 20, pp.27-29. Searle, J.R. (1993). Metaphor. In A. Ortony (Ed.), Metaphor and thought (pp.84-111). New York: Cambridge University.

Shapiro, E.L., & Ginzberg, R. (2002). Parting gift: Termination rituals in group therapy. International Journal of Group Psychotherapy, 52, 319-335. Spandler, H., Burman, E., Goldberg, B., Margison, F., & Amos, T. (2000). ‘A double-edged sword:’ Understanding gifts in psychotherapy.

Is it ethical for a psychologist to accept gifts from clients?

Understanding the Legal & Ethical Considerations of Gifts in the Therapeutic Relationship – Alain Montgomery, JD Staff Attorney July/August 2022 Introduction Gift giving is one of many ways to demonstrate our sense of appreciation and gratitude, to celebrate someone or to mark in time a milestone or watershed accomplishment.

This article will discuss the legal and ethical considerations that relate to gift exchanges within the context of the therapeutic relationship, predominantly from the perspective of when a client presents their therapist with a gift. However, it is important to note that the same legal and ethical considerations equally apply when a therapist gives a gift to their client.

Ethical Considerations There is no outright ethical prohibition against the giving and/or receiving of gifts within the therapeutic relationship. However, in certain circumstances a therapist may be subject to an ethics complaint or formal discipline for the giving and/or receiving of gifts.

Therefore, it is imperative to understand the applicable ethical standards that pertain to gift giving and receiving. Under the CAMFT Code of Ethics, marriage and family therapists have an ethical obligation to maintain high standards of professional competence and integrity.1 The Code of Ethics specifically addresses some of the factors therapists must consider when deciding whether to give or receive a gift within the therapeutic relationship.

The CAMFT Code of Ethics states the following: 5.8 GIFTS: Marriage and family therapists carefully consider the clinical and cultural implications of giving and receiving gifts or tokens of appreciation. Marriage and family therapists take into account the value of the gift, the effect on the therapeutic relationship, and the client/patient and the psychotherapist’s motivation for giving, receiving, or declining, the gift.

As indicated by the applicable ethical standard, therapists are encouraged to be aware of and evaluate a host of interrelated and equally important elements to assess when presented with a gift from a client or when deciding whether to give a gift to a client. While the CAMFT Code of Ethics lists a number of factors, the guidance is not exhaustive.

Therapists may need to consider other variables depending on the particular client, the therapist’s theoretical orientation and their practice setting. Let’s take a closer look at the considerations presented in the CAMFT Code of Ethics: Clinical Implications Whether or not a therapist chooses to accept a client’s gift, reject a client’s gift or offer a gift of their own, the therapist’s intent should be to ensure their response—and the manner in which it is communicated and handled— strengthens the therapeutic alliance, reinforces the effectiveness of therapy and enhances clinical outcomes.2 Here, additional relevant factors may need to be considered, such as, the client’s reasons for participating in therapy, the goals of treatment, the applicable diagnoses, the stage of treatment in which the gift is exchanged and the length and duration of the therapeutic relationship.

  1. Hence, a therapist must decide whether the overall clinical benefit of accepting an appropriate gift outweighs the risks to the therapeutic process if the gift is refused.
  2. It is recommended that therapists seek clinical consultation as a way to obtain objective feedback from colleagues about potential clinical implications.

While there are a myriad of clinical perspectives regarding appropriate gift related behavior, when a client presents a gift to a therapist, therapists are encouraged to understand the client’s reasons for giving the gift. It is acknowledged repeatedly in the empirical research and literature that: “Gift acceptance without some attempt to understand its meaning from the patient’s perspective may bypass an opportunity to illuminate the patient’s subjective experience.” 3 It is important to accept that a client’s gift giving may not be well intentioned.

A client’s motivation for giving a gift could be a way to express negative feelings or could be a manifestation of acting out. Where a client’s motivations are unclear, therapists are encouraged to process the various potential meanings and intentions that underlie the gift. When appropriate, it may be necessary or beneficial to explain to the client that their gift will be kept and that nothing will be done with it until there has been an opportunity to discuss what the gift represents.4 Such an approach may mitigate potential feelings of rejection the client may experience if their gift is declined.

