I am a therapist, and I love expressions of gratitude. A heartfelt card, a meaningful verbal thank you—these mean a lot to me. Therapists work hard, and while we make a decent living, we do not generally do it for the money. We honestly like to help others to improve their lives. I know this gives me great pleasure personally and professionally.

I also love the holidays, including giving and receiving gifts. When it comes to my patients, however, this is where it gets awkward. As a therapist, I am trained to consider multiple motivations behind my patients’ actions, not to judge but to better understand them. A gift can mean a lot of different things, which is why they can become more complicated than they seem at first glance.

Here are some considerations about what a gift from a patient might mean:

Honest and genuine gratitude. This is the least controversial

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