Psychosocial Therapy for Families Affected by Brain Injury

Girl kissing mother at the hospitalTraumatic brain injury (TBI) is defined as an “alteration in the function of the brain or other evidence of brain pathology caused by an external force,” according to the Brain Association of America in 2011. Defining brain injury has not been consistent in the medical research because of the complexity of the brain physiology. Improvements in technology has helped improve understanding of the brain but there still remain significant unknowns. Science journalist Carl Zimmer describes the brain as:

  • an intricate network of billions of neurons
  • a collaboration of neurons in constant communication
  • a chemical labyrinth that senses the world inside and outside
  • an organ that produces love and sorrow,
  • keeps our hearts beating,
  • keeps our lungs breathing,
  • composes our thoughts,
  • and constructs our consciousness.

Nobel Laureate Eric Kandel described the human brain as “the most complex organ in the universe.” Damage to this vital organ can cause significant limitations to a person’s ability to process the activities of daily living and function both mentally and physically. Traumatic brain injury (TBI) happens suddenly but can leave a lifetime of permanent disabilities.

Medical research has not successfully discovered curative interventions to repair the brain to pre-injured status. The lack of proven effective treatments for restoring impairments means focus for interventions is on treating the symptoms associated with the multiply traumatic changes associated with brain injuries. This void in medical treatments indicates the need for psychosocial support for the TBI survivor, the spouse/partner, and family members. The main focus of therapy is 1) to help facilitate adaptation to a changed life, 2) to facilitate a quality of living with limited abilities, and 3) to create a collaborative new reality of well-being.

Impact on Family Dynamics

Traumatic brain injury does not happen in a vacuum. It is a chronic health issue that affects the entire family. Murray Bowen’s family systems theory explains how traumatic changes to one member of the family cascades throughout the family system. In nature, this is like throwing a pebble into a pond and observing how the water ripples throw out the pond. When one family member suffers traumatic changes, the stress is felt throughout the family system. The established patterns and roles are altered, changing the entire family dynamics. The heighten changes are a major stressor and cause a negative shift in the family’s well-being.

Family members are often described as the “neglected victims” of TBI. Many marriages end in divorce after brain injuries. The loss of an intact family causes further losses for the survivor. The difficulty learning to understand and cope with the monumental changes post injury are some of the reasons there is a need to conduct therapy from a family perspective. The therapeutic process needs to address loss, grief, and adaptation to creating a new life. Maintaining and developing socializations skills as well as a strong support system of family, friends, and a spiritual leader are helpful to the healing process.

‘An Invisible Disease’

There are many challenges to traumatic brain injury that sets it apart from other chronic illnesses. First, it has been described as an “invisible disease” and a “silent epidemic.” It is estimated that 1.7 million people are diagnosed each year. However, these numbers are considered an underestimate because of the lack of visible damages and the subtleties of impairments. The extent of cognitive deficits may not be apparent until much later. The insidious nature of the impairments means family members and professionals may overestimate the abilities of the survivor.

However, trauma to the brain frequently causes pervasive cognitive dysfunction and variety of personality changes, such as impulsivity, anger, fatigue, irritability, unpredictability, and depression. Lack of critical thinking, impaired social perceptiveness, and lack of empathy are also considered hindrances for the lack of awareness the survivor has about his or her own impairments and the decrease in motivation to adapt to a new reality. These problematic issues have a negative impact on martial/couple relationship, family dynamics, and relationships in general. Yet, the research indicates that a meaningful and supportive relationship can contribute to the TBI survivor’s healing from the psychological trauma.

Including Partners and Family Members

The recommended plan of care for the injured person includes psychosocial support for the caregiver, spouse, and family members. The North American Brain Injury Society (NABIS) reports a need for more effective incorporation of family support based on the last decades of research. Marriage and family research has shown that maintaining strong and supportive relationships are integral to helping the survivor cope with challenging changes, as well as for the spouse and family members to adapt to living with a new person.


  1. Bowen, M. (1985). Family therapy in clinical practice. Northvale, NJ: Jason Aronson.
  2. Brain Injury Association of America. (nd).
  3. Brey, R. (2006). The silent epidemic: Traumatic brain injury’s massive impact on suffers and society. Neurology Now, 5.
  4. National Institute of Mental Health (NIMH). (nd).
  5. National Institutes of Health. (2008). Traumatic brain injury: A family finds its way. National Institutes of Health: Medline Plus, 3(4), 2-7. Retrieved from NIH Medline Plus:
  6. Nichols, P., & Schwartz, R. (2004). Bowen family systems therapy. In Family therapy concepts and methods (pp. 119-146). Allyn & Bacon.
  7. North America Brain Injury Society, NABIS. (2008). Barriers and recommendations: Addressing the challenge of brain injury in America. Washington, D.C.
  8. Wood, R., Liossi, C., & Wood, L. (2005). The impact of neurobehavioural sequelae on personal relationships: Preliminary findings. Brain Injury, 19(10), 845-851.
  9. Zimmerman, C. (2004). Soul made flesh: The discovery of the brain and how it changed the world. New York: Free Press.

