Couseling After Brain Injury: 13 Things Want to Know But Are Afraid to Ask

Katy Wilder Schaaf, PhD, Lillian Flores Stevens, PhD, and Stephen Smith, PhD, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University
Everything You Wanted to Know About Counseling After Brain Injury But Were Afraid to Ask

Brain injury can change your life in many ways. Many people report feeling worthless, misunderstood, lonely, and frustrated after their injury. In fact, over half of people who have a brain injury also experience depression. People with brain injury might also experience anxiety, difficulty controlling emotions, changes in relationships with family and friends, financial strain, and difficulty adjusting to changes in work, school, or home life. Life after a brain injury can be overwhelming for both the survivor and family members.

Your doctor may have recommended counseling or psychotherapy. The terms counseling, psychotherapy, and therapy are very similar and are often used interchangeably. However, a therapist vs. a counselor may have different ways of approaching treatment.) After injury, patients often go to many therapies, such as physical therapy, occupational therapy, speech therapy, etc. Counseling is simply another form of therapy that helps people recover emotionally after their injury. Going to counseling does not mean you are “crazy;” it is a tool you can use to help you feel better about your life today and more hopeful about the future.


1. What happens when I go to counseling?

Your experience in counseling will depend on the particular problems you want to work on. There are many different ways to help you address your concerns. Counseling is not like a medical doctor visit where the doctor tells you what to do to fix your problem. Instead, you will be actively involved in learning how to identify and solve your own problems in the future. Those who benefit the most from counseling not only work on their concerns during sessions, but also at home.

2. Can counseling help me?

Counseling has been shown to be helpful to many people who are recovering from an injury. Since counseling often involves discussing unpleasant aspects of your life, you may experience temporary uncomfortable feelings like sadness, anger, and frustration. However, over time, counseling can lead to improvements in relationships, solutions to specific problems, and decreased feelings of distress. Because personal experiences vary, there is no guaranteed result of counseling.

3. Why do I need to go to counseling? I have support from family, friends and my community.

Family, friends and community can be excellent sources of support and can be there for you when you need help the most. However, a trained counselor can provide you with additional support that can add to the help you receive at home or in your community. A counselor may work with you to develop new skills and coping mechanisms that help you feel better and more capable of handling problems on your own in the future. Counselors may also help you to discuss situations in which you are receiving conflicting advice from friends or family.

4. How do I know that what I say will be kept private?

All licensed mental health professionals are required to follow a code of ethics. The code of ethics requires that counselors only share information about treatment with people authorized by you. As the consumer, you can sign a release of information for your counselor to talk to other people. There are a few exceptions which you and your counselor should discuss. These exceptions include: (1) your counselor being concerned that you are a danger to yourself or to someone else, (2) you reporting child abuse or neglect, (3) you reporting elder abuse or neglect, or (4) your records being subpoenaed by a court of law. If these things come up in session, your counselor should talk to you about reporting them to the necessary people.

5. What is the difference between a psychologist, psychiatrist, counselor, therapist, and social worker?

This is what a typical person in each field may do:

  • Counselor, Psychotherapist or Therapist
    • general term that could refer to many mental health professionals
    • provides counseling/therapy
    • provides mental health referral if medication or other services are needed
  • Psychiatrist - has medical training
    • provides medication management
    • provides brief counseling
    • typically schedules appointments less frequently than other mental health professionals
  • Psychologist
    • has advanced training in mental health problems
    • provides counseling/therapy
    • conducts personality/cognitive assessments
  • Social Worker
    • provides counseling/therapy and referrals
    • provides case management

When you first meet with your counselor, feel free to ask what type of training he or she has and what types of mental health services he or she provides. Each mental health professional may have different specialties. Make sure the counselor you meet with is trained to help you with your specific needs and has previous experience with brain Injury.

6. If I go to a counselor, will he or she try and get me to take medication?

The only health professionals who are able to prescribe medications are psychiatrists, other medical doctors, or nurse practitioners/physicians assistants. So, most counselors are not able to prescribe medications and will work with you on behavioral ways to make changes in your life. If you think that medication could provide some additional benefit, you should talk with your counselor and let them know your feelings. Your counselor may provide a referral to another professional to discuss medication. Your counselor can also talk with you about how to approach the appointment.

