Social Communication Skills After Brain Injury

Craig Hospital
Social Communciation Skills After Brain Injury

Communicating is something that can be difficult for everyone. Often, it is made even more difficult by a brain injury.

Communicating is more than just talking. To actually "communicate" we also must share information with another person. Effective social communication includes:

  1. being able to listen to and remember what you hear
  2. taking turns with the other person, and not interrupting
  3. sharing the information you have accurately and without rambling
  4. saying things in an organized manner and making sense
  5. using tone and emotions that fit the situation
  6. "give and take" with the other speaker. Don't make the other person do all the work
  7. being aware of how what you are saying is affecting the other person

If we combine all the things that we just listed above, they are part of something called "Social Communication."

Characteristics of social communication issues

People who have trouble with social communication might have some or all of these characteristics:

  • Their communication is confusing to others.
  • When they talk, they may give too little or too much information.
  • They might be disorganized.
  • They might ramble and repeat themselves.
  • They might not catch and correct errors they make when talking.
  • They may not make sense.
  • They may not stay on the topic.
  • They may not give the listener enough detail.
  • What they say may not be interesting.
  • They may talk or process information too slowly.
  • The other person may have to ask a lot of questions and do more than his or her share of "the work" to keep the conversation going.
  • They may give more information than the other person wants to hear.
  • They may not know how to use "clues" or "hints" from the other person. This includes things like gestures, eye contact, and emotions.
  • They may not be able to tell if they are making the other person uncomfortable.
  • They may fail to read the other person's emotions. Is he sad? Is she angry? Is he in a hurry?
  • They may not know what the other person is driving at; they may not know what the intent is or where the other person is coming from. For example, if someone found out that his best friend had just lost a job, he would talk one way. If he learned that the same friend had won the lottery, he would talk in a different way. And, if he saw a friend at a party he might talk differently than if he saw the same friend in a library.

What happens when communication skills are not good?

People with brain injury can struggle with social communication right after their injuries, and for months and even years afterward.

Here are some of the things that can happen over time when brain injury makes social communication difficult:

  1. At first, it may just be a lot of work to know what to say and how to interact with others.
  2. Then, some people may just stop trying. They may not want to get involved in conversations.
  3. Others may not want to get involved in conversations with the person who has the brain.
  4. After awhile, it may be hard to make or keep friends; it may be hard to find a "girlfriend" or a "boyfriend."
  5. It may be hard to keep a job.
  6. Eventually, self-esteem may be affected. The person with the brain injury may not feel very good about himself or herself. He or she might have a sense of failure.
  7. As a result, some people may start to feel isolated. This feeling can continue many years after the injury.

Re-learning communication skills

If you, or someone you know, has some of these symptoms after a brain injury, there is good news: social communication skills can be improved in many people. Training and practice help - especially when the practice is in real-life situations. One good way to work on your social communication skills is to join a treatment group of people who are working on the same thing. Groups usually have several people with brain injury, and they are usually led by a psychotherapist or speech therapist who is experienced in social communications. But, if there are not any groups near you, you can still practice on your own with a partner, friend, or family members.

Social communication exercise:

  1. Review the issues and symptoms that are described above. Make a list of the ones that you think are problems for you.
  2. Work with a partner, friend, or a family member to get their ideas too. If they listed any different problems, add those to your list also.
  3. Start with the things that are the most significant problems for you or that limit you the most.
  4. Set a goal. Pick one problem that you want to work on. Think about things you can do, when talking, to help this problem.
  5. Tell your partner or family member what your goal is. Ask them to give you feedback about how you are doing. If your goal is to not interrupt others, ask them to let you know when you have interrupted. This should be done in a way that does not embarrass you. For example, they could give you a "secret" signal if you are in public, or they could talk to you privately later on. You may want to have a time each week when you can get feedback on how you are doing with your goal.
  6. Remember that getting feedback on how you are doing can be hard. You may not agree with what the other person is telling you. It may be frustrating. However, becoming aware of your strengths and weaknesses is the first step toward improving your social skills.
  7. Keep practicing your communication skills and goals when you are out in public - when you are shopping, at school, or at a party. If your partner or family member is able to observe you while you are having a conversation with a stranger in the "real-world," check with them afterwards. Ask them for specific and honest feedback. Be sure to ask them about the particular problem area you were trying to focus on.

Some final tips to remember

  • Keep good eye contact
  • Get to the point, and stay on the topic
  • Take turns talking and listening
  • Remember to ask questions
  • Be friendly and relaxed
  • Be aware of body language - yours and the other person's

Practice, practice, practice, and then practice some more. It will almost certainly get easier if you do. Good luck!

Posted on BrainLine July 25, 2008. Reviewed January 28, 2019.

From Craig Hospital, Englewood, Colorado. Reprinted with permission.

Comments (14)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

None of this actualy is HOW to have a conversation again. Working on problems is good and all, but HOW? Not all of us can access extremely expensive therapy to get the HOW TO of focusing and holding a conversation. Every single thing I’m finding online dances around the subject like a pacifist kung fu master in a fictional movie, or a bullfighter dodging the charging beast. Not one single HOW for the one with the TBI.

