|
Changes in Relationships - Fact Sheet
 The impact of a brain
injury has often been likened to throwing a pebble in a pond—the influences go
far beyond just the person who has acquired the injury, including partners,
friends, family, carers and work colleagues.
The issues and needs of partners
and family members will vary according to the stages of the recovery process.
Each stage will bring its own joys, challenges, hopes and needs. Old coping
methods may remain helpful for some; for others, new methods will need to be
developed.
Resentment, anger, despair, grief and
numbness may be emotions encountered. Your task in the process of recovery is
to sort out what you are feeling, and seek out help and support for yourself.
Stages of Rehabilitation
Acute (hospital) stage
In the acute stage, the physical trauma to
your loved one is often life threatening. No one wants to leave the hospital;
everyone’s focus is on the patient.
Your focus at this time is on your loved
one who has been injured; your own needs right now hardly seem to matter. Your
friends want to help; this is the time to let them. The rest of your
“outside-of-the-hospital” life still needs tending to, and your friends can
relieve that worry by taking care of the house, children, car pooling, shopping,
and so forth. Beyond attending to day-to-day tasks, some may want to offer
emotional support as well. You may have conflicting feelings about this. Your
good friends will understand and be there for your needs, whatever they are.
You might find it helpful to name one or two of them as coordinators. They can
return phone calls for you, offer apologies and thanks to others, and do whatever
else needs to be done.
Post-acute stage
In the post-acute stage, the patient is
medically safe and has been moved to a rehabilitation centre. At this point,
you can relax a bit and start to put order back into your world outside of the
hospital. Part of this may include offering multiple thank you’s to your
friends. You may feel exhausted and out-of-sorts. This is part of the natural
letdown of the initial trauma, a time when you realise that you have been (and
are) tired and worried. You may not feel like talking to, or being with, your
friends right now. You may be pre-occupied by your own concerns. You may not
want to talk constantly about the injury and burden your friends, but you don’t
really want to talk about anything else, either.
You may want to be with your friends – but
then won’t want to. This is a perfectly natural reaction even if it feels
disconcerting to you. Ask your friends for their patience and grant yourself
the same. You may find more comfort being with other families in the
rehabilitation unit who are going through what you are, than being with your
old friends. Take advantage of the support if it is what you need.
Community re-entry stage
In the community re-entry phase, the person
with a brain injury moves back into family life and begins to renegotiate his
or her social world. You, as care giver, begin to redefine your world as well.
When a loved one returns home everything
initially readjusts around that person. Your friendship needs will change
again. You will find it difficult to leave your loved one and go out. You may
want a friend or two to visit, but even that may feel like it is too much, because
of the extra work that now goes on in your world. Some friends may be
comfortable with what has happened, and with the difference they observe in
your loved one – and perhaps in you. One of the first ways to address their
fears or discomforts may be to educate these friends about the injury. With
information, they can become more comfortable with the situation.
Many of you at this stage will find
yourselves feeling anger and resentment at your friends’ happiness. You may
feel isolated, with no way to share these feelings with old friends. You may
wish to seek out support groups of other caregivers, who are feeling just as
you are; these groups can provide a good social support. Above all, remember
that it is time now to give your own needs priority. You do need to go out, to
take time for yourself.
In The Long Term
Family
One of the common issues that families face
is their son or daughter with an injury returning to the family home despite
having lived away from home prior to the injury. For the person with the injury
this can represent a huge loss of independence and self-reliance. For the
family, they now have someone who is either fully dependent or
semi-independent. Family members’ lives can change significantly. Their future
plans may be put on hold to take care of their loved one. They often have to
cope with dramatic personality and behavioural changes. Some of the most
distressing changes can involve aggression, rapid changes in mood,
self-centredness,  Impulsivity, sexual and social Disinhibition, poor motivation
and lack of empathy. Friends of the family often distance themselves over time
and become quite bitter unless they have a good understanding about why this
behaviour occurs.
Partners
The rate of marital and relationship
breakdown is very high following acquired brain injury. The pressures on a
spouse or partner can be immense. They may have to take over the running of the
house, become the sole wage earner, increase or decrease their hours of work,
make most of the decisions and provide support to the person with the injury.
Finances may become a major concern due to medical bills and loss of income. A
change in the sexual relationship of a couple can also be a very distressing
and sensitive issue. These changes may involve either a reduced sexual drive
(hyposexuality) or increased sexual drive (hypersexuality).
Children
The person with the injury may have had
children before or after their accident or illness. From a child’s point of
view it is often more difficult to have known their parent before the injury.
In this situation the child has to come to terms with why their parent has
changed so dramatically after coming home from hospital. After the accident it
can be extremely difficult for a child to understand why their parent needs care,
walks or talks strangely, never remembers anything, gets upset so easily and
why they no longer want to play with them.
Children may display increased acting-out
behaviours, emotional problems, or relationship difficulties. Negative
parenting performance such as yelling, ignoring or being impatient by both
injured and uninjured parents is reported in most families. Most families
report substantial breakdowns in relationships between children and their
injured parent when it is the father who is injured. Most non-injured parents
report substantial depression, which correlated significantly with negative
behaviour in children.
Friends
A very common statement made by people with
acquired brain injury is ‘you find out who your real friends are’ after the accident.
Unfortunately, friends can disappear at the time when the person most needs
their support. It is also common for people who have spent a long time in
hospital to feel that they have missed out on a lot of experiences with their
friends and that they now have trouble relating to their friends and sharing
their interests.
Supportive friends learn to adjust their
expectations of the person with the injury and seek new activities for spending
time together e.g. watching a game of sport instead of going to a nightclub.
Alternatively, the person may wish to meet other people with a brain injury by
joining a specialised group rehabilitation programme or a less structured brain
injury social group.
Major issues for couples
Both men and women with brain injuries find
the loss of autonomy and independence is their biggest problem, and both
mention personality changes and memory deficits as significant. Among married
couples, wives identify their personality changes and Cognitive deficits in
their husband with a brain injury as primary problems. Husbands, by contrast,
place loss of autonomy and mood swings in wives with a brain injury at the top
of their lists. Families in which husbands had sustained brain injuries place
higher importance on job loss and income change than do families in which wives
were injured. Women with brain injuries and non-disabled wives value support
groups and other emotional support methods as coping strategies, whereas the
men stressed problem-focused and goal-orientated strategies. Individuals with a
brain injury who experience higher ratings of cognitive and social dysfunction
are more likely to be depressed and anxious. Non-injured spouses also show
increased anxiety and depression, with wives more affected than husbands.
|
Changes in relationships 
