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Changes in Family Relationships After a Brain Injury

The deficits and changes that occur as a result of a brain injury tend to disrupt normal family relationships and create adjustment problems for family members close to the patient. Spouses caring for his or her companion and children living at home are affected the most and are under a great deal of stress. Unrealistic expectations on the part of the patient and family members further complicate matters. Almost all family members will feel distressed at varying times. It's natural and to be expected.

Counseling can help the adjustment and aid you in your care of the patient. It's realistic and expected that counseling should play a part in the recovery process. We encourage you to talk with a social worker about your feelings and concerns during the hospitalization and, even later, when the patient returns home. Sometimes difficulties don't arise until well after most of the therapy has stopped and the patient is home.

Changes Create Adjustment Problems

Changes that occur after a brain injury that are most likely to create adjustment problems can be roughly grouped into five broad and somewhat overlapping categories: 

  • Impaired social perceptiveness resulting in self-centered behavior
  • Impaired self-control, which leads to impulsive behavior, restlessness, and impatience
  • Social dependency, difficulty in planning and organizing activities, decreased initiative
  • Apathy, silliness, unpredictable emotional responses, irritability, and either a greatly increased sexual interest or loss of sex drive
  • Inability to benefit from an experience

The Frustrated Patient

The patient may verbally abuse family members, especially the spouse and children living at home. Many patients, frustrated and frightened by their condition, feel they are an unworthy burden and feel demeaned by the care they need; but, they are also scared of losing the care and attention. Because family members caring for the patient could serve as reminders of the dependency, they tend to become the focus of the patient’s possible low self-esteem. Family members often suffer criticism, accusations of unfaithfulness, rejection, hostility, complaints, and demands. There may be threats of physical violence, although violence directed at family members is rare.

Special Problems Involving Children

Young children often feel the effects of the changes within the family. They may be ignored by the brain injured patient and inadvertantly neglected by the healthy parent who is trying to keep the family going. Many patients who are parents compete with their children for the spouse’s attention and affection. Seeing children grow and learn to do things the patient may be unable to do may serve to deflate the patient’s own self-esteem.

Older children may suffer less because they have greater freedom to avoid the disabled parent. Children in the upper grades and teenagers may act out by skipping school, failing to do what is required, and leaving home earlier than they might have had the brain injury not occurred. In other cases, older children may try to take on the role of the injured parent, and experience confusion regarding their place in the family. An excellent reference regarding how children may cope through this experience is the booklet When a Parent Has a Brain Injury: Sons and Daughters Speak Out. Ask your social worker for a copy.

How Counseling Can Help

While not all of the emotional or practical problems that arise can be removed by counseling, many can be lightened. For most families, counseling can help minimize stress and maximize satisfaction for both family members and patients.

The psychologist and social worker are likely to serve as your primary advisers in the beginning stages of rehabilitation and may recommend additional help from other sources. Counseling has several goals:

  • Helping family members readjust their expectations
  • Providing practical advice for managing the patient
  • Increasing family members' awareness of their own needs and their responsibilities to themselves and one another
  • Enabling family members to function effectively while providing the most suitable care in terms of their needs and the patient's needs
  • Identifying appropriate resources

Family Support Group –The Brain Injury Association of Michigan (BIA of MI)

The Brain Injury Association of Michigan was formed by a group of brain injured individuals, their family members, and professionals concerned about the unique problems of people with brain injuries.

The BIA of Michigan is a non-profit agency, supported by fund raising events, membership dues, contributions, and grants. Local chapters are located throughout Michigan. The Brain Injury Association of Michigan supports the four major goals established by the Brain Injury Association. These goals range from prevention to long-term rehabilitation:

  • Stimulate public and professional awareness of the problem of brain injury – the Silent Epidemic
  • Provide a central clearing house for information and resources for the brain injured and their families
  • Develop a support group network for the brain injured and their families
  • Establish specialized brain injury rehabilitation programs, encourage existing programs, and develop new programs where none exist. 

Information on the BIA of Michigan and local groups can be obtained from your social worker.

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