Also, this approach creates the opportunity and conditions to explore the underlying clinical aspects of the client’s gift giving inclinations or patterns. Cultural Implications Sensitivity to a client’s culture of origin is imperative because the cultural meanings of gift giving and receiving outside of the therapeutic context can provide deep insight and understanding about the meaning of a gift exchange within the therapeutic relationship.

The CAMFT Code of Ethics encourages therapists to obtain knowledge and develop a personal awareness of their client’s cultural attitudes towards gift giving.5 For example, in some cultures exchanging gifts is a highly valued custom while in other cultures gift giving is unimportant. Having a cultural understanding of gift giving etiquette can help avoid misunderstandings which could result in a client taking offense when a gift is not acknowledged or accepted.

In the article, “Reflections on Gifts in the Therapeutic Setting: The Gift from Patient to Therapist,” Andrew Smolar, M.D., writes: “The therapist must weigh the degree to which the patient’s cultural traditions are influencing inclinations regarding a gift at the time,give something to the therapist.therapists should also gauge how open the patient will be, according to culture of origin, to discussing the idea of gift exchange.

  1. Some cultures would consider such a discussion, even if the gift were not outright rejected by the therapist, insulting to the gift giver.” Thus, it is important to understand how cultural nuances enter the therapeutic relationship through gift giving.
  2. Since gifts have different meanings in different cultures, therapists must strive to understand and respect the client’s cultural norms with respect to gift exchanges.

Value of the Gift While there are no prescribed limits on the monetary value of a gift that make it appropriate to accept, the value of the gift is an important factor. With respect to considering the perceived monetary value or cost of a gift, it is generally accepted that small, inexpensive and appropriate gifts are neither clinically detrimental nor unethical.6 On the other hand, concerns may arise when a client presents a gift that is objectively high in value, expensive or costly because such gifts could be inappropriate to accept even if the client has the wealth or financial means to afford such a gift.

Therapists must bear in mind that the value or cost of a gift is not determinative as to its appropriateness because even very inexpensive gifts or those without any monetary value can be highly inappropriate depending on their suggestive content or connotations. Effect on Therapeutic Relationship: Therapists have an ethical obligation to set and maintain clear and appropriate boundaries that prioritize therapeutic benefits, safeguard the best interests of clients and refrain from behaviors and actions that exploit the trust and dependency of clients or cause harm to clients.7 Understanding the importance of boundaries in therapy as they relate to gift giving is primarily the responsibility of the provider.

As Smolar explains: “Patients often begin treatment with only a limited understanding of their motives, and with a limited understanding of the ground rules of therapy.the beginning phase of treatment is typically marked by patients’ uncertainty about the treatment relationship.” 8 Empirical literature suggests that a therapist’s approach and attitude towards gifts should focus on the welfare of the client.

  1. Therapists must evaluate and understand whether accepting or declining a gift would strengthen the therapeutic alliance, distort the nature of the professional relationship for either the client or the therapist or violate professional boundaries.
  2. Even when considering whether or not to adopt a strict “no gifts” policy—which is not inherently unethical—therapists should examine how such a policy could potentially cause a client to feel rejected or humiliated.

For example, when a client who has difficulty in outwardly expressing feelings of gratitude—or who has difficulty giving anything to anyone— presents a gift to their therapist because they feel the therapeutic environment is a safe space in which to do so, a therapist’s decision to not accept the gift could be damaging.

Hence, the outright refusal to work with or to accept a client’s gift could undermine opportunities to have clinically valuable discussions, fracture the therapeutic rapport or stand in the way of therapeutic outcomes. However, therapists who work in group settings or clinics with strict “no gift” policies can rely on the company policy as a reason to decline a gift so as not to offend the client.

