VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Family

QUESTION:
I'm a 28-year-old woman living with my parents. Five years ago I had a really bad brain injury. I was in the hospital for a while and they say I was in a coma. I would love to move out of my house but can't afford to yet. My parents are overbearing. They treat me like a seven-year-old and they won't let me do anything. At first, I really needed help from my folks, but now I can do most things on my own. Still, my mother tells me what to do, like when to do chores, who I should hang out with, and even what to wear. Sometimes I lose my temper with her, but I just can't stand the way she treats me. Oh, I have a 20-year-old brother, and he is away at college. I used to talk to him about this, but he started school six months ago. How can I deal with my mother until I move out? I don't even like to talk to her.

ANSWER
After experiencing a brain injury, a person goes through a period of recovery and adjustment which is often long and difficult. Family members and friends of the injured person also go through a "recovery" period of their own, adapting to the changes in their loved one which may have occurred. Sometimes the injured person and their family members (in your case, your parents) make progress in their adjustment to the injury at different rates, and struggle with different issues. This often leads to conflicting opinions about what might be best for a person, including how independent one should be.

In your case, it sounds like you’ve made a lot of progress in your personal recovery to the point where you are now feeling ready to become more independent. Congratulations! Your mother, on the other hand, may still recall the image of you in a coma or sometime early in your recovery when you were highly dependent on her for your most basic needs. Feelings of guilt over the injury ("why wasn’t I there to protect my child from being hurt?") and a sense of responsibility to protect you from future harm may be factors influencing her controlling behavior. These motivating factors are more than likely based on love and deep concern for the well-being of her child (regardless of your being an adult), and not from an ill-intentioned desire to control you. Remember, she is going through her own "recovery" from this injury and may not have caught up to your level of adjustment. By doing what she believes to be helpful, however, she may be doing the exact opposite in preventing you from mastering your goals, including the ultimate one of reclaiming your life and independence.

One of the keys to surviving the rest of your time living at home, and hopefully improving your relationship with your parents, is going to be effective communication, not only the ability to express feelings and opinions but also, to really listen to what the other person is saying. For example, if your mother really heard and understood how important it was for you to work towards greater independence, and how she may be unintentionally harming you by stifling your growth and fostering resentment, chances are she would work toward changing. Understanding where she is coming from may also help you see her in a different light, and react more assertively and maturely when she tries to impose her control. In addition to developing effective communication skills, you and your family need a safe place to express yourselves (e.g., regarding goals, sadness, guilt feelings, etc.) where, even if there are differences in opinions, expressing them will lead to effective problem solving and compromise, rather than shouting matches and resentment. Individual and family counseling with a therapist knowledgeable about brain injury is a good place to start. Involvement in a support group for brain-injured persons and their families is also an excellent place to witness models of others’ adjustment, and gain support from people with similar recovery issues. Finally, it may be helpful to seek feedback from objective others (e.g., medical doctors, rehabilitation psychologists or counselors) about how ready you really are to become more independent. "Expert" opinions that you would indeed benefit from exercising more control over your life may be a more powerful way to prove your point to her, and for her to allow herself to loosen the reins on your life. Good luck!

QUESTION:
Over a year ago I was injured in a fall. While I look fine, I still experience problems due to a head injury. My memory is limited, and my emotions are difficult to control. I also have residual pain in my head, neck, and back. I am very frustrated dealing with these problems so long after the accident, but what is most upsetting is that my family does not believe me. They say that I look fully recovered and that my problems are "in my head" meaning imaginary. My family implies that I use my injury as an excuse to avoid finishing school, moving on with my life, assuming responsibility, etc. How can I convince my family that my problems are real? Is there a way to make them understand brain injury better?

ANSWER
Your question describes the typical problems experienced by a person sustaining a minor traumatic brain injury (MTBI). Commonly MTBI does not alter appearance; however, it often results in a variety of life altering changes, some of which you have described, and these changes are frequently poorly understood by those who care about you. Problems that continue to be disabling some weeks or months after the injury may persist over a long period of time, perhaps your lifetime, but often can be improved upon with medical or rehabilitative intervention.

Education about the injury is an important aspect for adjusting to disability. Your family may be more receptive to videotaped documentaries about MTBI, i.e., Minor Head Trauma: When Problems Remain, available from the Brain Injury Association. This film provides an excellent overview of MTBI and includes case studies of individuals struggling to overcome their disabilities and return to school and work.

A neuropsychologist, a psychologist with additional training in brain-behavior relationships, can, by testing, identify areas of the brain adversely affected by your fall. If you never have been evaluated, you should by all means do so. A neuropsychological evaluation is used to develop a treatment plan by defining your strengths and weaknesses, developing compensatory strategies, and learning new ways for performing tasks more easily carried out before the injury. The goal is to increase your functional capabilities. Once you have a neuropsychological evaluation, you should request a copy of the interpretation and if possible, tape record the recommendations when you meet with the neuropsychologist to discuss the results. This conference is an opportune time to include your family and to enlighten them about your problems.

You may want to contact the Brain Injury Association in Washington, D.C. (1-800-444-6443 or 202-296-6443) to obtain a Catalog of Educational Resources from which to order some informational materials, inquire about other resources for individuals with MTBI, and request contact information about the Brain Injury Association in your state in order to learn more about materials available and access to support groups. You also should gather more information about pain management which frequently responds well to biofeedback and/or imaging techniques. Your neuropsychologist should have some recommendations about this treatment.

QUESTION:
What are some resources for families in need of support and counseling after a traumatic brain injury has occurred? Would a family counselor be helpful, or is some type of therapist experienced in brain injury more appropriate?

ANSWER
Brain injury support groups provide the best possible forum for persons with brain injury and their families. Contact the Brain Injury Association in Washington, D.C. (1-800-444-6443 or 202-296-6443) for information about your state’s Brain Injury Association, where you can obtain information about support groups meeting in your state. Support group attendance not only enables one to find better ways of coping with the stresses and life altering changes imposed by brain injury but also affords opportunities to meet other families with similar problems who may be able to suggest professional counselors or therapists that have been helpful for members of the group. Learning more about the nature and consequences of brain injury is also an important tool in designing better emotional coping strategies. When formal counseling is deemed appropriate, professionals experienced in brain injury are better prepared to understand the situation than traditional mental health counselors and/or others in the general counseling field.

QUESTION:
There are some counseling issues that are specific to families coping with brain injury, such as post-traumatic stress disorder, dramatic personality changes, family role changes, caregiving, etc. What are some suggestions for the therapist helping a family that has experienced brain injury?

ANSWER
Education, education, education! The more you understand about the problems you described, the better prepared you will be to help your clients. There are many excellent publications, periodicals, monographs, etc. to better acquaint you with the ways that persons with brain injury and their families cope with the day-to-day changes in their lives. Contact the Brain Injury Association in Washington, D.C. (202-296-6443) to obtain a Catalog of Educational Resources which lists literature, videotapes and other helpful informational material.

Get involved in your state’s Brain Injury Association; contact the Brain Injury Association headquarters in Washington, D.C. (202-296-6443) for a referral. Attend support groups, learn more about ways people affected by brain injuries are coping and creating solutions to some of their problems. Survivors of brain injury and their families are often the best "teachers" because methods they have discovered for managing life after brain injury is often more practical and functional than academic and thus, easier for laypersons to implement. It is more often than not their lack of preparation for the cognitive changes that create the greatest chaos in the home.

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