Therapy Dilemmas

Welcome to the Dilemmas page, each issue we will be presenting a number of short and fictionalized scenarios that a practicing counsellor or psychotherapist might encounter in their practice – We would like to ask for contributions from our readers – ways in which they personally would deal with the problem presented for the next issue – . Answers can be sent to and may be kept anonymous if you wish!

As these are short snippets of possible scenarios there is not a right or wrong answer to these situations – it is all about seeing the manifold ways in which different psychotherapists would work with their clients.


This issues Dilemma


Emily has been seeing her client, Sandra, a prostitute, for a few months in relation to Sandra’s issues with intimacy. At the end of their last session Sandra tries to give Emily £20 in addition to her usual £40 fee. What should Emily do?


Suzie says  “This for me could prove to be a pivotal moment in the therapeutic relationship. Sandra is essentially tipping her therapist by paying her 50% extra on her weekly fee. I personally would not accept the £20 from Sandra but it would be very important to decline this in a gentle and loving way and to acknowledge the kindness of the client’s actions. If for some reason Emily did accept the £20, I would suggest in the next session treating this an advance payment so the whole “tip” element is removed. As it’s the end of the session, Emily won’t be able to fully open this up until the next session but I think it’s very important to do so. I wonder for Sandra what it meant to her to pay extra? Also what did Emily pick up in the transference of this matter, was Sandra allowing Emily a glimpse into her world? Also how does Sandra feel about the money being declined and what does this mean for their relationship? I also feel it would be important to bring this matter to supervision for Emily, as I know personally this situation would have triggered issues for me in regards to value of my work as a therapist.

Claire says  I feel clear on how I would handle this – I would accept the money and keep it safe before bringing it back into the room to do some work with it in the next session, I would ask the client what it represents to them, and work with what the interaction between us brought up for them as I accepted it”

 Katherine says My response is kind of in line with the policy at my placement. Thank the client for their generous offer, explain that extra money can not be accepted- if time/able to ask what the extra £20 is for. The policy from my placement is any gifts given to the counsellor at the end of the session are to be shared amongst the entire centre- i/e flowers stay in the office, edible gifts are shared. Gifts do happen and I think at the end of working together it is a nice thing for a client to feel able to share a gift, money though can not be accepted – however if part of a service (i.e not a private client) the client can choose to make a donation to the service instead, in the appropriate way. I am not sure whether that is particularly helpful but that is my view”

Next Issues Dilemma

you are at a party, you are with a loud, extroverted and slightly drunk friend when they introduce you to someone else who you immediately recognize as a client who you are currently working with. This client has presented issues in therapy around trust and boundaries. Your mutual acquaintance does not know that they are in therapy, nor that you are working with them and they begin to talk anecdotally about your old university or school days together. How do you deal with the situation?

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