Psychotherapist’s Motivation for Giving, Receiving or Declining the Gift A therapist’s exploration of their own motivation for giving, receiving or declining a gift must be investigated through interpreting the meaning of the gift. It has long been recognized that gifts within the psychotherapeutic relationship can at times have a deep symbolic meaning beyond what words can express: “Gifts likely hold conscious meaning, as well.

In this way, gift giving serves as a symbolic communication between giver and recipient.this communication via behavior rather than words heightens the chances of misunderstanding. gifts are viewed as unconsciously motivated representations of symbolic desires.” 9 Thus, when a therapist is presented with a gift from a client it may be necessary for the therapist to explore and assess the gift’s meaning.

Attempting to understand the meaning of the gift is a way to understand what the gift may symbolize. For instance, it is important to understand whether the gift is a mechanism or tool through which the client is trying to please, manipulate, triangulate, humiliate or even seduce the therapist.

While it is certainly a delicate matter that needs to be handled with sensitivity and care, therapists can encourage and invite the client to share their experience of giving and receiving gifts and to talk about the meaning of the gift they present to their therapist. Understanding the client’s desire to give the gift—and the therapist’s own motivation for accepting or declining a gift—is a very important component of therapy.

When a Therapist Gives a Gift to a Client As previously mentioned, it is important to note that when a therapist gives a gift to a client, all of the same ethical and therapeutic considerations that have been discussed equally apply. With respect to exchanges from a therapist to a client, Smolar writes: “Think carefully about the sources of own motives when you give something beyond what the patient has come to expect within the therapeutic relationship.

therapists should be especially clear on the source of their motives.we should not forget that patients sit in a vulnerable position, and we must always try to remain aware of the manifold ways our actions may impact them.” 10 Therefore, therapists need to be very clear with themselves about their own intentions when offering a gift to a client and to share that meaning with the client to make sure the client does not misunderstand the intent and meaning of the gift.

Legal Issues There is no legal prohibition against the giving and/or receiving of gifts between a therapist and a client. However, this does not insulate a therapist from formal disciplinary action for either giving or receiving gifts. Let’s look at some examples of how gift giving and/or receiving within the therapeutic context gave rise to disciplinary actions against therapists and discuss their outcomes in the context of the relevant ethical considerations.

Case 1: Summary of Relevant Facts: In this case, a licensee provided treatment to a client who was previously diagnosed with Borderline Personality Disorder (BPD). The licensee gave the client mixed messages throughout the years of treatment regarding the boundary of their professional therapeutic relationship.

Specifically, the licensee gave gifts to the client and communicated with the client frequently through overly familiar and lengthy emails and text messages that would span hours outside of the face-to-face therapy sessions. BBS Decision: The Board of Behavioral Sciences (BBS) determined that this licensee was grossly negligent, incompetent and demonstrated a lack of skill and knowledge regarding the importance of maintaining clear and consistent boundaries in the treatment of their client.

The BBS held that the licensee engaged in a dual relationship with their client when they gave the client mixed messages throughout her years of treatment regarding the boundary of their professional therapeutic relationship and specifically when the licensee gave gifts to their client.11 Case 2: Summary of Relevant Facts: In this case, a licensee rendered psychotherapy to an adult woman who was diagnosed with bipolar disorder, post-traumatic stress disorder, and polysubstance abuse and had a history of sexual abuse.

The licensee gave multiple handwritten notes and cards to their client using emotionally charged words and also exchanged many gifts with their client. BBS Decision:The Board of Behavioral Sciences (BBS) determined that this licensee committed acts of gross negligence and incompetence and recklessly caused physical and emotional harm to their client.

The licensee used unprofessional language and contact to foster a dependency through giving gifts to their client that ultimately harmed their client.12 Case 3: Summary of Relevant Facts: In this case, Client X and her husband, Client Y, (Clients) began therapy with licensee. Over several years, Clients attended very intensive and costly therapy.

Clients attended some social events with the licensee who asked Clients if they could store items at their home. In February of 2010, the licensee accepted a $20,000.00 check from Clients for prepayment of further therapy sessions. In June of 2010, Respondent accepted a $1,000.00 check as a gift from Clients.

