Why Some People Don’t Heal: Understanding Secondary Gain in Mental Health
By Deirdre Arato, LPC | Trauma Therapist + Neuropsychotherapist
Introduction
Healing is rarely a straight line.
As a therapist, I have sat with countless clients who desperately want change — they want to feel better, stop the panic, end the triggers, release the pain — yet they stay stuck in the same emotional patterns. They show up to therapy, do the work, journal, practice coping skills… and still something holds them back.
That “something” is often a psychological concept called secondary gain.
And until it is acknowledged, no amount of healing strategies will fully take root.
What Is Secondary Gain?
Secondary gain refers to the unconscious benefit a person receives from staying unwell or stuck in a painful pattern.
The symptoms may be miserable — anxiety, depression, chronic pain, emotional shutdown — but the mind perceives that staying the same is safer than changing.
Examples of secondary gain:
Receiving attention, care, or support from others
Avoiding uncomfortable emotions or difficult conversations
Staying in a familiar identity (“the strong one,” “the sick one,” “the responsible one”)
Avoiding risk or failure by not trying something new
Secondary gain doesn’t mean someone is faking symptoms.
It means the nervous system believes:
“This is the only way to survive.”
The Brain Is Wired for Safety, Not Healing
Your brain cares more about predictability than happiness.
If you grew up in chaos, dysfunction, trauma, or rejection, your body may associate stress or emotional shutdown with safety. Healing requires stepping into unfamiliar territory, and unfamiliar can feel dangerous.
So the subconscious says:
“I’d rather stay in a pattern I know than risk something new.”
That’s where resistance shows up.
Not because someone doesn’t want healing —
but because healing threatens the system that has helped them cope.
Common Signs of Secondary Gain
You may be experiencing secondary gain if you notice:
✅ You know what would help, but you don’t do it
✅ Every suggestion has a rebuttal (“That won’t work… I tried that… What’s the point?”)
✅ A part of you fears who you’ll be without the struggle
✅ Being needed makes you feel valuable
✅ You feel guilty when you start to feel better
Sometimes suffering becomes an identity.
And letting go feels like losing a part of yourself.
Trauma + Secondary Gain
For many clients — especially trauma survivors — their symptoms once protected them.
Dissociation protected them from emotional overwhelm
Fawning protected them from rejection or conflict
Anxiety kept them alert to danger
These responses were adaptive survival tools.
The problem is, what kept you safe then may be keeping you stuck now.
Why Some People Don’t Heal (Yet)
Healing requires three things:
Awareness — recognizing the unconscious benefit
Safety — building nervous system regulation and grounding
Permission — allowing yourself to evolve beyond the identity of suffering
You’re not stuck because you’re weak.
You’re stuck because a part of your system believes healing is unsafe.
How Therapy Helps Break Secondary Gain Patterns
In my work with clients, I focus on:
Nervous system regulation (somatic and neuropsychotherapeutic approaches)
EMDR and trauma-informed interventions
Identifying unconscious emotional payoffs
Supporting new beliefs around safety, worthiness, and identity
The goal isn’t just insight —
it’s shifting the body’s relationship to safety.
When the nervous system feels safe, healing becomes possible.
Takeaway: You Don’t Have to Earn Healing
Your symptoms don’t define you.
You are allowed to be:
Safe
Supported
Calm
Free
And you don’t have to stay in survival mode to be worthy of love or connection.
Healing is not about trying harder.
Healing is about letting your nervous system believe that peace is safe.
If you’re ready to explore this deeper…
I help women and trauma survivors unwind trauma patterns and create new emotional blueprints rooted in regulation, empowerment, and healing. You don’t have to do this alone. Healing is possible — even if you’ve been stuck for years.