Tuesday, December 06, 2011

What to Get Your Psychiatrist for the Holidays

This is an update of a Shrink Rap post that originally was posted in 2006.  Seems like a good time for a re-run.

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-- unless you're paying an overdue bill-- and don't  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 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, and no doctor expects gifts from their patients.  


Frenetic said...

A well thought out message written in a card is best, I think. I remember last year sending thank you notes to the surgeons that performed my surgery, thanking them for improving the quality of my life - which they really did. They both commented on their individual cards the next time I saw them for a follow-up.

Now, have a brand new psychiatrist this year that has been amazing and really worked with me to find some solutions. I will spend some time to write out a thank you letter that I think is appropriate.

PDFdoc said...

Psychiatrists are in that group of specialties where the physician seen the patient over a prolonged period of time, and patients often do want to express their gratitude. I think that it is the polite thing to do to accept the gift, but understand that in large hospital/training program situations, blanket rules may be unavoidable.

I am not in the long term patient area, but still usually receive some cards and bottles of wine.

Earlier this year while manic, I stripped ebay's shelves, and presented my psychiatrist with a bumper sticker reading "some mornings it's just not worth chewing through the restraints", and a tile coaster imprinted with a Rorschach blot. I thought this was uproariously funny at the time, while he maintained his unreadable psychiatrist's facade, and suggested that I could go out to run in the middle of the night when I couldn't sleep, rather than shop. I don't know what kind of car he drives, but I have the sneaking suspicion that I won't be able to identify it by the bumper sticker.

So, maybe I'll stick to a card and bottle of wine for Christmas - thanks for the suggestions!

Dinah said...

Frenetic, you'll make his (?) day!

PDF Doc: Okay, WHERE did you get that bumper sticker???? If your doc didn't secretly love it, there is seriously something wrong with him. And I hope you live somewhere safe to run at night. A treadmill, perhaps?

Sarebear said...

I think it ate my comment. That's ok, I was going to delete it anyway.

Liz said...

thanks for this helpful reminder.


Carrie said...

I think I may have told this story before, but my psychiatrist sees me for no fee due to a too-long-to-explain issue. At any rate, for Christmas in 2008, I gave him a gift card to a restaurant. The total worth of the gift card was that of 3 visits. I didn't give it to him expecting different treatment or anything like that. The next visit, he returned it to me. I was so upset!!

In December of 2009, my now husband and I went out to dinner using that gift card - then walked to the Art Museum, where he proposed. So hey, it came into use anyway! Haha

Moral of this story is, I've not even given a card for the past few years - this year I might, as the cards we're giving are made of a wedding photo.

PDFdoc said...

Dinah - I'm not sure if I'm allowed to write the site where I got the bumper sticker...as you can imagine, I got about 30 different ones...good for holding my car together when it gets too rusty. Cafepress.com, I think, and they put thousands of expression onto just about any surface. And, I live rurally, so took my psychiatrist's suggestion and went back on ebay to buy a headlight and reflective vest (he wasn't impressed with that interpretation of his advice), but I actually have used them for their intended purpose, running in the middle of the night. I have tried running without light, but have ended up staggering from ditch to ditch trying to get home. I have a treadmill too, but my personal pack of dogs (5) chase me, and it's not worth the re-schooling every time!

Carrie, I think that your psychiatrist was insensitive not to accept your gift, and think that your wedding photo card is a wonderful idea!

Jen said...

Hmm. I've never thought about holiday gifts - possibly because my religion does not celebrate the major holidays - but I have been known to write thoughtful thankful cards at random. I'm sure the shrinks think there's much more meaning to it then the really simple truth - I am so thankful for all that you do.

Dinah said...

Thanks, PDFdoc. Not sure I'll order one, but I did think it was funny (and I do feel that way in the mornings myself.)

Carrie, I can't imagine that shrink didn't think it was very kind and thoughtful.

Just so everyone is clear, the holiday gift for the shrink idea was meant to be a bit humorous. I think one or two patients a year will give me some type of gift, and maybe one or two cards. It's really not part of the 'expected' and it's hard not to be a bit uncomfortable with it when it's been drilled so deeply into us. It has nothing to do with either the giver/ the gift/ or the intent.

I did buy chocolates for my hair stylist for the first time ever.

jesse said...

Chocolates for the stylist is a great idea. As is frequently the case, my attitudes on these things is similar to Dinah's. The key in accepting a Christmas gift is a combination of the overall context of it with the price of the gift. Baked cookies, yes. A small token, yes. Anything truly substantial though should not be accepted, much as the Shrink might want to (and, again, everything should be thought through in regard to the overall context and treatment.

When I was in training one of the residents was treating a man from Argentina. At Christmas he received an invitation to fly to Argentina on the family jet and spend two weeks at their ranch. He turned it down (being a Shrink is not always easy).

When I say the Shrink should look at the context, even in small matters a gift might come with a subtext: "I just told you some terrible things about me and I want to be sure you still like me." It can be a bribe. It can be a seduction. It can simply be a gift given out of gratitude. The important concept is that we think about everything. Unlike a physical examination done by an internist, everything that occurs might be some window into how we can help the patient, and we do not want to lose that opportunity.

Sarebear said...

I was a lot more naive about this issue back then, before I learned more from this blog and from experience in therapy (not that I ever wanted to give him anything.)

On the note of other Dr.'[s, well a week before my pregnancy was due I made a choc angel food cake from SCRATCH, and it never got eaten (I was in and out of the hospital every day in the last two overdue weeks of my pregnancy). I mentioned this to my GP at the first checkup and he enthusiastically said I'd have been welcome to have my hubby drop it off at his office and they'd have enjoyed it.