In July 2010, the licensee accepted a $30,000.00 check from Clients as prepayment of further therapy sessions. In September 2010, the licensee accepted a $3,000.00 check from Clients as a gift. In October 2010, the licensee accepted a $20,000.00 check from Clients as prepayment of further therapy sessions.

In December 2010, the licensee accepted a $10,000.00 check from Clients as a gift. In 2011 the licensee was having financial trouble and was having his home foreclosed upon and Clients wished to help avoid that result. In June 2011, Respondent accepted a $200,000.00 check from Clients.

Although there was a dispute about the nature of the $200,000.00 check, the licensee claimed it was a gift. BBS Decision: The Board of Behavioral Sciences (BBS) determined that this licensee was grossly negligent and incompetent in the practice of marriage and family therapy when the licensee accepted significant sums of money as personal gifts from Clients.

The Board concluded the licensee intentionally and recklessly caused harm to their client when they used the professional relationship to further their own interests, financially exploited their client and/or failed to maintain appropriate professional boundaries with their client and had unethical dual relationship(s) with their clients simultaneously with the therapeutic relationship, without taking sufficient precaution to ensure that exploitation did not occur.13 Discussion: The facts of these cases allude to the importance of maintaining appropriate boundaries to safeguard the interests of clients and refrain from behaviors that harm or exploit the trust and dependency of clients when gifts are exchanged.

These cases illustrate how gift giving and/or receiving within the therapeutic context, if not handled appropriately, can give rise to a host of ethical dilemmas and legal ramifications. Using the ethical guidance to assess and evaluate the meaning, the symbolism and the appropriateness of a gift in the context of the client’s unique diagnosis is necessary to mitigate the negative impacts that both gift giving and receiving can have on a client.

One of the above cases in particular emphasizes how the value of gift relative to the client’s ability to afford it is not determinative of whether or not those factors can still negatively impact the therapeutic relationship and lead to the exploitation of the client.

  • Thus, it is imperative to understand the ethics around gift giving in the context of the therapeutic relationship to avoid causing undue harm to clients.
  • Conclusion So, when you receive a gift from a client—or feel compelled to give a gift—as a token of either appreciation or celebration, may it be accepted and/or given with grace and gratitude in a way that is thoughtful, clinically appropriate and aligns with the ethical guidelines and legal standards of your profession.

Take advantage of the opportunity to consult with colleagues when needed and err on the side of caution when appropriate. Alain Montgomery, JD, is a staff attorney at CAMFT. Alain is available to answer member calls regarding legal, ethical, and licensure issues.

  1. Endnotes 1 CAMFT Code of Ethics, Section 5.
  2. PROFESSIONAL COMPETENCE AND INTEGRITY, Preamble: Marriage and family therapists maintain high standards of professional competence and integrity.2 Brendel, D.H., et.
  3. Al., (2007) Harvard Review of Psychiatry, as cited in Zur, O., “Gifts In Psychotherapy & Counseling Ethics, Cultural and Standard of Care Considerations” 3 Hahn, W.K.

(1998). “Gifts in psychotherapy: An intersubjective approach to patient gifts.” Psychotherapy, 35, 78–86 as cited in Zur, O., “Gifts In Psychotherapy & Counseling Ethics, Cultural and Standard of Care Considerations (Gifts in Psychotherapy and Counseling, by Ofer Zur, Ph.D.

Drzur.com)) 4 Id.5 CAMFT Code of Ethics, Section 5.7 SENSITIVITY TO DIVERSITY: Marriage and family therapists actively strive to identify and understand the diverse backgrounds of their clients/ patients by obtaining knowledge, gaining personal awareness, and developing sensitivity and skills pertinent to working with a diverse client/patient population.6 Zur, O., “Gifts In Psychotherapy & Counseling Ethics, Cultural and Standard of Care Considerations.” Retrieved from Gifts in Psychotherapy and Counseling, by Ofer Zur, Ph.D.

