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Hey everyone and welcome back!  I don’t think I have discussed this topic yet, yet is something that arises in therapy quite often. The topic is known as Secondary Gains.

Secondary gains are an intriguing, often overlooked aspect of mental health where individuals may unconsciously benefit from their symptoms or conditions.  These benefits aren’t always about seeking attention or being manipulative.  Rather, they are complex psychological mechanisms that can complicate the healing and recovery process.  Understanding secondary gains can be crucial for both individuals dealing with mental health issues and professionals aiming to provide effective treatment.

What Are Secondary Gains?

Secondary gains refer to the indirect benefits or advantages someone might experience from their illness or disability. These gains can be:

Social Benefits: Increased attention, sympathy, or care from friends, family, or caregivers.

Emotional Benefits: Validation of one’s feelings or experiences, a sense of relief from responsibilities, or even an excuse to avoid stressful situations.

Financial Benefits: Disability payments, time off work, or other forms of financial support.

Identity Benefits: Defining oneself through illness, which can give a sense of identity or belonging to a group.

How Secondary Gains Can Affect Mental Health

While these benefits might seem positive or even comforting, they can inadvertently prolong or exacerbate mental health issues:

Delaying Healing and Recovery: The comfort provided by these gains can lead to an unconscious resistance to getting better because the illness serves a purpose in one’s life.

Complicated Treatment: Therapists and patients might not recognize these gains, leading to treatments that don’t address the root cause, making recovery more challenging.

Relationship Dynamics: Relationships can become skewed, with individuals in the role of the ‘sick’ one, altering family or social interactions in unhealthy ways.

Anxiety: Someone might find that their anxiety symptoms prevent them from taking on new responsibilities at work, thus avoiding the stress of new challenges.

Depression: A person might stay in a depressive state because it elicits caring responses from family members, reducing feelings of loneliness or isolation.

PTSD:  When a person can use their triggers or trauma to their own gain for support, benefits from others, being able to take time off work, etc. and have no intention of healing, this would be a secondary gain.  

Physical Illnesses:  One might be surprised to hear that people have a Secondary Gain in regards to physical illness. Some view physical illnesses as “better” than emotional or mental issues.  Thus, why get better if I can get the sympathy or needed attention (even if negative) that I crave?

Navigating Secondary Gains

Awareness:  The first step is recognizing these gains. Therapy can help individuals and their support systems identify when secondary gains are at play.

Open Dialogue: Discussing these benefits openly without judgment can lead to understanding and acceptance, paving the way for a more honest recovery process.

Balancing Benefits: Therapists might work on creating alternative ways for individuals to gain similar benefits without relying on their illness. For instance, teaching assertiveness to communicate needs or finding hobbies that provide structure and community.

Gradual Change: Change should be approached gradually to avoid the shock of losing these gains abruptly. This might involve slowly increasing responsibilities or social engagements.

Therapeutic Approaches: I’m not sure there is a “best” approach to Secondary Gains.  However, it is something that I believe must be confronted – if true healing is expected.  Cognitive Behavioral Therapy (CBT) can be effective in addressing thoughts and behaviors linked with secondary gains. Motivational interviewing can also help by aligning treatment goals with personal values. In addition, directly finding solutions to potential trauma triggers or increasing the ability to regulate emotions can be effective using EMDR or Neurofeedback.

In my experience, when working with thousands of clients, a lot of people have some type of secondary gain.  The question remains, “does this impede their treatment towards healing.” 

In the End

Secondary gains are not markers of deceit but are indicative of human complexity in coping with life’s challenges. Understanding and addressing these gains can significantly enhance therapeutic outcomes, leading to a healthier balance in one’s life. If you or someone you know might be experiencing this, consider discussing it with a mental health professional who can guide you through this intricate aspect of recovery. Remember, the goal isn’t to eliminate these gains but to understand their role and find healthier ways to meet the underlying needs they serve.

Until next time,

Aaron Nicolaides, PhD, LCSW

Therapeuo Health – “Tackling physical and emotional pain”