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 and 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
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.
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.
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.
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.
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).
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.
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
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.
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.
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.
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.
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
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.
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.
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.
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.
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
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.
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.
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.
Family relationships
Relationships with children, parents, siblings, cousins, and other extended family will change for the person with a brain injury. These changes will be more noticeable if you live with them. The biggest changes these relationships will go through are communication and responsibilities/role reversals.
For the purposes of this page, the following content is written using examples of relationships between a person with a brain injury and children. These changes are applicable in all family relationships.
Communication
After a brain injury, a person may experience trouble with communication for a variety of reasons. They may be coping with changes to their cognitive abilities that make conversing, paying attention, or understanding others challenging. This is incredibly frustrating, especially for kids who may not understand why things have changed. Kids may become withdrawn or less talkative if they feel like they can’t easily communicate with their parent. They may also turn to you because they struggle to relate to their other parent.
Without communication, family relationships can quickly run into obstacles. That’s why it’s important to be as honest and forthcoming as possible while keeping in mind the age of the child and the appropriateness of the information. Children may not fully understand what’s happening and will need you (or the person with a brain injury) to take the lead in teaching them how to share their thoughts and feelings.
Tips for communicating with the person with a brain injury for family members
Children of all ages may find it difficult to understand why things have changed, and how to adapt to those changes. As a result, they may not feel as connected to the person with a brain injury. Find something that they can do with the kids – puzzle time, bonding over a favourite television series, or a love of nature – and prioritize that time. During the bonding activity, encourage the kids and the person with a brain injury to speak openly about how they’re feeling or what you’re thinking. If the person with a brain injury leads by example, children will follow suit. You may need to help get the conversation started or instigate the activity, but the goal is to help facilitate bonding time.
Disagreements are common among family members no matter what. After the brain injury, you may find that it’s not as easy to navigate disagreements between parents and children. They all may feel more reactive, angry, and hurt. This can happen quite often with children. Sometimes they say or do things without thinking, try to push their parents’ buttons, or may lash out because they don’t know how to cope with their feelings. But do your best not to let anger, sadness, or hurt feelings interfere with being respectful. Coach your partner to do the same. Your kids need to see that there is a more productive, respective way to communicate.
When you and a family member are having a conversation – no matter the seriousness of the subject – you should be actively listening to what they have to say. This may be challenging for children, but they will pick up on your example (even if it takes a little time).
If when conversing with the person with a brain injury you need them to speak more slowly, break down the conversation into smaller sections, or even record what they’re saying, tell them that is what you need in order to be an effective listener.
It’s important to communicate constructively. Family members should think carefully about what they want to say – they may even want to write it down.
Distractions such as the television, phones, gaming devices, or additional stimuli make it difficult to fully engage in conversation. These distractions should be removed (or the conversation should move to a quiet, distraction-free zone) so everyone can focus. It may be beneficial to have conversations with one person at a time or remind family members to speak one at a time, so the person with a brain injury can focus.
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 everyone knows it’s okay to take the time they need.
A psychologist or psychiatrist with a specialty in family counselling/brain injury will be able to address communication issues that are affecting you all. Therapy is a long-term process, so results won’t happen overnight – but if you are committed, you will see progress.
Responsibilities
After a brain injury, the person may not be able to take care of their children the same way. They may not be able to cook dinner for them, pick them up from school, or play with them – at least not right away.
These changes will be challenging and will generate a lot of emotions for all parties involved. You may feel guilty or anxious about your family members adjusting to the new roles. You or your kids may feel pressure to take on more responsibilities, or even feel resentment at the changes in their daily life.
It’s important to talk with your partner about the responsibilities involved in childcare. Decide who can do what (keeping in mind additional responsibilities). Maybe the parent who used to pick up the kids from school is now the parent that makes lunches. If the parent with a brain injury is unable to take on any childcare responsibilities, you may need to ask other friends/family members for help, or look into professional childcare services.
If your children are older, you can speak with them about taking on some responsibilities. For example, a child who can drive may be able to pick up a younger sibling from school or band practice. It’s important to keep in mind that while children are active members of the household, they also only have so much time to be kids. Some tasks or responsibilities will not be appropriate for them.
Other responsibilities will change as well, including household chores, financial earnings, and more. These will also need to be examined and discussed.
Tips for managing changes in responsibility
Adjusting to change takes a lot of time and patience. Everyone may be experiencing some trouble being patient. It’s important to try and remind your partner and your children that everyone is feeling some stress, and they may need extra time or extra support.
Responsibilities are important, but so is personal time. Breaks from responsibilities – whether it’s an afternoon, an evening, or a weekend – will allow you all to rest and reset.
Saying please and thank you and demonstrating that you value the time and effort of your family will make them feel loved and acknowledged. They in turn will do the same.
Friends
Your relationship with the person with a brain injury will change, particularly if you they are experiencing physical, cognitive or behavioural challenges. You may notice that when you see them, it’s not the same. You may not fully understand what is happening to your friend, how to act, and even stop visiting them as much.
This happens a lot, and while it doesn’t feel good, it’s a challenging situation for all of you and it will take some work on both parts for your friendships to adjust and evolve.
Tips for maintaining friendships after brain injury
This is an adjustment for you, but it’s also an adjustment for your friend with a brain injury. They will need some time to get used to the changes in their relationship with you, and they will need your patience.
Tell your friend how you feel. More importantly, listen to what your friend feels and needs. This could mean hanging out at home rather than a coffee shop, slower conversation, or help understanding social cues. You won’t always know what they need, so the more questions you ask and the more honest you are, the better friend you will be.
If your friend lives far away or you are unable to see them as frequently as you would like, keep in touch using email, texting, phone calls, video messaging, or even handwritten letters.
New relationships after brain injury
If you enter a relationship with someone post-injury, this may be different than other relationships you have had in the past. You may play more of an active role in day-to-day care if the survivor is your intimate partner. Since the relationship is new, you have an opportunity to build routines together. This can be great for both of you, because you’re able to learn about each other while developing your own system of roles and responsibilities with no attachments to the past or preconceived ideas.
New friend relationships may stem from support groups, new jobs, new neighbours, or other places where you meet people in your daily life. While it may feel awkward to talk about brain injury with a new friend, let them know you are there to talk about it when they are ready to take that step.
It can be difficult to form new relationships after a brain injury. Make sure to be open to relationships with new people, no matter their personal health situation. Socialization is incredibly important for people with brain injury, and your outreach could make their day. You can ask them for coffee, for a walk, for a phone call: whatever you would like to do, people will respond if they know you’re looking to continue building a relationship.
Intimate and partner relationships
Information for this page sourced in part from msktc.org
[1] Women’s Reproductive Health and Traumatic Brain Injury – a report from the University Health Network
Family relationships
Information for this page sourced in part from msktc.org
Friends and new relationships
