Saturday, November 04, 2006

What To Get Your Psychiatrist For Christmas, Hanukkah, or Kwanzaa

[posted by dinah]

One commenter (was it Sarebear?) mentioned some time ago that she didn't know what to get her psychiatrist for the holidays. I thought about this and decided the answer is easy:
Give your psychiatrist a holiday card and write something meaningful and kind in it. Say, "Thanks for helping me." Or "I'm glad you're in my life." "You're the best psychiatrist in the world" works nicely, too. If you hate your psychiatrist and for inexplicable reasons feel compelled to get them something anyway, then skip the note and just give a generic Seasons Greetings card.

Don't get your psychiatrist an expensive gift. And don't, not even as a joke, give your psychiatrist money or make comments about a holiday "tip."

So gifts and shrinks are often an unsettling combination. As psychiatrists, we're taught that treatment is offered for a fee. End of discussion and anything more represents a violation of boundaries. Psychiatrists in training are told not to accept gifts, and psychotherapists as a whole are taught to try to understand behaviors that skim the usual boundaries. So, theoretically, the psychiatrist should refuse the gift and explore with the patient what meaning the gift, the refusal, the whole exchange, has to the patient.

When residents ask me what to do when patients want to give them gifts, I say "Tell them the program has rules that say you're not allowed to accept gifts." This is the truth and the resident risks getting in trouble if they do accept gifts. If you can't take a pen from a drug rep anymore, why should you be allowed to take a timeshare from a patient? (Okay, I made that up, I've never heard of a patient gifting a resident with a timeshare, but we can all have fantasies, right?)

I'm in private practice, there's no program director, I make the rules. When a patient gives me a gift, I accept it and say, "Thank you." Why? Because it seems intentionally hurtful to do otherwise-- I assume it has meaning to the patient, that their feelings will be hurt if I refuse the gift, that the patient has taken the time, effort, and money to pick out a gift and this represents something meaningful to him and that it might be painful to have this refused. While the act of giving a gift might have a multitude of meanings, depending on the gift, depending on the patient's illness, depending on the circumstances, I just can't find a way to say No that would feel anything other than rejecting. So I accept the gift and thank the patient, and if the gift is edible, I eat it. This is the thing though: while I've decided that this is the way to go, at least so far for me within the realm of my own practice, I always feel like I'm doing something wrong by accepting a gift, training issues remain in the back of my head, and I'd really rather just have a card that says I'm the best psychiatrist in the world.

Disclaimer in honor of Dr. A, Fat Doctor, Flea, Midwife with a Knife and other non-shrink physicians: Doctors in other specialties have no such concerns with accepting gifts. They probably don't want anything that taxes your budget. Food is usually good, a bottle of wine, a plant, candles, all will do nicely. Fat Doctor, I hear, is in need of some good toe nail polish remover.


Sarebear said...

It was someone else, actually, but I'm tickled to be mentioned in a Shrink Rap post! I commented under that person about wondering about holiday cards and such.

Oh, another thing I thought of, is there is a website, where you can pick which program you want to donate to, and do it in someone's name even.

The programs are various ones like getting geese for people to raise (in third world countries) to make some income for them, and many other things that provide purpose and opportunity and other helpful things for people in difficult times in countries like that. I think you can even just buy one chick towards the program for someone . . . Anyway, doing that in someone's name, say, $10 towards improving someone's life in another country, and then put that on a certificate inside a card you give your mental health professional, I thought would be a way to give a gift to your ologist, iatrist, what have you, and yet it's a , well, it's a gift that's non-refuseable, and I don't think, inappropriate under these or most any other circumstances, either.

Plus, it feels good. I'll haveta look up that site and post it here, and you can put it in your post if you look into it and like it and find it a useful solution to the gift problem.

I must say, as a patient, being so grateful for the help my ologist gives me, that there's just times where I wish I could mark say the anniversary of starting therapy, or something, in a meaningful way that I can share with him (aside from working on myself, which I know is what he would like the most). So a small donation to that sort of thing I thought would be copacetic. (I hope I used that word right, lol).

Oh, and is that sareBARE a Freudian slip on your part? Hee hee.

Steve & Barb said...


Sarebear, this is just the best thing. I've heard of these "microloans", where you loan someone money to buy a goat, they turn it into a cheese- & milk-selling business in their village, and pay back the money over time, plus a small amount of interest. There are others that just give the money away.

But combining these idea with that of a gift to someone else is great. Especially if one can somehow track the individual's success (how cool is that to check out your goat-guy's site 2 years later to see that he now owns 50 goats and employs 12 villagers).

