Sophia is a licensed professional counselor who runs a private practice in a rural area. She has been working with Mei, a 32-year-old client who recently immigrated to the U.S. from a culture where gift-giving is a common and meaningful way of showing respect, even in professional relationships. Mei originally came to therapy because she struggles with attachment issues—mainly trouble trusting others and maintaining healthy boundaries in relationships.
Throughout the sessions, Mei would sometimes bring small gifts like homemade food, a scarf she made, or some nice stationery. At first, Sophia told Mei that accepting gifts was not really allowed in counseling and turned down the first one. But Mei seemed really disappointed and later explained that in her culture, refusing a gift could feel insulting or like rejection.
Sophia began to feel conflicted. While she desired to uphold ethical guidelines, she was also concerned about damaging the therapeutic relationship. As the only licensed professional counselor in her area, with the nearest colleague over 600 miles away, she often felt compelled to navigate ethical decisions without the benefit of peer consultation or formal supervision. Over time, Sophia began to rely on what she referred to as “community ethics,” which she believed were more appropriate than formal ethical guidelines in the context of her small rural community. As a result, she chose not to seek outside guidance and decided it might be acceptable to accept some of the gifts in order to maintain client trust. Additionally, Sophia believed that being viewed as culturally sensitive could enhance her reputation and help attract more clients, particularly as the sole licensed counselor in the area. She hoped this would communicate to others in the community that her practice was a safe and welcoming place to seek help.
Eventually, Sophia started accepting more gifts without really revisiting the boundary conversation. She began to notice that Mei was becoming more attached and was bringing gifts almost every session. Instead of addressing the shift in dynamics, Sophia chose not to say anything, worried it might rupture the therapeutic relationship and would get in trouble.