Entry Date: April 16th, 2023

On Secondary Gain... 

 

During new client consultations, I frequently hear reports that "I tried therapy but it didn't work." What does this really mean? It seems to mean that therapy has not led to the changes that a person was looking for and they are left feeling stuck. 

 

There are many reason's why therapy "does not work;" the main ones being the quality of the therapeutic relationship (therapist-client chemistry), the type of treatment being used, the change-readiness of the client, and most importantly; the therapist's education level, training, and clinical skills.

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But what if the above factors are functioning well? Why then might a person not see the changes they are looking for?

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A lot of times, it is due to what is called secondary gain.

 

Secondary gain is a term used in psychology to describe the benefits or advantages that an individual may receive as a result of a mental health condition, pattern of thinking, or maladaptive behavior(s). These benefits, or secondary gains, may stop a person from being able to actualize the changes they seek or improve in the areas they want.  

1. Deflecting distress: A child may develop a mood disorder and now Mom and Dad have stopped fighting because they have to work together to help their child.

 

2. Addressing loneliness and disconnection: The illness may solve the problem of feeling ignored and alone because of the attention, sympathy, or other advantages that the individual receives as a result of their mental health condition, problematic pattern(s) of thinking, or maladaptive behavior(s). 

3. Avoidance: An individual's problematic behavior(s) or thought pattern(s) may block them from having to deal with something too painful or challenging, such as dealing with what may be going on at work, school, or socially.

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4. Emotional release: An individual may use their condition, problematic pattern(s) of thinking, or maladaptive behavior(s) as a way to release pent-up emotions or to escape stressful situations.

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5. Special treatment or attention: An individual may receive special treatment, such as extra attention, special accommodations, or exemptions, as a result of their illness or problem.

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6. Financial benefits: An individual may receive financial benefits, such as disability payments, insurance claims, or compensation, as a result of their illness or problem.

It is important to note that not all individuals with a mental health condition, problematic thought pattern(s), or maladaptive behavior(s) are inhibited by secondary gain. If they are, however, secondary gain is rarely a conscious or deliberate factor.

 

Identifying and addressing secondary gain is always an important part of treatment. If we as therapist do not encourage our clients to think about the ambivalence they may have about the prospect of change, they will undoubtedly remain stuck.  

 

If you are a person who is reading this, who is working hard to change or extinguish a behavior or pattern of thinking, ask yourself: If this behavior or thinking pattern were to end, what might I lose? Or, If I do not change this behavior or pattern of thinking, what do I get to hold onto that is experienced as a benefit? 

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Cheers and signing off...

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Entry Date: March16th, 2023

On Resistance in therapy... 

 

A common definition of resistance in therapy is any behavior, attitude or action that impedes the therapeutic process. But this definition is far too general and does not actually define what it is because, in reality, a lot of things can impede the therapeutic process other than resistance. A better definition might be that resistance in therapy (or in life) serves to unconsciously protect a person from facing difficult emotions or memories that they perceive as threatening.

 

Resistance in therapy is par for the course in my line of work! A person is showing up for therapy because they want to address what is going on in their life yet another part of them wants to not deal with it. In my own practice, resistance is one of the most useful tools because it will often show me what is going on and define what needs to take place to help someone heal. Indeed, resistance is a normal and expected part of the therapeutic process that we are trained to recognize and utilize.

 

Once we recognize resistance for what it is, we can assess when (timing is everything) and how to address it so that we can a help our client move forward both in therapy and in their life with more freedom. In other words, if we can transform resistance into acceptance at a pace that is not too overwhelming to a person, therapy (as a verb) has just taken place. 

 

Below are some common behavioral signs of resistance:

1. Avoidance: Avoiding certain topics or questions, changing the subject, or being vague or non-committal in responses.

2. Defensiveness: Being defensive or argumentative when challenged or confronted about their behavior or beliefs.

3. Denial: Refusing to acknowledge or accept the existence of a problem or difficulty.

4. Intellectualization: Focusing on intellectual or abstract aspects of a problem or issue, rather than exploring the emotional or personal impact it has.

5. Minimization: Downplaying the severity or importance of a problem or issue.

6. Projection: Blaming others or external circumstances for their problems or difficulties.

7. Passive-aggressiveness: Indirectly expressing anger or frustration through subtle or manipulative behaviors, such as being late or canceling appointments.

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It is important to note that sometimes what might appear to be resistance is actually not and as doctors, we need to know the difference. For example, perhaps a client corrects something their therapist says. This might simply be clarification and a bid to be understood rather than resistance in the form of being defensive or argumentative. A person wanting to be better understood by their therapist is certainly not resistance. In fact, it's the opposite!

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So, readers, how does resistance show up in your life? How do you defend against aspects of yourself or your situation that you are not ready to integrate into conscious awareness? I can certainly think of ways that I demonstrate resistance!  

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Cheers and signing off...

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