Relationships after brain injury

Relationships with others are incredibly important to our overall health and happiness. 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 you experience. Brain injury can cause many changes, and you may have different thoughts and behaviours now. It will take time for you to adjust to your new self, and it will take time for the people in relationships with you to adjust as well.

While many of these changes are now outside of your control, there are steps you can take to make sure that your partner, family, and friend relationships are nurtured after your injury.

Intimate & partner relationships

Relationships between romantic partners can be drastically altered after a brain injury. You may be experiencing emotional, behavioural, and cognitive changes that make relating to your partner more challenging. You will also be experiencing complicated emotions related to your injury, which can spill over and affect how you treat your partner. 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.

Topics in this section include:

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 with communication. You may be coping with changes to your cognitive abilities that make conversing, paying attention, or understanding others challenging. This is incredibly frustrating for both people, especially when you’re used to being on the same page.

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 brain injury – and you may not want to ‘burden’ your partner. They are probably feeling the same way. They may be feeling strong emotions related to your brain injury, to their new roles, and the changing dynamics in your relationship. 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.

Without communication, relationships can quickly run into obstacles – and without communication, those obstacles will be impossible to overcome. It’s important to be as honest and forthcoming as possible with your partner and be mindful of how you’re communicating with them.

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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 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 easy to become preoccupied with your own topics and opinions – but don’t forget how important it is for your partner to be heard.
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. Keep a journal handy or record talking points You can also record things that make you frustrated and angry and wait until you are both calm to discuss.
Remove distractions
Distractions such as the television, bright lights, 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) so you can focus.
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
Communication is challenging for many couples, and this can increase after a brain injury. 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, or attention and memory problems can 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].

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.
Find activities you can do together
You may not have as much in common with your partner as you did before the injury. Finding new activities you both enjoy and can do together 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 because of 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.

You can also try to find support groups through your local brain injury association or through doctor recommendations.

Tips for coping with sexual challenges

  • Find positions that make you comfortable, particularly if you have mobility challenges
  • Plan sexual activities with your partner for when you 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 it
  • Remove distractions that would take your focus away from your partner
  • 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
  • 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.

Responsibilities

Before a brain injury, you may have had a lot of responsibility in the relationship. For example, you may have been responsible for cooking dinners, picking up kids, cleaning, or doing the errands. You may also have been more spontaneous with romantic gestures or initiated more communication about your relationship.

After a brain injury, you may not be able to have the same responsibilities. Your partner may need to take on more of the daily tasks, as well as additional ones involving your care. They may also become the main financial support for the household if you are unable to work or have to take a job with a lower salary. This change of responsibilities and independence for both of you is going to be challenging. It will trigger a lot of emotions. You both may feel pressure as recovery progresses and time passes.

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, or you may be focused on your own responsibilities and not those of your partner. Try to remember that they are feeling stress too, and they may need extra time or extra support.
Say please and thank you
Your partner is doing a lot, and the simple act of saying please and thank you is a tremendous kindness. It’s an easy way to show appreciation and demonstrate that your partner is valued.
Take breaks
Responsibilities are important, but so is personal time. Giving someone a break from their responsibilities – whether it’s an afternoon, an evening, or a weekend – will allow you all 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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