My therapist has loads of ornaments, teddy bears and objets d’art on the shelves of her office that I have become familiar with over the years. What I was not so familiar with was the fact that they were given to her by other clients. Had I known that at the time, I would have been practicing my best sling-shot at them while she made me a nice cup of tea.

One of my gifts is up there, too — a teddy bear, which I bought to keep an eye on her and make sure she is safe, and I begrudgingly have accepted that other items from the enemy have a right to be there as well. I have bought other gifts for her over the years, but these are mainly small, inexpensive and perishable items given for reasons of sincere gratitude for going above and beyond the call of duty in times of crises.

According to Nancy McWilliams’ Psychoanalytic Psychotherapy: A Practitioner’s Guide, “Gifts may be fairly innocent or may be loaded with meaning.” What she is saying is that a bunch of flowers or basket of fruit is OK, but a Mercedes-Benz, a sixty-meter yacht, a trio of islands in the Caribbean, or a 10-carat diamond ring might be sending more than just an expression of thanks.

Gift-giving is one of those rather gray areas in therapy. Should they be accepted for what they are, or should they be refused and interpreted instead? It was once thought, circa 1977, that accepting gifts would shut down any important conversation on the psychological relevance of the dynamics surrounding the gift giving. But it was actually discovered by therapists that not only did it not produce this important discussion material but refusal actually foreclosed the whole procedure, and sometimes the entire therapy, instead.

One of Nancy’s patients once confessed that she noticed she bought Nancy flowers whenever she had murderous fantasies about her. This rather delightful story increases rather than decreases the ability to second-guess the unconscious motives behind the giving of gifts and adds a great sense of humor into the therapeutic playspace that can be interpreted for a more meaningful depth of understanding.

So sometimes a cigar is just a cigar, and at other times, it is not.