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Coping with Conflict - Fact Sheet
 Families or partners are usually ecstatic when their loved one returns from hospital. But the  Cognitive after effects often create great strains that families or relationships may eventually crumble under.
In many cases there is a gradual awareness that the person has undergone irrevocable changes. A formerly easy going person has developed a short fuse and a fiery temper. A husband who used to help around the house has to be constantly reminded to do the simplest tasks. A formerly diplomatic woman now speaks so bluntly that friends have drifted away and family members feel criticised and abused. A daughter who was always concerned about others now never takes others’ needs into consideration.
Depending on the cognitive changes, a person who has acquired a brain injury may be labelled as lazy, irritable, self centred or rude. These misconceptions usually happen as people fail to realise there have been cognitive changes as a direct result of injury to the brain. It is usually much easier to pretend that the person is wilfully choosing to act this way which can justify the anger and resentment that have built up.
When there is little or no self awareness
One of the most difficult situations is where the family member has lost their capacity for self awareness. This can be a frequent outcome, particularly in frontal lobe injuries. This is very hard on families as in extreme cases, no amount of reasoning or logic will make any difference. Their loved one may have lost all ability to analyse their own behaviour or speech.
In these cases the family needs to develop a good understanding of why the cognitive changes have taken place to help them deal with any problems they cause. Realising that the person can no longer act they way they once did can help develop patience and understanding.
The next step is to develop strategies that will manage challenging behaviours that may arise. A fact sheet on challenging behaviours is available on the internet at www.biaq.com.au by clicking on the fact sheets link. It can be incredibly difficult for families to calmly respond in a consistent way to challenging behaviours but having a good understanding of acquired brain injury and useful strategies can go a long way to making a difficult situation bearable.
When the Person is Self Aware
Self awareness can be largely intact, particularly with milder injuries. There may still be many of the same issues, but with self awareness comes the ability to learn strategies. Often family members may tell them that some of their actions or words are inappropriate, or appear to be rude, critical or self centred. It may take them some time to realise they need to relearn some social skills as their impaired self awareness makes it difficult to see how they are impacting on others.
Families may need to be patient—sometimes their loved one may take months of this kind of gentle but firm feedback from family, friends, workmates and members of the public before they slowly realise they need to relearn some behaviours and communication styles.
An individual with a brain injury may need to relearn many lost skills—anger management, dealing with stress, how to be assertive instead of aggressive, how to solve problems and see things from other people’s points of view. The family needs to work with the rehabilitation team to help their loved one learn new strategies, and provide feedback on their behaviour and communication.
This can be a very difficult time. A family may be accused of being critical and vindictive when they give feedback on their loved one’s angry outbursts. A person may continually blame others when they lose jobs or friends, as they take so long to see how their actions have caused this. But with a supportive family, the individual has the opportunity to gradually develop their self awareness again.
Families Must Face Their Own Issues
Families often have trouble ‘letting go’ of the old person they used to know. There is a natural grieving process as a family comes to accept that their loved one’s former personality has changed irrevocably. But sometimes family members are unable to let go and will keep reminding their loved one of how they used to be. This can only make things worse for the person who has sustained the brain injury. They know only too well they have changed and forcing them to change back is an impossibility that can only lead to frustration.
Families can also develop bitterness and anger over time, particularly if they have been facing challenging behaviours over many months. Even if their loved one is working as hard as possible to learn coping strategies, the family can become very resentful if all there support is met with criticism and bursts of rage.
The strain can bring out negative behaviours in carers too. They may fail to respect their loved one’s privacy or need to be as independent as possible. They may become overly controlling or critical, thinking that all the sacrifices they are making as carers entitle them to not respect the rights of their family member. Responses from the family that are based on anger will always make the situation worse.
Getting Help
The pressure on a family can develop to a point where a standoff occurs. The carers feel all their support over the months has not been appreciated. They may have tolerated angry outbursts or embarrassment in public and are not prepared to face any more. Conversely the individual with the brain injury may feel the family doesn’t realise this is the hardest thing that they have ever faced in their life, that despite slow progress they have been working on these problems with all the strength they have.
As with all relationships, when a standoff has developed it can help to see a counsellor who can often appreciate both sides of the situation, and help develop the understanding and compromises needed to keep the family together. It helps if the counsellor has an awareness of brain injury — your State’s brain injury association may be able to link you up with one.
Spouses will often come to a point where they feel the marriage no longer exists, as is a sense their former partner has a different personality now. These are especially the situations where counselling needed to make the decision on whether to continue the relationship.
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Coping with conflict 
