Monday, December 24, 2007

My Recycled Post, Back Again After Technical Difficulties

Don't ask, this is recycled from last year. It was gone, now it's back, unfortunately the three new comments were lost.

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

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.

Roy 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.

Roy 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.

healthpsych 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!

jw said...

Well, you give a Canadian psych timmies! (Tim Horton's Coffee, Canada's national food).

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.

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!

guinness girl 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.


fishofdeath said...

In a slight reverse of the topic, I was actually very surprised to get a Christmas card from my therapist this year. I don't know if it was because I am also a physical therapy patient (her and her husband have a joint mental/physical therapy practice), but it was surprising. Not unwelcome, just unexpected.

Anonymous said...

I always felt that it would be completely inappropriate to give a psychiatrist anything, even a card. I have a lot of gratitude toward my psychiatrist but felt there was no acceptable way to express it, which is sort of unfortunate. I am pretty shocked that apparently people DO give gifts and it's considered okay. I always figured that would be a great way to get yourself labeled as a creepy stalker type with attachment issues.

Anyway ... Merry Christmas, everyone.

NeoNurseChic said...

Thanks for the trouble you went to! I'm actually leaving this comment from my new iPod touch! Cool, huh? Happy holidays!!

Take care,

Roy said...

A mild expression of thanks, like a card on the holidays, is probably an ok thing for many pt-pdoc situations, unless you are in analysis or intense psychotherapy, where the act of giving becomes "grist for the mill." But I think that giving a card is a long way off from creepy-stalker-type-with-attachment-issues. Mailing me a dead rat in a box... that would qualify as CSTWAI!

Anonymous said...

The best gift my hubby got as a resident was when a patient mailed him a rock, with hubby's name painted over it, to be used as a paperweight. There was a little note saying ' A happy patient, four days, room so-and-so'. I thought it was such a wonderful way of giving.

Disillusioned said...

When I ended mu sessions with a psychotherapist last year, I really wanted to give something as recognition of how much the work we had done had helped. He had got me to keep a record of positives - things I had done or others had said that provided evidence of my "worth" - as part of my therapy. So for him I got a nice notebook and, on each page, wrote one of the things he had done which I was grateful for, like "Thank you for all the time you have given me" and then decorated it, scrapbooking style. He seemed to really appreciate it, and it helped me to accept what was a difficult thing, the end of a supportive and positive therapeutic relationship.