After a brain injury, it can be challenging to maintain or build relationships. This is because of stress for all parties involved, changes to responsibilities and roles, and communication issues. It can also happen because of the behavioural, physical and cognitive changes your friend or family member experiences. It will take time for you to adjust to these changes.
While many of these changes are outside of your control, there are steps you can take to nurture your relationship with the survivor.
Topics in this section include:
Intimate & partner relationships
Relationships between romantic partners can be drastically altered after a brain injury. Your partner may be experiencing emotional, behavioural, and cognitive changes that make relating to them more challenging. You may both be experiencing complicated emotions related to the injury which can spill over and affect how you treat each other. Brain injury recovery takes a lot of energy and attention, and it’s possible you may experience feelings of neglect, loneliness or even grief for your relationship.
All of these factors will affect your relationship; they can be incredibly stressful, and without the proper interventions, can cause the relationship to break down.
Communication
Communication between partners is made up of conversation, gestures, and body language used to share thoughts and feelings. After a brain injury, you may experience trouble communicating with your partner. They may be experiencing cognitive challenges that make conversing, paying attention, or understanding others challenging.
Another reason communication suffers is because couples may feel they can’t share their thoughts and feelings with each other anymore. It can be hard to put into words the thoughts and feelings you’re having about your partner’s brain injury – and you may not want to ‘burden’ them. You may also have a lot of worries or concerns that you don’t feel you can share. The person with a brain injury may be experiencing similar feelings. This could change the way they communicate with you – they may change the amount they talk, the amount of physical interaction, or have stronger emotional reactions. You might be doing the same.
Without communication, relationships can quickly run into obstacles. It’s important to be as honest and forthcoming as possible with your partner and be mindful of how you’re communicating with them.
Tips for communicating with your partner
- Commit to working on communication
- Acknowledging that communication between you and your partner has changed is the first step in making improvements. Set aside time each day or each week to discuss how you would like to communicate and what you both could be doing. When you do get feedback on how you communicate, commit to putting the feedback into practice.
- Focus on respect, even when disagreeing
- Disagreements are a guarantee in relationships, and after a brain injury you may find yourself disagreeing about different things. But do your best not to let anger, sadness, or hurt feelings interfere with being respectful to your partner. They’re struggling with their feelings too, and while you may not agree with them, you can always tell them that you respect and value them.
- Listen actively to your partner
- When you and your partner are having a conversation – no matter the seriousness of the subject – you should be actively listening to what they have to say. If you need them to repeat themselves or write down what they are saying, tell your partner that is what you need in order to be an effective listener.
- Practice constructive communication
- Practicing what you want to say is a great way to organize your thoughts. It also gives you time to write down/record your points, so you don’t forget them. You can also record things that make you frustrated, angry or sad and wait until you are both calm to discuss them.
- Remove distractions
- Distractions such as the television, phones, other conversations, or additional stimuli make it difficult for you to fully engage in a conversation with your partner. These distractions should be removed (or you should move to a quiet, distraction-free zone).
- Respect the other person’s space
- Everyone needs space to be alone, process their thoughts and feelings, or just to do things they want to do. It’s important to respect that need for space, and make sure the other person in the relationship knows it’s okay to take the time they need.
- Work with a therapist
- A psychologist or psychiatrist with a specialization in relationships and brain injuries will be able to address communication challenges individually or as a couple. Therapy is a long-term process, so results won’t happen overnight – but if you are committed, you will see progress.
Intimacy/sexuality
Intimate/sexual relationships can change after a brain injury. It can be difficult for you to feel comfortable being close to your partner. Attention and memory problems can also cause relationship problems.
Changes in sexual relationships can be caused by changes in hormone levels, medication, mobility issues, emotional and cognitive changes, sexual roles and sexual interest, and sexual function. Some people have decreased sexual drive, while others may have an increased sexual drive. There can also be changes to reproductive functions, including menstruation [1].
You may find yourself not feeling sexual attracted to your partner. Alternatively, you may feel undesired, which could impact your self-esteem. It’s important to remember that your worth is not contingent on sexual desire, and that sexual relationships take time and commitment as well.
Tips for improving intimate relationships
- Create a positive environment.
- Both of you will feel more open and comfortable if you are in an environment that makes you feel that way. An environment that alienates one partner, negative feelings, or discomfort can all hinder an intimate moment.
