Secondary gain as hidden motive for getting psychiatric treatment

Background. - A high proportion (42.4%) of outpatients attending a psychiatric hospital appears to harbor expectations of secondary gain and hide this from their psychiatrists. This study investigated whether the prevalence of expectations of secondary gain could be replicated in a different sample, namely, a general hospital outpatient clinic attended by patients with less severe mental disorders, and whether patients hid these expectations from the psychiatrists they consulted. Methods. - The study was performed at a Dutch psychiatric outpatient department of a general hospital. In a prospective cohort, expectation of secondary gain was assessed by directly asking the patients via questionnaires whether they expected gaining specific 'benefits' from being in therapy. Results. - Of 99 patients, 41 (41.4%) expected secondary gain while being in therapy. In contrast, only nine patients (9.5%) told their diagnosing psychiatrist of these expectations. Discussion. - The present finding of a large proportion of patients expecting secondary gain is consistent with the results of an earlier study. Again, in most cases the diagnosing psychiatrists were unaware of their patients' expectations. Thus many patients have hidden expectations of what therapy will do for them, in terms of material or non-material benefits other than getting better. Earlier empirical studies have shown that harboring expectations of benefits other than therapeutic benefits may be detrimental to therapeutic success.