I'm still nervous on the whole issue of docs and gifts tho so I've never dropped anything off.

What about when your therapist gives YOU something? I know it would depend what, and especially WHY . . . but well I know of a situation that was unusual but appropriate (imho).

Lu said...

I'm not sure I understand this. I'm actually really surprised that anyone would give a gift to their psychiatrist, especially if the psych is their therapist. Is this really a thing that people do? It seems well beyond the realm of acceptable or desirable doctor-patient interactions. I don't mean to imply that I condemn people who give or accept gifts within these relationships; what I'm saying is that, based on my understanding of the issues that would be involved, I never thought anyone would do this at all.

Carrie said...
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Carrie said...
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Sunny CA said...

When I read this post the first time, I gave a Christmas card to my psychiatrist and told him he is the best psychiatrist in the world, along with other "thank you"s, and he proceeded to tell me that he is sure he is NOT the best psychiatrist in the world. I found THAT to be hurtful.

When I see my hair stylist near Christmas, I give her an extra large cash gift (about another 20% in addition to the 20% tip) because as a service person I already tip her with money and it is the gift she would most like to receive. However, when I worked as a nurse's aide in a skilled nursing facility in college, family of patients would frequently gift large baskets of candy or other food for the staff to share, and that never felt like a boundary violation, it felt like a thank you. I give gifts to my veterinarian and send him a Christmas card. That is a thank you to let him know I am grateful for what he has done for my pets during the year. It may be his job to save the lives of pets and I may pay him to do that, but he cares and is terrific at his job and I am grateful for that. Sometimes I give my dentist or general practitioner a gift if I visit during the holiday season. I have chosen them because they are really good at what they do. I do not take that for granted. There are lots of awful hair stylists out there and doctors and vets who can't diagnose illness properly and dentist who put in fillings that fail. Really. There are. I am very grateful, for "the team" of professionals I use that are so very, very good at their jobs that I consider them worth going to. I don't think being grateful to people who provide a service for a fee is pathological, especially people who are really good at their job and put their heart and soul into helping people. I think it is normal. That is why I generally give a nice bottle of wine to my psychiatrist at Christmas. He is not a typical psychiatrist. He's extraordinary.

Anonymous said...

I have seen the same therapist for 8 years (yikes!). And I always spend considerable time writing her a thank you note in my Christmas card. I also buy her a gift and she graciously accepts it. I do consider the "card" the more important part of the gift. I spend a lot of time choosing my words and expressing my gratitude.

The first few years, she mentioned that I was much more expressive in my writing than in therapy. That was interesting news to me. I assumed I expressed all these feelings in her office - maybe not so directly. So I learned that I needed to be more direct in my thoughts.

My gifts have run the gambit from a bottle of beautiful wine (after a trip to Napa Valley), to a book (I think it was called "God's Shrink"), a necklace ... and of course there was one horrible year when I was angry and gave her nothing. Do you think she noticed?

This year - I'm writing the card and I'm still deciding what to give her - and I will give her something. I can't imagine not having her in my life. She's my rock.

C.J. Brenner said...

I'd just give them a candy cane.

Anonymous said...

I've always given my therapist a small gift of appreciation at the holidays but nothing expensive (e.g. a book, a christmas ornament, a candle or something like that), but not my psychiatrist. The psychiatrist felt a little more formal and then there was the opposite sex thing with him, so I didn't want him to read anything into it that wasn't there. I probably wouldn't ever give a bottle of wine as a gift to someone unless I knew for a fact that they drink wine. Never know if someone is a recovering alcoholic.

wv = Supro. Short for Suprofloxacin, an antibiotic used to kill the type of bacteria found on physician's ties and lab coats. A Cyp1A2 inhibitor.


Sean Paul said...

I am a trainee and the standard policy at our clinic is to accept the gift and if it is food, it must be shared. Exceptions include lavish gifts and money. I do think that the meaning of the gift must be explored as well. But that does not always mean that the gift should be rejected.

Anonymous said...

I was in behaviorally-oriented group therapy with residents, and one left for a child fellowship. We all chipped in and got her some flowers to say goodbye. She accepted them. I think that was okay, because we were terminating the relationship but I also think that the fact that it was group therapy made a difference.

Anonymous said...

Of course, the therapist might not even be Christian. I figured out that mine was Jewish after I noticed that he was taking off all the Jewish holidays--mostly Passover.

withallmyheart said...

This is somewhat tangential. My psychiatrist had received, or had been given, a sculpture made by one of the other patients. My doc then put it in his office. When I asked "where did that come from?", I was gently informed that it came from another patient and meant a great deal to that patient (I am assuming it mean a great deal therapeutically to the other patient). When I put two and two together, I went ballistic (but in a good way).
The upshot was that the objet d'art was removed, (to my great sense of victory). All I could think was the very absurdly funny thought - almost a cartoon - of walking into a psychiatrist's office and there, displayed, were objects borne of each patient's psyche and illness. What do you think, Shrink Rap? Has this ever been an issue for you? ~~I mused, each week another patient could show his or her art work in the office..... I didn't know whether to laugh or cry, feel vindicated by my demands, or feel selfish - "Hey, what am I, chopped liver?"

Anonymous said...

So what about when your psychiatrist offers you something? Today I mentioned I was missing volume 1 of Proust's works, and my shrink said I could have hers, she wasn't going to read it anyway. I told her I had already borrowed it and shrugged it off. Damn, that was schizoid of me, I whish I'd at least thanked her as it was a nice gesture.