Monday, 29 June 2015

Secondary Gain

Sometimes your clients behaviour (however much they say they want to stop it/get rid of it) does something for them.  This is one reason why checking the wellformedness of their goal is important.
When your client says they want to get rid of a problem and yet demonstrates something else, this is where secondary gain may come into the equation.

Secondary gain is said to be a psychiatric term meaning that a person has a hidden reason for holding onto an undesirable condition. Frequently this reason is unconscious. It is obviously unconscious because the loss of holding onto the condition is often far greater than the perceived gain.

A few years ago I worked with an elderly woman who had chronic pain in one of her legs, there was no medial explanation for this.  She was considering have nerves removed so that she stopped the pain but her doctors were not sure that this would work as the pain was in her mind.

Strange explanation its all in your mind, yet how true.

In hypnosis she felt no pain, and was able to walk comfortably.  After our session she went shopping with her husband and had a wonderful afternoon.  Then as soon as she got home she was in pain once more.

Very interesting I thought.

I then found out she had a 50 year old autistic son who lived at home; and he expected his mum to do everything for him.  So much so that she had no time for herself.  That is unless her legs were tired (her sons expression for mums ailment) for then he left her in peace.

“I’ll leave her if she doesn’t try to get better….”

This was the declaration from an exhausted, stressed and unhappy 45 year old man who sat slumped in the chair opposite me.  The strange thing was, he wasn’t my client, it was his wife who had the appointment.  Living with OCD allows this woman to have waiter service from her husband, peace and quiet from the kids, she isn’t expected to do anything.  Her husband did everything and when he couldn’t he arranged for others to cover.  There was an army of cleaners, nannies, tutors etc to take his place whilst he kept a very demanding job.

There were no holidays as she couldn’t leave the house but that was OK cos he couldn’t afford any anyways with all the extra expenses.  He had health problems of his own that he couldn’t stop and deal with cos he needed to support her and as long as she was “trying: to get better he would do so.

So, consider that if you haven’t got the result you are expecting, it could also be because there is some secondary gain for the client and although they are saying that they want to get rid of the problem, it may actually serve them better to keep it; or at least appear to be ‘trying’ to get better.


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