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An interesting complication I've observed in some cases of insomnia is the patient's interaction with other members of the family. For example, a patient I'll call Joanne seemed reluctant to adopt any of the treatments I suggested for her problem. On digging further I realized that through her suffering from sleeplessness, Joanne was able to extract a high degree of sympathy and support from her family. She had somehow learned, subliminally, that by means of her illness she could manipulate others into expressing love and concern, thus reinforcing her own sense of self-worth. The reason for her reluctance to be cured became obvious: Without the illness that made people feel sorry for her she would lose a source of emotional support on which she had come to depend.

Conversely, there are family members who unintentionally reinforce the patient's insomnia by the attention they pay to it. Their own need to feel important or helpful to the victim is served when they express concern or sympathy. Unconsciously they create a situation whereby they encourage the patient to suffer from insomnia in order to satisfy their own need to be needed.