© Copyright 2014 All rights reserved. Permission to publish granted by Elva Hoxie, PhD, RN, MPH, MFT, Health / Illness / Medical Issues Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Brayden

    June 18th, 2014 at 12:00 PM

    What a difficult and trying transition this would have to be for any family no matter how strong they are. Just think about having a relative who one day is perfectly fine and then one accident and all of your lives are changed forever. There will of course be concerns about their helath, but you are right, the whole dynamic of the family could change and there are going to be concerns and problems that were never there before but that are now going to be front and center. This isn’t something that just the patient will have to face, but that the entire family will have to struggle through and no family, no matter how strong they are, can get through this alone. It is important for everyone to have a role, to have a job in connecting with the patient and making this life altering change as painless as possible.

  • Nellie

    June 18th, 2014 at 1:50 PM

    Why is there such a lack of medical interventions? Brain injuries can so dramatically affect lives, I would have hopes that millions would be poured into research for answers each year. Or maybe there is but when it comes to these kinds of injuries there are never any easy answers for recovery.

  • Anne R

    June 19th, 2014 at 1:27 PM

    You want to put all of your time and energy into helping the person who has had this accident but we must also not forget about the rest of the family, and not neglect their needs as well. Sometimes the best thing that we can likely do for the patient is to help their system of support stay strong so giving them time for themselves and time to recahrge and refocus can be good for the entire family, patient and support system as well. I know that the tendency is to reach out and do for those who are primarily hurting but the others that are with them do not have to become secondary as a result of wanting to do that.

  • dennis

    June 20th, 2014 at 4:16 AM

    This is hard on so many different levels because you see when roles have to change in the home environment that most of the family’s world that they have known can be turned upside down.
    You want to make it all happen but it is hard to break free of those roles that you have always had for yourself or for someone else to step into another pair of shoes and start doing things in a different way.

  • Babs

    June 20th, 2014 at 1:21 PM

    We are very lucky!!! My son is an TBI survivor who was supposed to die and is now mostly independent. The reason we are lucky is because we live in San Diego, California where there is an incredible program through the community college that is free to all ABI survivors. They offer 4 afternoons of classes on a large variety of subjects – all tailored to the needs of each student. We also have the San Diego Brain Injury Foundation for support at their monthly meetings and in between.

    ABI is traumatic for ALL family members and friends – the survivor is NOT the same person afterwards and it is a big adjustment. Reintegrating into the family and the world is very trying for all involved. There are very few people trained to work with the brain injured in a therapeutic situation – I am glad that we have at least one . . .

  • Courtland

    June 21st, 2014 at 6:00 AM

    When we all get married we all say the “for better or for worse” vow thinking, praying that this will never happen to us. Most of us never prepare for the fact that this could very easily happen to us and that our lives will change dramatically if it does.

  • skip

    June 23rd, 2014 at 4:18 AM

    Many times the person who has suffered from the injury could have a tendency to shut others out because they are aware enough to know what kinds of chanegs this has brought about for the whole family and they experience a great deal of guilt because of that.

  • Olivia

    June 24th, 2014 at 4:22 AM

    You must have someone to work with the family who can help all of them learn to be a family together again. Things may be different from what they used to be and others may have to take on new roles in the family to make things work, but if you have someone form the outside leading and facilitating this process then I think that you can see that things can go much more smoothly. The family itself is generally going to still be grieving the loss that they have experienced and there is enough pain to go around for all. This is why it is always nice to have someone form the outside to come in and be objective about the situation and help the family get back to functioning at least on a level emotionally where everyone feels as if their needs are being met.

  • Elva

    June 24th, 2014 at 1:03 PM

    So true Olivia, the family not only is adapting to new roles, but as emphasized by Babs comment, a new person. So the family is going through a grief process that is unique because the personality of the love they once knew is forever gone, yet, he/she physically still exist. The experience has been described as “a shell of the person they once knew”. An outside professional is exactly what can be helpful and supportive! Grief theory reminds us that each person grieves differently and bringing this to the forefront is helpful to the process. Thank you for you comment.

  • Elva

    June 24th, 2014 at 1:07 PM

    Skip, thank you for emphasizing that each person does grieve differently and highlighting the emotional challenges of the injured person. There is a great need for exercising empathy and compassion.

  • Matt R.

    July 1st, 2015 at 2:37 AM

    Very efficiently written information. I would like to thanks for the efforts you have put in to write this blog. Thank you so much for giving light to many problems we haven’t come across before using your blog.

Leave a Comment

By commenting you acknowledge acceptance of's Terms and Conditions of Use.


* Indicates required field.

GoodTherapy uses cookies to personalize content and ads to provide better services for our users and to analyze our traffic. By continuing to use this site you consent to our cookies.