Secondary disease gain - a taboo with therapeutic relevance
There are few terms in therapeutic work that are as sensitive as this one: secondary disease gain. It quickly sounds like manipulation, like "pretending to be ill", like drama. And yet the concept is neither derogatory nor malicious - but a psychodynamic phenomenon that helps us to better understand chronic processes.
Secondary illness gain means:
A person experiences certain benefits through their illness - consciously or unconsciously - that are not directly related to the actual symptom. It is therefore not about faking illness, but about experiencing positive side effects in a difficult condition.
What can secondary disease gain mean?
Taking it easy: finally you can rest, say no, withdraw
Attention: Family, partnersor doctorsprovide more intensive care
Creating meaning: the illness becomes part of one's own identity or task
Balance of power: In addictions, the disease becomes the only lever
Avoidance: responsibility, conflicts or excessive demands can be avoided
None of this is done with malicious intent - but mostly as a protective strategy of the nervous system. Illness becomes an unconscious attempt to find a solution to an overwhelming reality of life.
Why is this important for us therapists?
Especially when working with chronic pain, psychosomatic complaints or persistent symptoms despite successful treatment, it is worth taking this aspect into consideration:
Why is it so difficult to feel better?
What would health actually mean in everyday life?
What role does the disease play in the family system?
What wishes, fears or unspoken issues are attached to it?
The physical symptoms are real - but their persistence can have a psychodynamically stabilizing effect.
How do we deal with this therapeutically?
Not with confrontation. Not with devaluation. But with fine perception, empathic language and systemic intuition.
Helpful are:
Creating space for self-reflection without pressure
Highlighting the potential for action - health must become attractive
Strengthen physical resources to experience safety beyond the illness
Recognize biographical connections: What role did health or illness play earlier in life?
Therapeutic language takes the pressure off - without guilt, but with responsibility
Attitude before technology
The term "disease gain" should never be used in an accusatory or judgmental way. It is not a label, but an explanatory model. Our attitude determines whether a door opens - or whether a person withdraws.
Conclusion:
Secondary illness gain is not a sign of weakness or insincerity, but an indication of unspoken needs. If we accompany them respectfully, new paths can emerge - back to a healthy, self-effective life.
📅 F ancy more therapeutic depth?
My webinars on pain therapy regularly focus on psychosomatic aspects, inner protective strategies and therapeutic attitude.
You can find all the dates here: www.hockenholz.com/webinare