7. Will my counselor make me relive painful memories or talk about things that I don’t want to talk about?

Talking about problems is often difficult. You may experience temporary uncomfortable feelings like sadness, anger, and frustration when you discuss unpleasant aspects of your life; however, your counselor will never force you to talk about something you don’t want to talk about. You have complete control over what you share with your counselor.

8. How do I find a counselor?

There are different ways to find a counselor.

  • Contact your local Brain Injury Association.
    The association can provide you with a referral to a professional in the area who specializes in working with persons with brain injury.
  • If you have insurance, you can contact your insurance company and request a list of counselors covered by your plan
  • Talk with your primary care physician and request a referral.

9. What do I look for when trying to find a counselor?

There are many different ways to describe a good counselor. Here are a few things that you should look for when trying to find your counselor. A counselor should:

  • Be a person you feel comfortable with
  • Be dependable, respectful, and understanding
  • Show interest in the issues you bring to therapy
  • Have knowledge and training regarding your type of concerns
  • Help you set goals that fit your life
  • Be open to feedback and questions you have
  • Provide referrals if he/she is unable to help you with a problem

10. What happens if I go to counseling and don’t like my counselor?

Not every counselor is a good fit with every patient. If you are unhappy with progress in counseling or feel like your counselor is not a good fit with you, let your counselor know about your concerns. Your counselor may start by trying to work through some of your concerns. However, if it is clear that the relationship will not work, your counselor should provide you with some referrals for other professionals who might be of help. A good counselor will not be offended or upset about your desire to find a professional who better fits your needs.

11. How much time does counseling take?

Lengths of appointment times vary, but a typical counseling appointment is 50 minutes long. Some appointments may be shorter or longer depending on the purpose of the session. People can be seen every week, every other week, once a month, or even every couple of months. Together, you and your counselor can decide how often you will meet based on your own individual needs, goals, and circumstances. The length of time you will stay in counseling will vary depending on the issues you are working on and the strategies you and your counselor think will be most beneficial. Some people see a counselor only three or four times, whereas other people may continue to meet with or check in with their counselor for a much longer frame of time.

12. How much does it cost to go to counseling?

Cost varies depending on insurance benefits and service provider. Typically, if your insurance covers counseling, you would be responsible for all co-pays and co-insurance. If you do not have insurance, some community clinics provide counseling on a sliding scale. A sliding scale fee means that the amount you pay is based on your income. If you do not have insurance and are in need of counseling, be sure to ask about the sliding scale option.

13. Can I bring family members to my counseling sessions?

You can work with your counselor to decide whether it might be helpful to bring your spouse, parent, children, or other close family members. Sometimes counseling can be used to work on problems individually. Sometimes it is helpful to include family or friends to work on problems as a group. You and your counselor can decide on this together.

Sometimes, people feel strongly that their family be a part of their counseling. This may be because they feel their issues are directly tied to their family relationships, or it may be because they would like the support and feedback their family members can provide in session. If you feel that you would benefit most by having family counseling, you may want to consider looking for a counselor with a specialty in family relationships. Counselors identified as “Marriage and Family Therapists” or who have the initials “MFT” or “LMFT” after their name have this specialty.

Posted on BrainLine October 27, 2011.

Written by Katy Wilder Schaaf, PhD, Lillian Flores Stevens, PhD, and Stephen Smith, PhD, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University, Richmond, VA. Used with permission.

Comments (6)

Many Brain Injuries are caused by vehicle incidents. Helping victims get the compensation they need would be a worthy task and could be provided by Police and Victim Support. It is so difficult to get help at the moment, especially if the incident happened some time ago.

My TBI happened during my early 30's. I was in a single car wreck. I almost put my nose through my brain. To the point where I had spinal fluid coming from my nose. I'd crushed both cheekbones, nose, and de-gloved my face. I have several of the symptoms of TBI frontal lobe damage. Personality​ change, excessive talking, ( I call it diarrhea of the mouth ) inappropriate conversations with strangers. Attention problems, and memory problems mild depression. It seems to be getting worse. I go to a therapist and a psychiatrist. I'm not sure what I can/need to tell them to help with this.

Many therapist have sliding scale fees in order to.make counseling more affordable.

My TBI is cognitive impairment ending a professional career. Trying to organise counselling myself is need impossible. No one seems to understand this issue.

Having suffered a brain injury myself I found counseling very helpful. Now I would like to help other brain injury sufferers. Where do I go from here?

What's a person to do when you can't afford all the copays for therapy?? Especially when the survivor wants help!!

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