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Difficult Clients May Be Motivated by Secondary Gain By:
Calvin D. Banyan, MA, BCH, CI Every experienced hypnotherapist has felt frustrated by certain clients, who despite the hypnotherapist's best efforts, she just seems to refuse to change or allow the symptoms that brought her in for therapy to be removed. In some cases the culprit is Secondary Gain. This article will help you to detect it and then eliminate its affects which will help you and your clients to be more successful. In previous articles I have written about 5-PATH® (Five-Phase Advanced Transformational Hypnosis) and how it is designed to eliminate a client's problems through the use of, convincers, age regression techniques and forgiveness therapy. Then, in a recent article I gave a brief description of the final phase of that process called Parts Mediation Therapy™ or PMT. PMT is a special kind of Parts Therapy that is designed to remove Secondary Gain issues so that your clients can finally become free from their old issues when removing the cause of the problem alone was insufficient. Primary versus Secondary Gain Because of Secondary Gain issues, it is possible for a hypnotherapist to do everything right as she works with her client to remove the cause of a problem, and completely remove the cause but still have the problem exist. In these frustrating cases, the hypnotherapist needs to understand the concepts of Primary and Secondary Gain as they relate to a client's problems or issues. Primary Gain is the benefit that your client receives as a result of manifesting the issue for which she has come in to see you about. Most, if not all of your clients have their problem or issue because at one time in her life there was a benefit in having it. Here are a few examples:
1. Alcohol Abuse Primary Gain:
The alcoholic may start drinking in order to be accepted by a group of peers. Secondary Gain:
Then she finds out that when she drinks enough to become intoxicated she feels more relaxed and confident around others. 2. Smoking Primary Gain:
The smoker may start smoking for the same reason, in order to be accepted by a particular group of peers. Secondary Gain:
Then later on she finds that having a cigarette can make her feel more relaxed as she uses it to take a break from life's stressors. 1
3. Childhood Tantrums Primary Gain:
The child who becomes angry and throws her first tantrum may do so out of a natural reaction to an unfair situation she finds herself in. Secondary Gain:
Then she finds and learns that when she has a tantrum that her frightened mother will give in to her demands. In each case, the problem behavior, be it drinking too much alcohol, smoking cigarettes or developing an anger problem, had a reason for beginning that is different from what may be sustaining the problem today. If your therapeutic tools only consist of direct suggestion or age regression, then you will be unable to help these individuals. Secondary Gain Can Exist When Either Primary Gain is Undiscovered or NonExistent Sometimes the Primary Gain can be difficult to identify, or may not actually exist, but even so, a Secondary Gain issue can exist. For example, an individual may accidentally injure herself at work, and as a result experience a great deal of pain because of the injury. She is then relieved of her work and given medical treatment. She then may even qualify for Workmen's Compensation or other form of financial aid. These benefits were not the cause of the injury, but after the injury, when she receives these substantial benefits which would be lost if she fully recovers from her injury, gives her good reason (subconsciously or unconsciously) for holding on to the pain of the injury well after the injury has physically healed. This is often quite different from consciously malingering (pretending to be ill). In this case, for the client, the pain is real even though there is no longer a physical cause of the pain. Some types of Secondary Gain that may arise in her case are:
1. Not having to return to a job that she did not care for. 2. Possibility of receiving new training in a more desirable job. 3. Receiving disability payments. 4. Receiving social support from family, friends and governmental services. Such added benefits, which may have been unanticipated at the time when the problem first arose for your client, can become a very powerful reason to hold on to the problem later. This benefit is a gain that is secondary to the original cause of the problem, hence the term, Secondary Gain. Secondary Gain May Be Falsely Labeled "A Client's Lack of Readiness to Change" Hypnotherapists working in the many specialties around the world have become frustrated when they use the tools that they have come to rely on, and have proven successful through out their careers only to find that with some clients, those tools do not work. In these cases, the frustrated hypnotherapist may simply surmise that "This client was not ready to change." However, this "lack of readiness" may really be a lack on the hypnotherapists' part, in that she did not have the tools that she needed to help this particular client. This is where PMT comes in and will work when everything else has failed. 2
