SECONDARY GAIN – you’re not immune

"Secondary gain"¹ as a concept is tossed around willy nilly, where assumptions are often made about others’ values and ethics, and where judgements can often lead to the further suffering of people who have already suffered dreadful misfortune.  

Consider the person who is the victim of an accident at work – an accident which leaves them injured mentally, physically or both.  

Consider how that accident’s aftermath impacts their whole life, their ability to provide for themselves and their family.  

Consider the impact on the lives of their partner and children…  

Consider how their self-confidence and self-esteem diminish, their frustration and sense of hopelessness and uselessness increases, their anger at the injustice of it all intensifies...  

…And then consider the further psychological injury inflicted by others who insist that the reason for their not returning to work is laziness, and that they’re free-loaders simply taking advantage of the system.


“Secondary gain” is real. It does happen. But it’s usually much more subtle than we allow. It’s a dangerous and damaging thing to assume it of others. Rather than accusing others of it, let’s take a hard look at ourselves and ask some questions:

Why do I not do ‘X’ when I know it’s best for me?

Why do I settle for certain things when I know I’m capable of so much more?

Why do I judge other people, when I truly have no idea what their internal experience is?

Why do I blame everyone else for my own experience?


If you think you’re immune to “secondary gain” in your life, you’re wrong. Here I’m referring not only to “secondary gain” in reference to illness, but also in staying unhappy, dissatisfied, frustrated, stuck… Secondary gain can look like:  

a way of staying ‘safe’,  

a way of escaping the pressures of the world,  

a way of avoiding responsibility for ourselves and our lives,

a way of avoiding challenge and discomfort,  

a way of retaining a status quo that’s known, even if it doesn’t serve us, just for example.

Are you starting to get a sense of what I’m getting at?

Let me tell you a few stories.



Mandy* came to me suffering from migraines. She’d experience them at intervals of anything from a week to 5 weeks apart and they were utterly debilitating, causing nausea, vomiting, excruciating head pain among other things. They’d last about a day, and then it’d take 2-3 days for her to fully recover.  

She’d suffered from regular migraines since she was a child and had tried various treatments – some of which helped a little, but none had resolved the problem. All the scans were clear. There was no obvious physiological reason for the migraines.

I talked to Mandy about how these conditions can be (and I stress, can be – it’s only a possibility, not a certainty) a way for us to unconsciously protect ourselves. As we discussed this I saw a flash of recognition on her face. She said: “Well, it is a way for me to shut out the world. I just get my husband to cancel everything and I can lock myself away.”


It so happens that Mandy had had huge responsibilities as a child. More than any child could comfortably cope well with. So, she had a very good reason for having migraines. They protected her from that pressure. She was able to escape her burdens for a while.  

Please keep in mind – this was all subconscious, not conscious. It’s not like she was somehow intentionally causing her own pain. No. Consciously, she’d love to be free of the pain and debilitation they cause. But her subconscious hadn’t been on board with that.  

Can that all change? Yes! 100%. Most definitely. We won’t go into the ‘how’ here though.


Robert* had Parkinson’s Disease. He and I conducted a 10-day study whereby we had an hour-long session per day and he scored the severity of several of his symptoms before and after each treatment. He made no other changes to his lifestyle or diet. By the end of the 10 days Robert’s scores had dropped from 7-10 to 2-4. His leg no longer dragged. His posture was upright. His fine motor skills had vastly improved. His thinking was clearer…

Robert was heavily involved in fundraising for Parkinson’s research and had been told he’d inevitably suffer a slow, steady decline in his health.

After what I considered a very promising study, indicating that the predicted steady decline wasn’t necessarily a foregone conclusion, I told Robert that I could show him how to give himself treatments in order to keep improving his health and reducing his Parkinson’s symptoms.

Here, I’d been guilty of an assumption. I’d assumed Robert wanted to be well and free of his symptoms. I was wrong. He wasn’t interested in learning the techniques I offered him to help himself. And that must be ok, too. After all, who am I to judge? I realized I’d been more invested in Robert’s healing than he himself had been.  

I don’t know what Robert’s secondary gain was. Let me rephrase that – I don’t know why Robert’s illness was important to him. We didn’t have the opportunity to explore that. As a practitioner, however, it was an important lesson for me.  


Matt* had been in a car accident and was in the middle of proceedings deciding what insurance remuneration he was entitled to as a result of the accident. He suffered from physical pain as well as mental health issues resulting from the accident. Driving and being driven had become torturous to him, and often led to panic attacks.

I asked him how it would feel to stand up in court, demanding what he was entitled to, yet feeling fit and strong, with no panic attacks or mental discomfort. He realized it would feel very odd. After all, his being adversely affected by the accident was the basis on which his case stood!

We decided to work together after the court proceedings were over. Otherwise, we both recognized that there would have been a secondary gain – a very good reason for him to stay unwell.  


We’re all susceptible to secondary gain in our lives, in one way or another. We’re all vulnerable to sustaining our status quo, whether or not it truly serves us. It’s worth exploring in ourselves. It can lead to extraordinary lightbulb moments and clarity.

However, making assumptions about others is dangerous, arrogant and potentially vastly damaging. Let’s not do that. If we’re to help others explore the possibility of their own secondary gain, let it be with non-judgement, humility and respect. After all, that’s how we ourselves would like to be treated, isn’t it?

Let’s all be the change we choose to see in the world.

In gratitude,


¹ In the words of David A. Fishbain, Freud defined “…secondary gain as an interpersonal or social advantage attained by the patient as a consequence of the illness.”
*Not their real name.

About Sally

As a former international opera singer, Sally Wilson knows a thing or two about being at the top of your field. And she’s discovered first-hand what it feels like to step away from the spotlight and lose your identity.

Through coaching, Sally helps her clients let go of their self-sabotaging beliefs and discover freedom, joy and fulfillment. As an accredited TRTP™ practitioner, Sally uses evidence-based practices to create changes that are quick, safe and lasting.

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