I haven't completely checked these out, but here are a few sites which appear to do something like this...

Universal Giving
Village Banking

ClinkShrink said...

When I was a resident I had a psychotic inpatient who wanted a pass to leave the unit. The nurses were really busy and the policy said that patients had to be escorted whenever they left the unit. I was going stir crazy, so I volunteered to escort him. We went across the street to the drug store where he bought cigarettes (yes, he heard about that from me) then on the way back we stopped at the hospital library so he could return a book. (The librarian recognized him and called him by name, which I thought was a good sign.) When we got back to the unit he pulled a playing card out of his pocket (the eight of clubs) and handed to me, thanking him for the time off the unit.

To this day I don't know for sure what that playing card represented. I had a vague sense then that it served some protective function, but for all I know he could have meant "you are cursed and will turn into a duck within three days". I'm not sure if I accepted a gift or not.

Regardless, periodically since then when I've been in risky or uncomfortable situations I sometimes think to myself, "It's OK, I've got my eight of clubs." The magic may have worn off by now, but at least I haven't turned into a duck.

Steve & Barb said...

According to this site, the eight of clubs signifies "INSTABILITY - Internal strife; the foundations within are crumbling.".

Perhaps he was trying to tell you something?

(Okay, maybe not the most reliable site...'s interpretation seems less ominous.)

Dinah said...

Sarebear: oops! I fixed your name.

Wow! What an idea. Can I feed someone in a third world country a dinner of duck in cherry sauce and give this as a gift to Clink? I can hear her asking why I didn't feed her....

And Roy, should I donate Macs and IPODs to someone in third world countries in you name?

So I started thinking, can I make a donation in honor of my patients? Then I realized I can't use their names.

For those who want to stay closer to home, there are Foodbanks to feed the hungry locals, in Baltimore there is HealthCare for the Homeless.

Clink, hang on to that card, you never know.

ClinkShrink said...

Eight? Did I say eight? I meant six. The six of clubs is much better:

Naivete; failure to attempt to understand the world around one."

Yeah, that's it. Much better than instability.

Dinah you always feed me great. As long as you don't feed me to the homeless I'll never complain.

Anonymous said...

I gave mine a rechargeable flashlight with a note that expressed my thanks for his help in illuminating a difficult path I was walking. Corny, but less than $10, and my appreciation was real.

Sarebear said...

Glad you like the idea!

Feeling more secure, and less drafty in here in my sarebearishness. Hee hee.

Dreaming again said...

My therapists birthday was in October. She'd recently moved offices I gave her a gift for her office. A decorative candle.

I have been wondering about the holidays and my psychiatrist this year. Last year, Thanksgiving time, I mailed him a letter, first time, rather intense, about some childhood memories that I'd realized carried more significance than I'd given them credit for.

He'd gotten the letter, and because it came Thanksgiving week, just figured it was a Thanksgiving letter (he'd gotten several Thanksgiving cards). When I had an appointment the next week and had to have him read the letter in front of me ...I realized NEVER send through the mail an emergency letter at holiday time!!!!

Maybe this year, I'll just give him an autographed copy of my book when it comes out ...hmmmm

Midwife with a Knife said...

Hm... you know, a card that says, "You're the best obstetrician in the world" would go a long way. My favorite "gift" hass always been baby pictures, even if by email, of babies I've delivered.

Even though I'm still in training, and with student loans and all am kind of "poor", now my patients are much poorer than I am, and recieving a gift from someone who couldn't really afford it would just make me feel weird.

Pictures of moms and/or babies who are alive and doing well, however, is something I can save and look at when I've had a hard day (like a maternal or fetal/neonatal death) to remind myself that sometimes moms and/or babies are alive and well, mabe even because of my involvement in a case. I think that giving someone a goat is great (especially
under the circumstances sarebear detailed), but if you're looking to give me something that I will get maximum enjoyment, peace of mind, courage, and...well... courage and peace, just give me some baby pictures. :)

I don't really know what the psychiatric equivalent of baby pictures is, really... unless it actually is a card that says, "You're the best psychiatrist in the world!"; you know, something that you can look at when you've had a day where everything seems really bad, and feel like you're OK.

I think that people don't appreciate what a precious gift those baby pictures can be sometimes. So, everybody, give your OB those cute baby pictures, even if you think they might be annoying, they're not. Your obstetrician probably looks at them in the middle of the night while delivering a stillborn child and thinks that maybe they can come and do this job another day.

