Giving feedback on behaviour

After a brain injury, some people will have difficulty with self-awareness, communication, mood, social skills and behaviour. They might not realise when their behaviour is inappropriate, so providing immediate, kind, direct and clear feedback is very important. Using subtle cues about behaviour, or giving information that is too vague or general, makes it difficult for the person to gain a clear understanding of what is expected.

Relearning sociable behaviour is easier when family, friends and co-workers agree on set limits and give the same feedback on what is acceptable or unacceptable behaviour. This can be achieved by:

• identifying behaviours that are inappropriate and appropriate
• deciding on management strategies
• using the strategies the same way in each situation.

When a person says or does something inappropriate, use simple language and be specific. For example, ‘I don’t like it when you shout loudly at me’ is much clearer than ‘I don’t like it when you are rude’.

It might be necessary to remind the person of the unspoken rules of social behaviour that are otherwise taken for granted. Again, this should be clear, direct and immediate. For example, ‘I would rather you didn’t talk about…’ or ‘you are staring at that woman – she might feel uncomfortable’.

Simplify feedback if the person has trouble understanding. Pictures, diagrams or other communication aids can be helpful. Let the person know which behaviours are acceptable or expected and check whether they understand.

Repeating information at regular intervals is helpful if the person with brain injury has difficulty with memory and learning. Memory strategies such as writing things down, using signs, checklists or prompts are also useful.

Talk about the behaviour, rather than the person when giving feedback. This allows the person to feel supported, while knowing that their behaviour is not.

For example, ‘I understand why you are frustrated, but I don’t want to you shout at me’, or ‘let’s talk about what we can do about your frustration’.

Feedback should be given in a calm and uncritical way. Be matter-of-fact and firm, without strong emotional reactions such as anger, impatience, shock, disapproval or fear.

Negative reactions can trigger more anger and aggression.

It is important for the person to know what they should do, as well as what they should not do. For example, ask the person to say please, or speak politely, or wait until you are finished talking.

Provide an alternative path to the behaviour. For example, ‘you sound angry, do you want to talk about this later?’ or ‘could you wait until I have finished, please?’

It also helps to understand why the behaviour occurs.

If it is because a person feels overwhelmed by a noisy environment, it is better to leave than stay and manage the consequences.

Redirect the person to other activities or topics that are appropriate or acceptable. For example, jokes with a sexual content might not be acceptable, but other jokes might be; touching on the breast or bottom may be off limits, but touching on the hand may be an acceptable alternative.

It is just as important to mention examples of appropriate behaviour using positive behaviour support techniques. For example, ‘I’ve noticed how calm you have been today’ or ‘you really seem to be listening to other people’s points of view’ and ‘thanks for waiting until I finished what I was saying’.

Positive feedback and encouragement is an important part of learning and maintaining appropriate behaviour.

Experiment with genuine ways to give encouragement. Examples include:

• ‘I like to see how you are helping others’
• ‘I admire you for . . .’
• ‘I like the way you did that’
• ‘you are doing so well . .’
• ‘thank you for your help’
• ‘you put a lot of effort into that task’
• ‘you got that finished quickly’.