When We Give More: Reflections on Intangible Gifts from Therapist to Patient

Since Freud’s time, psychoanalytically oriented therapists have been wary accepting gifts from patients, and have also been reluctant to give them to patients. This article first provides a literal definition of the word “gift,” and then defines it within the context of the therapeutic relationship. It then reviews the literature on gifts and presents clinical examples describing five categories of offerings from therapist to patient, experienced by the patient as gifts, namely: 1. the gift of a transitional object; 2. the gift of self-disclosure; 3. the gift of time; 4. the gift of physical touch; and 5. the gift of developmental presence. Examples of therapists considering but not offering gifts to patients are discussed and viewed from the perspective of whether they are requested by the patient, whether they arise from within the therapist, or whether they are offered in a context of reciprocation. Guidelines for how and when the therapist could attempt such interventions most safely are suggested, placing particular emphasis on countertransferences.