Dilemma – The Coat – Spring 2017

Welcome to the Spring 2017 edition of the dilemmas page, in which we ask for answers to fictional ‘what if’ nightmare scenarios that we might find ourselves in as psychotherapy trainees. The range of responses from our readers from within the psychotherapy world provides us with tools should anything similar ever happen to us in our personal practice.

‘The Coat’

 

You have a client who is receiving psychotherapy from you at a low cost owing to their circumstances (£10 per session). At the end of your session they leave and as you come into the waiting area to pick up your next client you are informed that they have left a present for you at reception. It is an expensive coat which you know they would not be able to easily afford. They have had issues with shoplifting in the past. How do you deal with this situation?

 

Suzie Chick’s response

“I would firstly strongly recommend this whole matter to be brought to supervision before next session as there is much to consider.

This gift needs to be brought up with the client. There is something quite underhand and secretive about leaving the coat at reception and not giving it during the session. I’d want to explore the client’s experience of this; why they felt the need to give a gift in the first place, the nature of the gift itself (a coat seems a bit odd to me), and why they were unable to give it in person.

It seems obvious that the client wants to convey their gratitude to the therapist and I feel it’s important for this to be acknowledged and for their expression to be handled with respect. It’s not the gratitude that’s the issue, it the way it’s been expressed. I’d want to approach this matter with curiosity and convey to the client that this whole experience can be useful for us in our work together. I don’t want them to receive my exploration as critical or punitive.

As a final part of our discussion, I may try to hand the coat back to the client, explaining that I’ve acknowledge their gratitude towards me and their words are more than sufficient and so a physical gift is no longer required. This aspect will very much depend on how the whole discussion goes and how our alliance is working in the moment. Trying to return the gift may come across as dismissive or rejecting. I may want to express some discomfort about keeping the gift (again supervision is key here).

In terms of whether the coat could be stolen goods is a difficult issue and needs to be handled delicately. Just because a client used to shoplift, it doesn’t necessarily prove this coat has been stolen. I’d see what the client decides to disclose about the coat in session and I may approach the issue expressing my concern about their financial situation and even though the gift is a lovely thought, I am aware that this may have cost a lot. I am really unsure whether I’d name the shoplifting explicitly (I’d need to bring this to supervision) as I wouldn’t want to seem to accuse them in anyway. So I would tred very carefully around this, and probably check in with them as to how they are feeling when discussing the coat and its cost (keeping an eye too on their body language).”

Kelly Hearn’s response

I would keep the coat at reception. There is something quite passive (and manipulative) about the means of delivery. At the next session I would start with this. Why the gift? Why the secrecy? I’d be curious about the means of (non) delivery first.

I’d then give the standard disclosure that ethically I am uncomfortable accepting a gift of that value from a client so have to decline. With that (hopefully) clear, I’d approach the discrepancy between low cost therapy and high value gifts and inquire if anything had changed in the client’s financial situation or whether we needed to rethink the arrangement (adding that low cost is there for people who genuinely need it and sometimes as financial conditions change so must rates so we can accommodate others at lower rates who can’t afford more).

I would explore all of the above focusing on genuine connection and communication with the client before making any link or reference to shoplifting. It’s an obvious link by a behaviour that is likely to be full of shame and I’d first want the client to know that he/she is safe with me to disclose any and all without judgement. As with so many things, here the behaviour (presumed shoplifting) is a symptom more than the issue so I’d want to try to get a better understanding of the issue(s) first.

 

Next Issues Dilemma – The Wizard

A client who you have been working with for a few months came to you originally saying that after a suicide attempt in their teens, they had been diagnosed with schizotypal personality disorder by a psychiatrist and have been on medication for two years. After a month of working with you they express the feeling that they disagree with their diagnosis, and would like to end their medication as well as contact with their psychiatrist immediately. They express many unconventional spiritual beliefs and believe in magic etc but have not made any inclination of being suicidal in the time you have worked with them. How would you approach this situation?

 

 

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