I’m 19 years post Severe TBI. Pre-frontal cortex and right temporal lobe damage.
It took 6-8 years to become a financially contributing member of society again. (I was able to get off disability, hold a job and pay taxes)
I had gone back to school and studied Communications. Basically re-learned, how to learn. I’ve come up with several work arounds for a lot of the verbal issues, like word finding and forcing the words to actually come out of my mouth. :)
Working as a Represenative for several manufacturing companies, I am quite respected in my multi-state territory as an expert in a very technical field.
All of this is considered miraculous, by medical professionals and most who hear the story. And I agree, it’s pretty amazing.
At the same time, I’m dreadfully alone. Once the calls from people who need something from me stop, I have no connection with people. I haven’t been able to feel a loving human connection in 19 years.
Everything I do during the day, is an act. I can read and respond with people in a work context, but not in a social context. My ability to relate to people on an inter-personal level seems to be gone.
Depression rules my life.
I wish more than anything I could flip a switch and stop existing. But the guilt and shame associated with suicide prolongs my living.
People in a similar place, you are not alone in your loneliness.
We look fine, and are much higher functioning than a lot of other survivors, but it’s miserable.
Yes, the main focus needs to be with heavily debilitated survivors. Those resources are what helped the practical part of my brain re-engage. Hopefully one day we have the knowledge and resources available to help survivors at all levels, and even more so on the emotional side.
Thanks to everyone working toward this goal.

MB, you are a strong survivor. Don't give up on yourself. Stay engaged with your medical support team and keep checking back with them to see what is new that they, and you, can do for you. I hesitate to suggest, however, has anyone told you whether neurofeedback therapy might possibly help in some way ? NeurOptimal is a very high quality treatment. Perhaps there is a practicing therapist in your area who can advise you. Finally, is there no TBI support group you can turn to for comradeship? I can't imagine it wouldn't help in some way. Blessings to you in your journey.

Thank you babies who every gave out this information..been trying to figure out how to get my baby better with his brain injury. And getting no help from the doctors. Their minds are on other things. Ur being with my baby fir 32 years everything has changed in just a few hours. Now I no what I have been doing wrong, breaks my heart that I feel I have been going at this in the wrong direction..thank you for everything, I can never ever repay you for this knowledge, I have asked several times at least 8 different people to speak with someone, but always something else going on he has brain cancer, but thank god found out today is doing better.. but my baby has changed forever. Now I understand everything about how he is feeling inside but having a hard time expressing ya always for this info..take care. Robert Scholes

I've been suffering with Tbi for 22 years (serious car accident where I was struck by car and drug) I have communication issues. No doubt. Boyfriend of 10 years has given up. Ready to walk away. I've tried swapping communication tactics. I always fail. No matter how I try I'm getting nowhere. And I don't have time for groups. I have 2 kids. So I'm stuck with someone who doesn't want to speak to me. People in stores. And my dog

I can be a friend if u want someone to communicate with. I can relate to the things u are talking about. I'm a TBI survivor and have similar things for the last 10 years. Find me on FB Josh Solt my picture is me with dreadlocks.

It may be more difficult to do, but you may want to try communicating via texting or messenger or some other form of writing. For some of us with TBI, writing and reading communications is a bit easier.

I understand your comment/question. After my TBI, loss of communication skills and abilities dramatically affected me. I have been avoiding interaction and conversation due to fear and embarrassment. It is very isolating. I am much more self-conscious around people I know so I found the best way to practice is with people who you don't know, and don't know you. And don't be too hard on yourself, you will make mistakes, you may talk too loud, you may forget what the other person just said, but don't give up, keep trying!!! It is in our human nature to need to interact and engage with other human beings, and I found that human beings are actually pretty kind, understanding, and compassionate for the most part. The practice has actually helped me gain a small bit of self-confidence back.

All of these treatments are great. If, like the article says you have someone to cope with (friend, family etc). However how does one who has no one, (tbi- fatal car crash with bf) other than his dog really put these treatments to use? Doesn't make much sense to this tbi victim.

Thank you for i have spoken aloud and felt awful after wards . Local support groups I find to be helpful , yet channeling enough to help one see error's ! Then a coffee shop with one friend at a time .

How can i work on social skills if it's only me, myself & i. yes, no one wants to be bothered w/me!

Part of communication difficulties can involve what is known as Central Auditory Processing challenge where voices, sounds are only partially sequenced/processed. There is a working memory aspect to much of it. There are cases where persons can repeat what another says verbally but have to write it down on paper so the words are processed visually.
I might ad that sporting events sound like a nightmare with all of the stimulation. Bookstores and Coffee shops make great meeting places, so does the library. Blessings.
For survivors of Traumatic Brain Injury, there is one word that encompasses many of the difficulties that survivors face, communication. Initially, survivors might be discouraged and more willing to remove themselves from social situations. I have found that retreating into yourself, lack of interaction, is the wrong way to go. Instead I would recommend opening up early on instead of falling into a routine that can be inescapable. A few spots that I have found helpful include coffee shops or sporting events.