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What Is Secondary Gain and How It Can Hurt You

I’m often struck by the fact that psychological concepts that I recognize like the back of my hand are unknown to many clients. I don’t know why I’m surprised, considering that the education of a therapist is based on possessing a thorough knowledge of psychology. One of these concepts that people don’t readily see and often need a therapist to point out to them is called secondary gain.

To put it simply, a primary gain is one we’re conscious of and a secondary gain is one that is generally unconscious. The term is often applied in relation to poor health. The primary gain from going to the doctor would include getting proper diagnosis and treatment. The primary gain from telling people about your sickness might include informing friends about why you’ve been isolating or even finding out if they’ve gone through what you’re experiencing. With primary gain, we have an intentional, conscious agenda.

With the secondary gain, we’re unaware that we’re wanting and getting something more from an interaction. For example, we may go from doctor to doctor because we haven’t been diagnosed properly (primary gain) or because it fills our time or makes us feel special being so difficult to diagnose (secondary gain). In secondary gain, we don’t realize that what we really want is to meet some unconscious unmet need. For example, we may complain to friends about awful symptoms because their listening to us makes us feel cared about.

Here’s an example. The parents of a client divorced when she was a child. She lived with her mother who worked hard to be a single parent while struggling with abandoned and bitter feelings about her husband leaving her and their four children. Mom was depressed and stressed, and food wasn’t important to her. Sometimes she cooked for the family, but mostly she took them out for fast food or let them fend for themselves. Grocery shopping was sporadic. My client found being fed unpredictable and developed a fear of going hungry (due to the scarcity of food in the house). Fast forward to my client now, as an adult living with her brother and their elderly mother. My client often says she’s too tired to food shop or prepare food after work and depends on her mother to fix meals for her and her brother.

Secondary gain occurs by my client feeling nourished (at long last) by her mother, something she’s longed for since her parents divorced. Mom now enjoys secondary gain as well, assuaging her guilt about having been too busy and depressed to feed her daughter and son well earlier in her life. Neither is aware of the mutual unconscious

compact they’ve made. My client can feel good having Mom finally shop and cook for her and her mother can feel better that she is now taking proper care of her children. Not only are these needs not spoken about, but they are also completely unrecognized.

Can you think of situations where you gain something that you don’t acknowledge you want from your actions? What you call sharing or venting might be your way of getting people to finally listen to you. By making an illness sound worse than it is, you receive sympathy and agreement from people that you’d better stay home and not go to work or school. By being tight with money, you get others to pay for you or buy things for you which makes you feel special. The point with a secondary gain is to find your hidden desire and acknowledge it so that it doesn’t drive your actions covertly and so that you can get your needs met directly and openly.

Best,

Karen

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