- Find activities you can do together.
- You may not have as much in common with your partner as you did before the injury. Finding some new activities you will both enjoy can help nurture new intimacy.
- Focus on empathizing with your partner
- Intimacy requires you to be in tune to what your partner feels/needs. Try to take some time each day to think about how they may be feeling and what they may need, and start conversations with your partner about their feelings.
- Try to be as open as possible with your partner
- A lot of times intimacy struggles stem from mental and emotional blocks. You don’t feel your best, and you may not want to be intimate. Communicate that to your partner, and talk about what you need.
- Work with a therapist
- A psychologist or a psychiatrist are able to help both you and your partner explore the challenges you’re facing and work through issues. It won’t happen right away, but over time you will notice improvements.
Tips for coping with sexual challenges
- Find positions that make them comfortable, particularly if they have mobility challenges
- Some positions can make you or your partner feel more confident and comfortable. If your partner is struggling with mobility, you will want to talk to them about this. You may even want to research new positions.
- Plan sexual activities with your partner for when they have the most energy
- Fatigue is a big obstacle for people with brain injuries, and sexual intimacy requires lots of energy. By planning out intimate moments beforehand, you are able to capitalize on periods of peak-energy.
You may also be experiencing fatigue as a caregiver. It’s important to care for yourself and do what you can to manage fatigue.
- Remove distractions that would take your focus away from your partner
- Bedrooms can often become more like cluttered, multi-purpose rooms. Many people use their computers, watch television, and more in their bedroom. This can create distractions that can take away from the moment. Reorganize your bedroom so that it is specifically for sleep and for intimacy.
- Talk to doctors about your sexual concerns
- You may feel a little uncomfortable talking about your personal life, but there’s no need to feel embarrassed. The only way to find solutions is to seek out the answers. Doctors understand that this is an important part of health and wellness, and will be able to provide you with advice or referrals to experts.
- Work with a psychologist or psychiatrist or sex therapist
- A therapist can help both you and your partner communicate more openly about your sexual relationship and provide advice on developing that aspect of your relationship.
Responsibilities
Before a brain injury, your partner may have had more responsibilities in the relationship. After the injury, responsibilities such as cooking dinners, picking up kids, cleaning, or doing the errands may have all fallen on you. You may also be responsible for new, care-related tasks for your partner and be the main financial support for the household if your partner is unable to work.
When you’re juggling that many responsibilities, it’s easy to become burnt out, frustrated, or feel pressured by the situation and subsequently your relationship. This is normal; but it’s important to address these changes and take steps to manage them.
Tips for managing changes in responsibility
- Be patient with each other
- Adjusting to change takes a lot of time and patience. You may be experiencing some trouble using patience, especially if you feel your partner doesn’t understand the extra responsibilities you now have. Try to be patient with your partner; remember that they are feeling stress too.
- Take breaks
- Responsibilities are important, but so is personal time. You should have the option to take a break from your responsibilities in the form of respite – whether it’s an afternoon, an evening, or a weekend. These breaks will allow you to rest and reset.
- Work with a psychiatrist or psychologist
- Changes in responsibilities can lead to a lot of emotions, all of which can impact a relationship. A therapist can help you and your partner navigate these emotions and relationship changes. This is a long-term process that requires your commitment and participation.
Divorce/separations
Sometimes after a brain injury, people may be worried about separating or divorcing. It’s not good to focus on this immediately after the injury – instead, focus on all the ways you can work on your relationship with your partner. It is normal after a major life event – such as brain injury – to feel a sense of instability. You might feel hesitant, unsure, or even loneliness within the relationship. The important thing to remember is that a relationship doesn’t have to be all or nothing. You and your partner may have to adjust your expectations and your communication in order to figure out how to navigate this new situation. This is something you may have to continue doing for the duration of the relationship.
In some cases, a relationship cannot continue after a brain injury. This decision is not always reached immediately, but months or years in the future. There are many reasons for this, and some of those reasons may be related to the brain injury. This is a highly personal decision. These kinds of decisions will need to be made together, and with the help of therapists and counsellors. If you have children, you will need to work with the other parent (or their lawyer) to make sure you reach an agreed-upon custody arrangement. You will also need to talk with your children about the family changes that are happening.
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