A study to determine whether the expectation for secondary gain held by psychiatric outpatients was associated with therapy outcomes.

The study was conducted at a Dutch psychiatric outpatient department. Our investigation set out to explore the expectation of obtaining secondary gain by directly asking the patient and clinician via questionnaires whether the patient anticipated to get specific ‘benefits’ from being in therapy.

From 166 patients, 70 (42.2%) reported to expect secondary gain while in therapy. We found a significant relation between expectation for secondary gain and treatment outcomes. Patients with expectations for secondary gain were significantly more prone to poor therapy outcome. Only in nine of 147 cases (6%) did patients explicitly express their expectations for secondary gain towards a psychiatrist. Moreover, expectations for secondary gain did not appear to be related to Axis I and Axis II diagnoses.

Secondary gain appeared to be a ‘veiled motive’ for getting therapy: patients did not express their expectations for secondary gain explicitly towards a psychiatrist. This aspect of veiled motives is of particular relevance in regard to the fact that expectations for secondary gain appeared to affect therapy results.