Psychotherapy in general has viewed the framework or ground rules of therapy as a necessary but relatively peripheral element of therapy, in contrast to the more significant position given to the content. If the patient relates a number of messages with a similar theme, then the therapist should be alerted to the particular significance of the ground rule for the patient. Privacy and confidentiality overlap and in many ways go hand in hand, as information regarding the patient may be passed on to others either directly or indirectly. The accepted gift creates an unhealthy and unrealistic form of merger between both parties, by suggesting that the relationship is other than a purely professional one. Psychodynamically, difficulties associated with fees may represent other underlying concerns. The manner in which the therapist handles the ground rules of the fees of therapy may therefore have implications for the ongoing relationship.