Patient gift offerings, father-daughter incest, and the theory of reparation: An examination of therapist beliefs about patient gifts

Claire Marie Dumas (1988)

This dissertation is a study designed to investigate therapists' response to patient gift offerings in therapy, specifically, in the treatment of survivors of father-daughter incest. The thesis that this gift-offering phenomenon serves as an act of reparation, (as conceptualized by Melanie Klein) is considered as it relates to the work survivors must do in therapy. A survey of the literature on father-daughter incest, gift-giving in therapy, and reparation was conducted in relation to this thesis. Six "experts" or "experienced clinicians" in the individual treatment of survivors of father-daughter incest were selected to be subjects for the study. All identified themselves as having a psychodynamic orientation. Data were gathered through a semistructured interview. These data were sought in order to investigate one particular aspect of a very complex process involving gift-giving in treatment and therapy with incest survivors. This specific aspect is the therapist's response to, and understanding of, the gift-offering phenomenon. The psychotherapists' specific responses (actions, thoughts, feelings, and internal conflicts) to the offer, the meaning ascribed to the offer, and the meaning ascribed to the therapists' responses are described and examined. The results indicate that five out of six therapists accepted the gift offer; one rejected it. The gift offer is interpreted to be a self-enhancing mechanism which assists the patient in the work of therapy. It was reported that, when the offer was seen as a confused attempt at self-enhancement, it was rejected in favor of correcting the confusion and recognizing the intent. In all instances, the therapists' response was reportedly governed by a perception that a particular response should be informed by that which concerns the patient's self-esteem. No therapists reported using the theory of reparation intentionally; one, and possibly another, reported using the theory unintentionally. Only one subject fully applied the theory to the incest-survivor, gift-giving context. Therefore, the thesis that the theory of reparation is useful and applicable to an understanding of the gift-offering phenomenon in the treatment of survivors of father-daughter incest is not confirmed. The study concludes that the gift offer is a self-enhancing, curative mechanism whose acceptance or rejection by the therapist should be related to the self-esteem work which is indigenous to the survivor's therapeutic task. The investigation has implications for theory, clinical training, treatment, and future research.