Acquired Brain Injury doesn’t just affect the individual survivor, it has a profound effect on families and on individual family members. Families often experience changes to their role and structure, all whilst navigating issues of grief and trauma.
Specialist psychological support, delivered by clinicians who understand the unique challenges that accompany ABI, can be a resource for families navigating this uniquely challenging situation.
Support can include individual psychological therapy for family members of ABI survivors, family therapy, or a combination of both.
Grief and Loss
Family members may experience a sense of loss for their loved one as they were prior to their injury. The grieving process can be complicated by issues such as:
Family members may be providing care to a family member, whom they may perceive as physically present but psychologically absent. This is sometimes called “ambiguous loss”.
It can be difficult to process feelings of grief alongside feeling gratitude that their family member is still alive or not more impaired.
Family members may be left struggling to understand why they experience persistent distress, sometimes many years later.
The nature of this loss is often misunderstood or unseen to wider society, leaving family members with a sense that their distress is invisible to those around them. This is sometimes called “disenfranchised grief”.
These issues can make it difficult for family members to come to reasonable terms with their grief.
Often as families enter transition points, such as a child moving away from home or the birth of a grandchild, feelings of grief can return or may feel more difficult to manage.
Psychological therapy can support family members to recognise where there might be issues of unresolved grief. Enabling family members to make space for these difficult feelings and experiences, bearing witness to important losses whilst also paying attention to areas of continuity, feelings of hope and gratitude.
Trauma
Family members of ABI survivors are often living with the impact of trauma. This can disrupt what sense of safety and continuity may have been present before the injury occurred.
Family members may have been present when the injury occurred, may have been traumatised by being informed of the injury, or by experiences of healthcare services.
Experiences of trauma can leave family members feeling unsafe, hypervigilant to further disasters occurring. It is common to experience difficulties relaxing and sleeping, feeling that they need to constantly keep “an ear out” for their injured family member which may be made worse by night-time caring responsibilities.
At other times family members may feel like the feelings from the injury or accident feel very fresh, “like it happened yesterday”. Experiences of nightmares or even flashbacks may also be present.
Recovery from trauma, following an ABI within the family, can be facilitated by specialist trauma-focused psychological support. This can include:
Learning about the impact of trauma on the brain and mind
Screening for Post-Traumatic-Stress-Disorder
Re-establishing a sense of safety in the family
Supporting the processing of trauma memories
Paying attention to areas of post-traumatic growth and meaning making
Carer roles
Family members may have had to unexpectantly take on caregiver roles, leading to changes in family relationships. It’s not easy to be a carer, whilst also being a spouse, parent, or child of an ABI survivor.
ABI survivors may show changes in their decision making, which can include being more vulnerable in relationships or risk-taking behaviours. Family members in caring roles often need to navigate the very difficult tension between supporting independence and promoting safety.
It is well documented in research that carers of ABI survivors can be more likely to experience mental health difficulties, including difficulties with anxiety and depression. There is a developing understanding of the circular patterns of influence within families, whereby family member’s distress seems to influence the ABI survivors progress in their rehabilitation.
Psychological therapy for carer can provide a space for families to reflect on changes to their relationships. This may include acknowledging growth and achievement, as well as areas of difficulty and distress. It may also involve considering where support can be accessed through social networks and professional services.
Children and Young People
Children and young people can be profoundly affected when a family member experiences an ABI. It may be very difficult to understand the changes in their loved one and they may be left feeling confused and distressed by what’s happened.
When a parent sustains an ABI, Children can experience a kind of double loss, where one parent is experienced as changed after an ABI and their non-injured parent may be less available due to their new caring responsibilities.
Visiting their injured family member in hospital can sometimes be traumatising for children and young people, as this may include seeing their loved one or other patients on ward environments who may be very unwell or confused.
At other times families may choose to protect the child from the distressing realities of what has occurred. For some children this can leave them with a sense of confusion and that something is wrong but without a way of understanding and making sense of this experience.
Following an ABI in the family, children may present with difficulties including:
Behavioural problems
Academic difficulties
·Appearing worried or anxious
Difficulty separating from their parents or caregivers
Psychological support for children following an ABI within the family can include:
Finding age-appropriate ways of understanding what has happened
Ensuring the child or young persons’ voice is heard
Strengthening the support they receive from their family and peers
Attending to behavioural or mental health difficulties
Enabling appropriate involvement in the rehabilitation process
Support with developmentally appropriate tasks
Linking in with schools and other services