HP said...

When I was on internship, one of my patients gave me a framed photograph she'd taken herself. It was great, I loved it and really appreciated the thought behind it but I was very uncomfortable. It didn't seem appropriate to take it because of the boundaries reasons yet I also felt that it was offered with good intentions and would be potentially hurtful to refuse. I knew the no gift rule but my supervisor said it really was dependent on the nature of the gift. A box of chocolates - not so bad - something more personal like this, trickier. In the end, she advised me to accept it. After that, I think they elaborated on the 'no gifts' policy in their intake information - that would definitely make it easier to explain away refusal and reduce the likelihood of offence.

One of the other interns got given some sexy lingerie by one of her famle patients...I'm glad I didn't have that particular dilemma!

NeoNurseChic said...

And...and....and.....Let's not forget the nurses!!

Oh who am I kidding - parents give us gifts all the time. Usually in the form of food. And almost always incredibly yummy. :) I can't remember if there was anything today, but 2 days ago, we got some very nice cookies and pastries from a family who is adopting one of our babies. We've gotten a very very wide variety of gifts over the amount of time that I've been in the NICU.

Sometimes, however, parents will ask what they should get us. I always say "nothing." While I might joke and say, "A new car!" or some other random thing (I enjoy joking - especially with parents I know well...and anything to lighten the atmosphere of the NICU is good - within certain time and place!) But really, I always tell parents who ask that they really do not need to do anything.

When parents bring things in, we do accept it. If it looks funny or seems odd or it's from parents that have verbally disliked us (doesn't really happen...) then I doubt I would eat it, if edible, but we always still are accepting, no matter what. I do feel that it would be hurtful otherwise. (Or at least, I would feel bad refusing the gift that the parents spent time and money and thought on...)

And so then that ties it in with your post - I've actually never given my psychiatrist anything for the holidays. When he finished residency, I gave him a card and copies of my 2 piano cds and one piano/vocal cassette tape, but that's it. I've never even given him a holiday I feel kinda crummy! But really - I just kinda skip over the holidays when it comes to my physicians. I don't even know when my psychiatrist's birthday is....not even a general idea except that he's about 5 years older than me! But that's really only an estimate...

My family has given nurses big boquets from Cookies by Design...that's ALWAYS appreciated!! We have always given nurses that have taken care of me all kinds of food. Mainly because I've always been in the hospital for pretty long periods of time. I can finally say that this December, we're coming up on 2 years since I've been in the hospital (for an extended stay and also for non psych reasons - never been hospitalized for psych reasons)! YAYYYYYyyyyyyyy Used to be that I couldn't go more than 5-6 months without landing in the hospital. And it's not that the docs don't deserve gifts, but I guess when we saw what the nurses were doing and still sometimes took the time to talk to us and be kind to us - well - we always thought they deserved a little something! (In the form of food!) And this was before I was even thinking of becoming a nurse! When I was in the hospital the first 6 times, I was always premed.

So I dunno - I guess this year will probably be the same as every other year. I feel kinda like a putz for not doing anything, but I never have. Maybe I'll give my psychiatrist a card if I end up going close to the holidays. I don't actually know if he celebrates Christmas or anything.

I *do* have to work on Thanksgiving this year...Thursday, Friday, and Saturday. (Somehow got out of working an 8 hour shift on Sunday by a stroke of luck or an oversight that I won't be mentioning!) One of the nurses is organizing a little Thanksgiving dinner - we'll be ordering a Turkey. I signed up today to bring Nut Bread - my mom is going to give me the recipe and lend me the pan. My family may actually be going to my grandparents' for Thanksgiving, so this will be my only Thanksgiving dinner! At least this year I don't have to work Christmas or New Year's. Last year I did end up in the ER which knocked me out of my New Year's shift, but next year I'll be working Christmas... Booo....

Sorry to ramble! Enjoyed reading this post!

Take care!
Carrie :)

Anonymous said...

As a BPD masochist, my psychiatrist dropped me from his practice in October 2005. For Christmas last year I gave him a $50 gift certificate to a cool Indian restaurant near his office.

I would have liked a thank you--even if it was scrawled on a PostIt note.

DrivingMissMolly said...

I'm glad to see this addressed here. Before I gave my last psychiatrist a gift, I researched gift appropriateness on the Internet. There are some strong admonishments for not accepting, but there are strong reasons to accept as well, especially those involving rejection causing hurt to a patient.

