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AS A SECOND YEAR RESIDENT IN PSYCHIATRY, I WAS GIVEN A GIFT BY THE grateful parents of an inpatient whom I was treating. The beautiful and obviously expensive jacket was manufactured by the family's company. I approached my ward chief with my dilemma of whether or not to accept the gift, i.e., was it "ethical" to accept the gift, would I offend the family if I didn't? He smilingly counseled me to "keep it; one day people will even pay you for what you do."
As an advanced candidate in psychoanalysis, my female analysand unexpectedly presented me with a gift at the first Christmastime of the analysis. Once again I was perplexed with how to respond; my ward chief's advice no longer sufficed; my many unaddressed concerns returned and focused this time on the question of what response would most foster the analysis. My search for specific references in the psychoanalytic literature yielded surprisingly little. My struggle with the theoretical and technical aspects of gift-giving in the analytic setting led to this paper, which is a review of the relevant literature, a presentation of my clinical experience, and a discussion of the topic using the clinical material presented.
The first psychoanalytic reference to gifts in the treatment setting was made by Freud (1917). Examining the path of the child's erotic interest from feces to money, he discusses "the gift" and counsels those who question this libidinal derivation of gifts to "study the gifts they receive as doctors from their patients" (p. 131). He states that "faeces are the infant's first gift … he will give [it] up only on persuasion by someone