Development of Parts Mediation Therapy When I first began my study of hypnotherapy, I ran across materials from Charles Tebbitts and Gerald Kein on the subject of parts therapy. But at the time I found age regression and forgiveness therapies to be more appealing than Parts Therapy, because they worked more directly on the cause of my client's problems. But later when I found that some clients were unable to become free from their problems because of Secondary Gain, I took another look at the different kinds of Parts Therapy available and studied them again. I then took this ability that we have as hypnotherapists, to divide a client psychologically into Parts, and applied standard mediation procedures to it. When a client has been hypnotized and sufficiently deepened to the state of somnambulism, she is able to hallucinate. In this state, the hypnotherapist can simply suggest to her client that she has a part of herself that wants to continue in the old way. When the hypnotherapist begins speaking directly to that Part, her client will hallucinate being that Part, separate from the self, with all of the specific needs, wants and desires that are of interest to that Part in mind, along with its particular perspective on the client's situation. Once the Part has been emerged and the communication has begun, the hypnotherapist can proceed as a mediator. Mediation is a process that is used in all kinds of disputes around the world including disputes between individuals, organizations and even countries. When a mediation process has begun, the mediator meets with the parties in the dispute to help them resolve it by bringing her special skills to the problem. As a result the parties are able to change what they have been doing as a result of an agreed-upon set of new behaviors that will give each or the parties what they want. This kind of an agreement is often described as being a win-win agreement. I received my training in Mediation Theory in graduate school. Very soon after receiving my certification in mediation, I used it (mediation techniques, but without hypnosis) as a form of therapy while I was working as a Psychologist at the North Dakota State Hospital. This application of mediation techniques as psychotherapy was groundbreaking and I published a paper about it in the American Psychiatric Association journal, Hospital and Community Psychiatry. It was ground breaking because I had created a new kind of therapy out of mediation technology, when it was thought that using such techniques would not work as a therapy, especially if the individuals were mentally ill, as was the case. After publishing the article I wanted to do more research on the use of these techniques and their usefulness as a therapy to help people experiencing relationship problems. Then I began to realize that the process could be used to help individuals who were experiencing internal conflicts that were adding to their mental illness or other problems such as addiction, obsession, compulsions and so on. Unfortunately for me at the time, I was merely a graduate student and could not interest any of my professors in doing research into the idea that mediation could be used as a therapy. It was not until I became a Certified Hypnotherapist and began studying the different kinds of Parts Therapy did that last few pieces of the puzzle fall into place. The somnambulistic client could hallucinate sufficiently to experience being divided into parts so that the hypnotherapist, acting as a mediator could work with the client using these techniques. Once the client had been divided into parts the mediation process could be used to 3
overcome internal conflicts, in this case caused by Secondary Gain. That PMT is most effective when the cause of the problem has been eliminated through the use of such insight techniques such as Age Regression Therapy and Forgiveness Therapy. Using PMT before the cause of the problem had been neutralized would cause the problem to return in most cases. PMT is Different from Other Parts Therapies In my study of the different kinds of Parts Therapies, I found that many of those approaches were an attempt to balance different aspects of the Self such as the Creative Part or the Brave Part, or even the Wisdom Part, which either the hypnotherapist or the client perceived to be out of balance in the client. For example, in such a case a client may complain that she is not as creative as she once was, at which time the hypnotherapist will conduct a Parts Therapy process in which the Creative Part will be encouraged to "move up to the front of the stage," or to otherwise become more powerful or present in the client's life, and so on. PMT was designed to help the client to discontinue a symptom or behavior that is either being reinforced or demanded by her present environment (but different from the reason for which she started having the problem), hence some kind of Secondary Gain. When to Use PMT with Your Clients PMT is designed specifically to remove Secondary Gain issues, and is only to be used when Age Regression Therapy and Forgiveness Therapy (or other techniques that are used to remove the cause of the problem) have successfully removed the Primary Gain issues. For example the 5-PATH™ Hypnotherapist will routinely take her clients through the first four phases:
Phase I:
Hypnosis Testing and Direct SuggestionPhase II:
Age Regression and Informed Child TechniquePhase III:
Forgiveness of OthersPhase IV:
Forgiveness of Self While Phase I includes preparing the client for hypnosis, depth testing, convincers, and direct suggestion techniques, Phase II, III and IV are designed to neutralize the cause of the problem (i.e., erroneous beliefs from the past and painful emotions that accompany them such as fear, anger and guilt). When this kind of work has been done successfully, most clients will not need any additional hypnotherapy. In most cases that the hypnotherapist sees, when the Primary Cause has been removed then simple direct suggestion is sufficient to change the behavior or enable a healing. Note that, the 5-PATH® Hypnotherapist would not automatically proceed with Phase V, PMT unless she has reason to believe that Secondary Gain issues are at work and causing the client to be unable to change, heal, etc. In fact if the problem continues after Phases I through IV have been completed, the therapist should first suspect that some part of one (or more) of the phases were not done sufficiently or completely. Only when she has reason to believe that Secondary Gain issues are the source of the continued problem should she consider Phase V. The hypnotherapist can aid herself in making this decision by asking herself and the client, "What will she (the client) lose if she gets well or changes her behavior?" If she loses 4
something, then that thing is generating the Secondary Gain and PMT is the indicated course of therapy. If she has nothing to lose in getting better, then the problem exists in some incomplete part of Phase I through IV. For example, perhaps the ISE (Initial Sensitizing Event) was not discovered and neutralized in the age regression. It would be more beneficial for the hypnotherapist to return to doing age regression in this case than to move on to PMT. How to Do PMT The process of conducting a PMT session can be easily outlined. Once the hypnotherapist has this outline, she can use it to guide her through the hypnotherapy process. Additional information about how to conduct this kind of process can be gained by reading any book on the subject of conflict mediation. Here is the 12 step process:
1. Evaluate your client's situation to determine whether PMT is indicated as a course of therapy. If the problem has returned, was lessened but was not removed, or if the problem stopped for a short period of time but returned, reevaluate what was done so far. Ask yourself, "Was the age regression or other techniques such as forgiveness therapy completed to your total satisfaction or do think that it could have gone better?" If you believe that more could have been done, go back and complete it. If you believe that:
1) the previous therapies were all completed satisfactorily, and 2) that your client must lose something substantial in order to get well or change, then proceed to PMT. 2. Induce hypnosis and deepen to somnambulism. When you have decided that PMT is indicated in a particular case, make sure that you can induce and deepen your client sufficiently so that she will experience a deep level of hypnosis. Somnambulism is required so that your client is able to hallucinate actually being the different Parts of herself, so that the subconscious material that is driving the behavior can be uncovered and discussed from the different perspectives. 3. Suggest that the client has a part of herself that wants to change and a part that wishes to keep doing what she has been doing. Once your client is in hypnosis, you will suggest that part of her seems to want to continue in the old way. Then ask if you may speak to that Part directly. This part will be named according to what behavior or symptoms that it is producing. For example you might name a part, the Still-Wanting-To-Smoke Part, Still-Wanting-To-Drink Part, or the Still-WantingTo-Be-Ill Part, and so on. 4. Introduce yourself as a mediator. Inform the different Parts that your role is only that of a Mediator and that you are not here to judge nor do you have any authority in this matter. Your role is only to improve communication between the two Parts. She will make all of the important decisions. 5. Uncover the needs, wants or desires being fulfilled by continuing in the old way. 5
Now you will proceed by honestly speaking with each Part, the Self and the part that does not want to change, so that you can find out what needs, wants or desires are being met by continuing in the old way or beginning to behave in the new way (without the problems or issues that brought your client in to see you). 6. Show both parts any common interests that they have. As you uncover why each Part wants to either change or not change you will find that both want to do for some very good reasons. Show each Part how the reasons to both change and continue in the same way are ways to fulfill real needs, wants and desires. Have each Part acknowledge this and that the intent of both Parts are good and are intended to contribute to the good of the whole person. 