After much deliberation I decided it would be alright to bring him a gift at our last session (he was a resident), since it was a termination gift and of modest value.

I ordered two moleskine notebooks for him because I liked the symbolism of blank notebooks for a resident/baby psychoanalyst.

I wrapped them in black organza ribbon and sewed gold tassels to the ribbon ends. I expressed my gratitude and my best wishes for a happy career and personal life in a blank card I attached behind the notebooks. I then shoved it all into a paper bag.

At the end of our last session I pulled the bag out and said; "I got you something." He turned red. I handed it to him and said something brief. Then I got up and fled as quickly as I could because I was afraid he would reject it and I wanted the card to speak for itself.

I heard him call my name as I got on the elevator but I kept going...

This holiday I have a new shrink. I know he is Jewish. I don't know what, if anything I'll get him. He is so new to me. I was thinking of a charitable donation in his name accompanied by my usual UNICEF card.

Last year I got therapist a huge poinsettia for the office. I think items for the office aren't as personal feeling so they may be more acceptable to patient and therapist or psychiatrist.

Thanks for the post, Dinah.

Thanks Dr. R

NeoNurseChic said...

I like the poinsettia thing... My current doctor's office is so barren - he seriously needs a picture on the wall or SOMEthing! Not that I will do anything - but that would be nice. His old office had a picture on the wall and he had a nice comfy couch in there. Must've been a permanent office fixture because now his office has your standard teacher's desk, a desk chair, another standard desk chair for patients to sit in, a computer, and 2 shelves that he's filled with books. That's it. Of course, in his last office, he had no window - and now he has a really nice big window - that looks over a parking lot but still. Perfect window for people watching I guess!

I've always known about the receiving gifts thing because honestly they hammer nurses about it (and anyone who works in a hospital) quite a bit, too. I can see where it is a bigger issue in psychiatry than in other specialties because if you accept or refuse the gift, it means different things and both could be good or bad...and that's completely discounting what the gift even is.

Once, a good friend of mine told me that he did a rotation with my psychiatrist when my friend was a med student. He described my psychiatrist as "the very laid back, friendly guy." So when I gave the cds and card to my psychiatrist, he didn't get up in arms at all - he didn't turn red, he didn't seem anxious or alarmed. He was surprised, but did not say or reflect anything (via facial features or other nonverbal cues) that showed he was concerned. He did say, "I'm honored that you would share this with me." That's how he has always handled certain things I might say (if I was saying, for instance, how much he has helped) and anything I've ever brought in. The day I gave him the cds, I had actually brought my laptop with me and we watched my performance of 2 songs that I have on DVD. I had wanted to share them with him. My best friend Laura and I always used to talk about how it would be very funny to have a big tv screen over our heads while giving a recital that displayed every thought going through our heads. My psychiatrist said that he liked that I could give running commentary about all my thoughts connected to the piece I was playing while we were sitting and watching my performance of it. Recently, I brought in the program from the NICU memorial to show him. And for each of these times, he's always said that he's honored or he's touched or something very similar that I would share these things.

Guess that's certainly a different way of accepting a gift, whether it be something physical or something that I might say about our work together.

Just an interesting insight to me!

Dinah said...

Actually, I would like to suggest that giving a photo of a baby you gave birth to, or a CD of yourself performing, isn't really a "gift" in that it's not something you've gone to the store and purchased of monetary value to give someone for only their benefit, but that as sweet and touching as it is, it is really more a gift of sharing yourself, and that even the pickiest of psychiatrists would be hard pressed to refuse or be anything but honored by such a gift.

I'm not sure what to say about office gifts. I have a book in my waiting room that a patient gave me for it, I think she wanted to share this with others in distress (it's called The Blue Day Book) and I've had many comments about the book, all positive, and I've told her that people have liked it. I'm not sure what I would do if a patient gave me something I didn't like, but I would probably feel obligated to display it if that's what the patient wanted.

Still, the card saying I'm the best psychiatrist in the world would make my day, if anyone wants (I've never gotten one). A charity contribution (I like HealthCare for the Homeless) would be great, and I'd be pleased to be honored with financing someone's goat in a developing country. I may get this for Roy for the holidays. Clink gets a used playing card, maybe the ace of spades.

Sarebear said...

The Blue Day book . . . is that one of those ones w/funny animal pics and great captions to go with them?

Someone mailed me this book, years ago, and it's the beginnings of my "rainy day" kit, for when I'm having a really bad day.

Course, I don't know where I put the basket I was starting to put stuff in, like Sense and Sensibility, The Blue Day book, and a few other things.