(drzur.com) 7 CAMFT Code of Ethics, Preamble, Section 4: Dual/Multiple Relationships; CAMFT Code of Ethics, Sections 4.1: Dual/Multiple Relationships and 4.2: Assessment Regarding Dual/Multiple Relationships.8 Smolar, A., “Reflections on Gifts in the Therapeutic Setting: The Gift from Patients to Therapist,” (2002) American Journal of Psychiatry, Volume 56, No.1, pg.12.9 Knox, S., “Gifts in Psychotherapy: Practice Review and Recommendations,” (2008) Marquette University Publications.10 Smolar, A., “When We Give More: Reflections on Intangible Gifts from Therapist to Patient,” (2003) American Journal of Psychotherapy, Vol.57, Issue 3.11 BBS Disciplinary Action.

  1. Case No.2002016000247 12 BBS Disciplinary Action.
  2. Case No.2002015001970 13 BBS Disciplinary Action.
  3. Case No.2002016001955 This article is not intended to serve as legal advice and is offered for educational purposes only.
  4. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise.

Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in this article.

What are some concerns regarding accepting gifts from clients?

Ethics Alive – Gifts From Clients: The Good, the Bad, and the Ethically Ugly by Allan Barsky, J.D., MSW, Ph.D. Everyone loves gifts, don’t they? Well, maybe it depends on who is giving the gift and under what circumstances. For social workers, being offered a gift from clients may be cause for celebration, cause for concern, or both.

Assume you have been working with Cleo, a client experiencing high levels of social anxiety. Over the past few months, you have helped her reduce her levels of anxiety to the point that she now enjoys personal and work relationships that she once dreaded. In your final session with Cleo, she offers you a present.

Your first instinct may be to tell yourself, “Accepting gifts from clients is unethical. I need to find a polite way to decline.” But is accepting gifts truly unethical, and if so, why? Under what circumstances might accepting gifts be ethically justifiable, or even desirable? Some people may assume the NASW Code of Ethics (2008) specifically prohibits accepting gifts.

  1. It does not.
  2. It doesn’t even mention gifts, per se.
  3. The NASW Code does have provisions related to gifts.
  4. Standard 1.06(a) advises social workers to “avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment.” Standard 1.06(b) instructs social workers not to “take unfair advantage of any professional relationship.” Standard 1.06(c) says that social workers should set “clear, appropriate, and culturally sensitive boundaries” with clients.

Taken together, these standards certainly put social workers on notice that there are risks related to accepting gifts from clients. Thus, there are some situations in which accepting gifts would be clearly unethical:

if accepting a gift biases a social worker’s judgment (e.g., if you were tempted to give Cleo favored treatment because she gave you a gift) if the social worker manipulates clients into thinking that providing gifts is necessary to obtain services that they are already entitled to receive (e.g., if you indicate to Cleo that she needs to provide a gift to receive counseling) if the social worker has not established appropriate professional boundaries with the client and the gift-giving reflects this lack of appropriate boundaries (e.g., if you befriend Cleo and she gives you a gift as if you were her friend )if you are in a position of authority over the client and the client is vulnerable to your decisions (e.g., if you are a child protection worker deciding whether to remove a child from Cleo’s home) if the gift has a deep emotional meaning to the client, and the client may later regret giving the gift (e.g., if Cleo gives you a home-made vase that has minimal market value but is deeply meaningful because it was a gift from her dearly departed brother) if the nature of the gift is inappropriate given the nature of the services and/or your professional role (e.g., if Cleo gives you a sample of drugs that she found helpful in reducing her anxiety)

As a social worker, your primary commitment is to your client (Standard 1.01). The main interest to consider is the impact of gift-giving on the client. If gift-giving is an authentic expression of the client’s gratitude, then the principle of self-determination suggests that social workers should honor the client’s wishes.