7. Generate new ways to fulfill those needs, wants and desires. Once you have shown that even the Part that does not want to change wanted to keep doing what it was doing for some very good reasons you will need to rename the Part. The Still-Wanting-To-Drink Part or the Still-Wanting-To-Be-Ill Part will not want to change unless you change its name. The name change should be made to better describe it. For example if the Still-Wanting-To-Drink Part was doing so because it helped her to relax and be social, then it can be renamed to the Social Part, or the Relaxation Part. This shows the Self and the other Part that when the agreement has been made that it will still exist with a purpose, and that it was an important part, doing an important job. This will aid in the reintegration of the two parts later. When the Part has been renamed you can then generate solutions that will fulfill the needs of the whole person, that of both Parts, and without all of the problems that were being caused by the old way. Here is another example, if you find that your weight loss client has failed to lose all of the weight that she wanted to lose, you can do PMT and uncover the part of her that has caused her to continue to eat too much or to continue to snack between meals. When you speak to the Still-Wanting-To-Eat-Too-Much Part or the Still-Wanting-To-Snack-Too-Much Part, you can find out why that Part is causing her to do it. If you find out that she is eating to manage an emotion, like when she snacks because she is either bored, worried, angry or depressed, then we can generate other things that she can do when she feels that way. (For more information on emotional eating read my book, The Secret Language of Feelings). At this point you and her parts will be able to generate lots of ideas so that you can come up with a good plan. 8. Narrow the ideas generated into a specific plan or agreement. Once you have generated some ideas it is time to narrow them down and form a single agreement or plan that both Parts are willing to use. The plan should be simple but comprehensive and provide benefits to both Parts. It should be a win-win agreement. 9. Reality test the agreement. Next, you will proceed by asking each Part if the agreement seems realistic given the challenges that she has in her life. Is it a practical plan? Can you always do what was agreed upon? If for some reason one or both parts are uncertain if the plan will work, then set up a trial period like a week after which your client will come back and have another session where the Parts can either agree to keep the plan as it is or make further 6
adjustments meant to make it more useful and practical. 10. Reintegrate the parts. Once this has been done it is time to reintegrate the parts. The self now realizes that the Part that was causing all the problems was not a bad Part of herself. It was doing what it was doing in an attempt to help the whole person. Now you suggest that the two parts once again become one person with a new plan for success. I like to have them shake hands as they accept the agreement and then "melt back into being one person." 11. Use the agreement as a direct suggestion script. PMT is an insight technique. Insights into why she was continuing in the old behavior will be uncovered and new ideas that will enable her to change or heal were generated. This causes the subconscious mind to have to reorganize around this new information. This helps your client to become more suggestible than when you use other, non-insight techniques. For a brief time, while the subconscious mind goes into what is a fluid-like state, which will soon solidify again, the suggestions given can last a life time. During this highly suggestible state you can give your clients suggestions that will be held tightly in her subconscious mind once it has re-solidified, becoming a permanent part of her. Take advantage of this time by directly suggesting that she will use this new agreement to help her meet her goals, especially the goals that brought her into your office. 12. Emerge your client and conduct the post-hypnotic interview. Close the session by emerging your client and giving her the opportunity to talk about what had happened. When I use insight techniques such as this, I like to have the client bring the changes into the waking state by doing the following. I'll ask my clients to put an end to the following sentences, "I've changed because now I know ______________." When she puts an end to the sentence, she verbalizes what changes have occurred at the intellectual level. When she does this, she takes on a feeling of ownership for the changes made. Then I continue and have and her put an ending to the following sentence, "I've changed because now I feel ______________." This sentence enables your client to express how she feels about what just happened in a positive way, further causing her to take ownership for the changes that have occurred during the PMT process. Summary There are several approaches to using Parts Therapy which can be very useful in a number of situations. Parts Mediation Therapy, on the other hand, is only used when there is a reason to believe that your client has been unsuccessful despite the Hypnotherapist's efforts to help her client by removing the cause of the problem. The process follows established mediation procedures, which are used to remove the conflict inside of your client that is causing her to respond to Secondary Gain issues. As you become proficient in using this technique, you and your clients will be successful when no other process has succeeded. Find other items by Cal Banyan.
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