If that's the book I'm thinking of, the same guy has done other ones, that I wish my family and friends would give me to cheer me up. They really give me a giggle.

If I was waiting in a psychiatrist's waiting area and saw that book, I'd instantly know, or rather, think I know, that they had a sense of fun and humor.

NeoNurseChic said...

But I still bought the cds I used to record my recitals on...and paid $200 and $150 respectively to have them professionally recorded. Come to think of it, I should be charging people for copies of it, no? LOL

Just kidding around here...

I do like the Blue Day book. My mom gave it to me when I was a student at Penn State - during one of my times when I wasn't doing so hot. I saw another one by the same author recently and really wanted to purchase it, but I haven't yet! I even have the blue day journal - my blue day journal is filled with quotes and song lyrics that I like. Then I started writing about my headaches in it at one point - just personal thoughts I'd had... I also have a list of friends and phone numbers in the back of it - whenever I made that list, it was a list of people I knew I could call and count on when I needed a friend. :)

Fat Doctor said...

Dinah: My silence was unintentional. I check in here daily but for some reason must have missed the day you posted this.

As for the toenail polish, I took a reader's advice and bought some pure acetone. Worked like a charm!

By the way, I want to thank you for picking up on some identifying information in one of my posts and alerting me to it. I fixed the post, as you can see, and didn't post your comment. I figured you'd understand. Sincere thanks!

Anonymous said...

Oh, yay! I give my therapist a nice card every year at Christmas, thanking her for helping me to enrich, improve, and understand my life. Glad I wasn't supposed to include a sweater or a gift card or, oh, say, a timeshare, too. :)

I'm new to Shrink Rap, but I came over from Fat Doctor's site. Any friend of hers is a friend of mine. :)

DrivingMissMolly said...

HEIFER INTERNATIONAL! That's the name of the place I used to get a catalog from that sells the animals! You can give bees, a water buffalo, a knitting basket, and many other things.

I wouldn't feel comfortable sending a "Your the best psychiarist in the world" card because well, as a borderline patient, I will hate him the next day anyway....Haahhahhaha. Sorry.

I noticed that my therapist has three "stick ups" on his bookshelf. I have wanted to tease him about them, but I am pretty reserved in RL. A good office gift would be a candle and warmer. Yankee Candle Company makes nice little holiday sets in various holiday-ish scents such as cinammon and balsam that might be enjoyable.

DrivingMissMolly said...

Dinah, Clink and Roy, Heifer International will allow you, for $20 to purchase a flock of ducks!!


jcat said...

I'm in South Africa, and I think we're a bit more relaxed about doctors accepting gifts from patients, as long as they aren't too costly.
I've been seeing my current psychiatrist for 18 months now. Didn't get him anything last xmas, cos I didn't feel like I knew him well enough. We have a kind of standing joke about his ultimate bribe being a Porsche Turbo Convertible, so for the anniversary of seeing him this year, I went to the Porshe dealer, and asked for the cheapest, identifiably Porsche Turbo part that they had - turned out to be a thing for the centre of the wheel, and cost very little, and gave that to him with a card that said that the best thing about a really horrid year had been seeing him.
For christmas this year, I bought a feng shui frog, that I really liked, and wrote a soppy card. I would be really hurt if he wouldn't accept something - it doesn't matter to me whether he displays it or not, but it means a lot to me to be able to acknowledge his help and caring, with a gift of something that I have put thought into.

Been seeing my psychologist for 3 years now, and our relationship is a lot less formal, especially seeing as she practices from home. So I know her pets, have met her fiance in passing - I buy birthday and christmas gifts for her, and we're both comfortable with that. Sometimes I'll take dog treats with me, or fresh biscuits - just small things to thank her for being there for me. She's gone out of her way to help me at times, like visiting me in hospital, and bringing things that she knew I needed. So it goes both ways.
I don't think that shrinks should have too much of a moral crisis over accepting presents - as long as they aren't way too personal (the underwear!!) or expensive. And as long as they are given without expectation, just to say thanks for caring.

Aeriena Eve said...

I got my ologist this!

I just thought it was funny. I also go to another clinic, and I'm friendly with a lot more people there so I make a gigantic tiramisu and write "Galaxy 12 People" in chocolate sauce on top.

I also have a habit of giving my social worker different vegetables, like a squash with his name calligraphied onto it, and a really, really big zucchini.

I figure joke gifts and food gifts are appropriate without overstepping boundaries.