  • The client may feel a sense of pride and satisfaction from being able to thank the worker with a gift.
  • However, if the client feels exploited or manipulated—or if the client receives inappropriate services as a result of gift-giving—then encouraging or accepting the gift would be unethical.
  • So, under what circumstances might accepting gifts be ethically justifiable? In broad terms, accepting gifts may be justifiable when they promote the principles of beneficence (doing good, particularly for the client) and nonmaleficence (avoiding harm, particularly to the client).

Assume that Cleo comes from a culture in which gift-giving is appropriate and perhaps culturally expected, even in professional relationships. Assume, further, that Cleo may feel rejected or disrespected if you do not accept her gift as a gesture of thanks.

  1. Rejecting the gift could also have a negative impact on her progress in counseling.
  2. To accept the gift would do more good than harm—particularly if there are no risks or perceptions of exploitation, inappropriate boundaries, or biases in your professional decision making.
  3. Along these lines, Standard A.10.f of the Code of Ethics (2014) of the American Counseling Association 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.

  • Rather than having a blanket rule about accepting gifts, this standard invites counselors to assess each situation, including the client’s and counselor’s motivations for accepting the gifts.
  • If a client feels pressured into providing a gift or if the counselor is motivated by greed to accept the gift, then accepting the gift would be unethical.

Note also that this standard asks counselors to take the therapeutic relationship into account. If Cleo offers you a gift because she has a low level of trust in the relationship and wants to ensure your support, then accepting the gift may be tantamount to exploiting her vulnerability.

  1. If Cleo and you have an egalitarian relationship, then the risks of exploitation are lower.
  2. In terms of the monetary value of gifts, social workers should consider the value in relation to the client’s level of wealth and income.
  3. If a client is living in poverty, then a gift worth $20 may be significant.

If the client is wealthy, then a gift worth $20 may be perceived by the client as a small token of appreciation. Some agencies put specific values on what types of gifts may be accepted. Some agencies prohibit gifts of any value. Some agencies allow gifts to the agency (as a whole), but not to individual social workers.

Remember that even if an agency has a policy prohibiting acceptance of gifts, it may be ethical to accept them. You may need to advocate with the agency to change the policy, or to grant exceptions on a case-by-case basis. The question of accepting gifts is not simply an either/or issue. When and how are also important considerations.

To pre-empt problems, it would be helpful for clients to know the social worker’s or agency’s policy on gift-giving from the outset of the helping process. Informing clients up front allows the parties to avoid that ugly moment when a client has made the effort to make or purchase a gift, only to have it rejected.

If a client offers a gift during the middle stages of work, then the worker may remind the client of the policy. If a client provides a gift at the termination stage of services, then the risk of exploitation may be lower. Because the client has already received services, it is less likely that the client is providing the gift to sway how the social worker provides services or other benefits.

Still, there are concerns about professional boundaries and whether the client may want the professional relationship to transition into a personal or romantic one. If you decide it is inappropriate to accept a particular gift, then consider how you can inform the client in a respectful manner.

Thank you for this beautiful gift. Although our agency does not allow workers to accept gifts, I appreciate your gratitude and want you to know that I’ve valued the opportunity to work with you. Your Christmas gift is very generous. Thank you. Would it be okay with you if I shared this gift with the rest of the agency?

Clearly, it is helpful to individualize your response so the client knows your gratitude is genuine. You may also need to explain the reasons that you cannot accept a gift. A final guideline on accepting gifts is transparency. If Cleo offers you a gift and you are concerned about telling your supervisor or co-workers, this raises a warning flag about accepting gifts.

  • If you do accept the gift, then you should be prepared to let your colleagues know about the gift, without fear of condemnation.
  • You might ask yourself, “How would I feel if I checked my favorite social networking site one day and saw a story about my receiving this gift, for all the world to see?” Further, as a matter of risk management, you should document a client’s offer to give you a gift, how you responded to the offer, and your justification for responding in that manner.

Decisions about whether and how to accept gifts can be complex. When in doubt, ask your supervisor or other professional colleagues for assistance. Explore the context of the decision, including the client’s and your motivations, as well as options, risks, and potential benefits.

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