Should Therapists Give Gifts to Patients?

To the Editor: I appreciated the article "Gifts from Physicians to Patients: An Ethical Dilemma" by David Krassner (1) in the May issue. I commend his candor and his attempt to research a "forbidden" subject.

The psychoanalytic aspect of our education urges us to consider multilayered meanings of any therapist-patient transaction. The dynamic and forensic facets of certain transactions would encourage us to abstain from gift giving in case of misinterpretation by the patient.

In my opinion no blanket rule can realistically be made. The therapist, who has spent time establishing a relationship with the patient, must decide on an individual basis about giving a gift to that singular and unique patient.

Freud wrote about the importance of totems, and Winnicott described transitional objects. Perhaps a gift—and we're not talking a Rolex here—can help a mind that has heretofore not been able to hold the concept of an object in its absence, and can encourage development.

I have given modest gifts at specific times in treatment, after devoting a great deal of thought to the reasons. I do believe the benefits outweighed the risks.

Dr. Epstein is affiliated with the Los Angeles County Hospital and the University of Southern California Hospital in Los Angeles.