When Problems Paradoxically Hold a Couple Together

In my couples therapy work, it is not uncommon to encounter relationships that appear stuck. Symptoms or problems persist despite intervention. Conflicts recur despite insight. While the severity of distress and external stressors are often cited as explanations, psychoanalytic theory has long pointed to another, less visible factor: the advantages that accompany suffering.

This phenomenon is known as secondary gain, a concept first articulated by Sigmund Freud in his effort to explain the persistence of neurotic symptoms. Although often misunderstood, secondary gain remains a clinically relevant lens for understanding why change in intimate relationships can be so difficult.

Freud’s Distinction Between Primary and Secondary Gain

Freud introduced the concepts of primary and secondary gain to describe unconscious processes involved in symptom formation. In his model, symptoms are compromise formations: they simultaneously express forbidden or distressing impulses and protect the individual from the anxiety those impulses would otherwise generate.

Primary gain refers to the internal psychological relief achieved through the symptom itself. The symptom reduces intrapsychic conflict and anxiety by keeping disturbing wishes, affects, or ideas out of conscious awareness. This process is primarily unconscious. In some cases, symptom formation may also involve regression, with the individual reverting to earlier modes of functioning and unconsciously adopting a more dependent position that allows for protection or care.

Secondary gain, in contrast, refers to the interpersonal and social advantages that arise because the symptom exists. Freud described these as benefits that follow the symptom rather than cause it. Examples include increased care from others, relief from obligations, legitimised dependency, etc.

Is Secondary Gain Unconscious?

The question of whether secondary gain is purely unconscious has been the subject of debate. Contemporary literature highlights definitional problems and warns against the overuse or misuse of the concept, particularly when it is conflated with malingering or conscious deception. Fishbain’s review points out that secondary gain is frequently inferred rather than demonstrated, and that clinicians may overestimate its explanatory power.

Freud viewed both primary and secondary gain as rooted in unconscious processes. However, later observations suggest that secondary gain may become consciously recognized. Individuals may occasionally recognize benefits associated with illness or distress, even if they are reluctant to acknowledge them. Certainly, the presence of potential benefits does not necessarily mean that symptoms are consciously produced or intentionally maintained. As a matter of fact, individuals may incur substantial secondary losses—such as loss of social roles, income, autonomy, or self-esteem—while still appearing “stuck,” suggesting that the economy of gains and losses is far from straightforward.

Secondary Gains In Dyadic Intimate Relationships

Couples Therapy

Source: Freepik

In the context of intimate relationships, secondary gain takes on particular significance. Psychological symptoms rarely affect only the individual; they reshape relational dynamics. Depression, anxiety, somatic symptoms, or chronic distress often alter patterns of care, responsibility, and power within a couple. Literature documents a range of secondary gains associated with illness and psychological symptoms. These include increased dependency, enhanced attention from partners, overprotection, relief from performance expectations, and legitimised withdrawal from demanding roles. In some cases, symptoms allow individuals to avoid situations that provoke shame, conflict, or anxiety while maintaining relational connection. Partners may participate in these dynamics unintentionally.

Caretaking responses, lowered expectations, or protective behaviours often arise from genuine concern. Over time, however, they may stabilise the symptom’s role in the relationship, making change feel destabilising for both partners. Similarly, relationship distress or ongoing conflict within a marriage can also serve a stabilising function. Symptoms or distress may help maintain the relationship itself, divert attention from deeper relational issues, or resolve role conflicts within the family system. Paradoxically, chronic conflict can provide structure, predictability, and emotional engagement, even when it is painful. In some cases, it allows couples to remain connected without confronting more threatening questions about intimacy, dissatisfaction, or separation.

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Conflict, in this sense, becomes a deceptive glue, disruptive on the surface, but cohesive underneath. Research on secondary and tertiary gains further suggests that family systems may unconsciously collude in maintaining distress when it serves to reduce overall tension, preserve cohesion, or stabilise roles.

Crucially, secondary gain does not negate suffering. Secondary gains may well coexist with significant losses, with individuals often clinging to distress despite the costs involved.

Research cautions clinicians against simplistic interpretations of secondary gain. Equating secondary gain with manipulation, lack of motivation, or malingering undermines empathy and risks therapeutic rupture. Used carefully, however, the concept remains valuable.

Understanding the Role of Secondary Gain in Couples Therapy: What Role May Difficulty or Distress Play?

Secondary gain may help explain why individuals and couples may resist change. Symptoms and conflicts may persist not because clients are unwilling to improve, but because improvement threatens established functions.

For clinicians working with couples, attending to secondary gain invites a shift from “Why won’t this change?” to “What role is this difficulty playing?” When explored with curiosity rather than accusation, secondary gain can illuminate hidden dependencies, unmet needs, and relational compromises that keep couples stuck. Understanding what distress does in a marriage may be a prerequisite for understanding how it might finally loosen its grip.

Sometimes, symptoms or distress stay because they are doing a "job" that you don't know how to do any other way. They might be protecting you from change that feels too unacceptable or fast, or conflict that feels too heavy. The couples therapy I offer doesn’t aim just to "fix" the symptom. It’s to help you uncover and meet those underlying needs—for care, safety, or anything else—in a way that doesn't require you or the relationship to be "sick" to get them.