Carers & family members
Relationship problems after a brain injury
Families are usually ecstatic when a
loved one returns from hospital but over time the effects of a
brain injury can place a great strain on relationships.
A formerly easygoing wife now has a short fuse and a fiery
temper. A husband who used to help around the house has to be
constantly reminded to do the simplest tasks. A son who was always
concerned about others now acts in a selfish manner.
Common problems include:
- short temper and emotional ups and downs
- inability to start tasks and/or see them through
- low tolerance for stress and anxiety
- egocentric behaviour
- apparent lack of gratitude
- saying and doing inappropriate things
- impulsive risk-taking behaviour
- lack of awareness how behaviour is affecting others
- difficulty understanding or accepting different points of
- frustration if needs are met quickly.
It is easy to understand how a person may be labeled as
lazy, self-centred, arrogant, rude, thoughtless, argumentative,
irresponsible and aggressive after a traumatic brain injury
(TBI) or other type of brain disorder. This can lead
to a lot of conflict with relationships and families.
Lack of self-awareness
Many of these problems stem from injury to the frontal lobes of
the brain. Unfortunately a common problem associated with this is
lack of self-awareness - if a person has lost the ability to
analyze and monitor their own behaviour then it becomes extremely
difficult to encourage more appropriate behaviour. In these cases
it is important to discuss behavioural issues with the
rehabilitation team and form coping strategies. If rehabilitation
is finished, contact your Brain Injury Association to find out
about behaviour specialists in your area.
Understanding is the first
Learn as much as possible about the brain injury, regardless of
whether it is a traumatic brain injury or other type of brain
disorder. It will be easier to cope, and respond
effectively, when you understand it is the brain injury affecting
the person's behaviour, emotions, personality and difficulty seeing
the world through other people's eyes - it is not a wilful decision
to annoy you. There can be a natural grieving process when a family
feels as though they have 'lost' the person they remember - it will
be easier to understand and accept the 'new' person when you
understand more about brain injuries.
When the person still has some self-awareness, it is important
to provide immediate, direct and clear feedback regarding
behaviour. It's common to not understand non-verbal communication
after a brain injury, so you may look and sound very annoyed but
this can be completely missed. An example of clear feedback is "I
feel frustrated when you walk in and change the TV channel without
asking me first."
Useful tips for feedback are:
- Provide the feedback in a calm non-judgmental manner
- Describe the behaviour as clearly as possible
- Ask if the person has understood what you've said
- Repeat the feedback regularly if needed due to memory
Look for the message behind a behaviour
Before taking a challenging behaviour personally, look for the
message. This could be:
- "It's so frustrating trying to handle my volatile emotions
- "This is an unfamiliar environment/activity and it's disturbing
- "I've got sensory overload from too much
A powerful technique to remember in conflict situations is using
"I" statements instead of "you" statements. Instead criticizing the
other person, you are letting them know how you see and feel about
the situation. Examples of both statements are:
- "I find it unpleasant when you yell at me loudly and stand so
- "You are a horrible person and treat me as if I'm nothing to
Setting limits is essential: it helps when the person knows
exactly what is expected of them in any given situation, and
prevents them from having unclear or unrealistic expectations. Set
limits as early as possible with the person, and set them often.
Limits can concern roles, tasks, activities, or about specific
behaviours that are appropriate or inappropriate. Don't set limits
you can't keep to e.g. don't threaten to leave if the behaviour
continues and then stay in the situation.
Develop strategies to handle conflict
It can be very difficult for families to calmly
respond in a consistent way to challenging behaviours but this is
easier when a positive behaviour plan is developed. See your Brain
Injury Association about behaviour specialists, and read our
detailed fact sheets on challenging
Be involved in rehabilitation
Even when the official rehabilitation is finished, in a sense it
never finishes - people regularly report improvements for many
years after a brain injury because they keep learning strategies to
compensate for lost communication skills, emotional control, stress
management, poor attention and low motivation. This process works
much better when the family is involved too, and will reduce the
amount of conflict over time.
Give positive feedback &
When there is a lot of conflict it can be hard to provide the
person with positive feedback, but where possible you should aim to
provide much more positive than negative feedback. People with a
brain injury often say they feel as if trying to recover from a
brain injury is the hardest thing they have ever done in their
lives, and often feel their partners or family don't understand
just how difficult it is.
Examples of positive feedback include:
"I like to see how you are helping others"
"You are doing so well with. . ."
"You put a lot of effort into that task."
If angry outbursts are common, have a safety plan in place. When
anger has got to a certain point it's best to remove yourself from
the situation if it safe to do so. Tell the person what you are
doing e.g. "You're getting upset, we are leaving for a few minutes
so you can calm down". Tell them you will return when their anger
under control. Maintain a safe environment if needed e.g. remove
potential weapons or dangerous objects that could be thrown or used
to damage property. Violence is never acceptable.