The spouses that I've worked with have really found it tough because they often feel as if they've lost their life companion, and the spouse is no longer the same. And it's not uncommon to hear spouses talk about it's as if they're married to a stranger now. Or some spouses may say, "It's like I've acquired another child. Instead of having one child, I have two children." And this isn't meant to be disrespectful for the person with the injury, but that's the experience that the spouses often feel because they don't have the support around parenting, or support for themselves in addressing their own needs, so it's a very isolating experience for the spouses. And for the injured person, sometimes because they're more dependent as a result of their injury, it often leaves them feeling as if they're treated like a child, and so that's tough for them. And so part of the work with couples is to help the injured person find new roles in their relationship and new ways of being within the family. Even if it's as simple as reading a bedtime story to their child, that's a meaningful role. Or it could be as simple as helping to set the table. That's a meaningful role. And with couples, there are often issues around intimacy, the loss of intimacy because of the role changes and because the person with the injury is often so different, as a result of the changes of the brain injury. So part of my work with couples is often helping them to rebuild intimacy. When I talk about intimacy, I'm referring to many dimensions of intimacy. Often people confuse intimacy with sex, and those are two very different things. I do a lot of education with couples around sexual changes after a brain injury because it's quite common that people will experience changes in arousal or changes in libido and changes in sexual functioning. So it's important to normalize that with couples, so that they don't feel like they're the only ones or that there's something really wrong with them. The education part is very important, but I also try to help couples look at many dimensions of their relationship. There could be ways of rebuilding emotional intimacy. There could be ways of looking at recreational intimacy, doing things fun together, or discovering new hobbies together. It could be around being involved in new activities or new projects. Those are ways to help couples rebuild their relationship, and I try to move it away from just sexual intimacy. If that's an area that couples want to work on, then, of course, but then part of it is also helping couples to redefine what it means to be sexual because, unfortunately, with media and society, it's really narrowed people's views of what it means to be a sexual being. And so when I'm working with couples where one person has had compromise to their sexual functioning because of the brain injury, I try to help them explore new ways of being sexual with one another, and--you know--sometimes people can discover new and neat ways that they may not have considered before and just to expand their definition of what it means to express love and sexual feelings for their partners. It could be as simple as holding hands. It could be as simple sitting in the sunset and watching the scenes. Families from different cultures may experience a real sense of taboo around talking about sexual relationships, and it's very private information, and so often what I do is--I mean-- first it's important to build a relationship, to build the report with the client and the family, and find out what it is that is important for them to work on. I also often say things like, "Well, it's not uncommon for couples to experience changes in their relationship, for example, changes in how they relate to one another, how they communicate, changes around intimacy and sexuality. So I try to normalize it and open the door for couples to explore those issues if it's relevant for them, and if they're not comfortable, they're not going to enter that door, and they're not going to lead me there, and I try to respect that. but at least they've been informed that these are things that couples commonly experience and that if they wish to address these issues or to ask some questions, or I can provide them with some literature, then at least that's a way for them to be informed that there are some options for them.
Posted on BrainLine April 29, 2009. Reviewed January 16, 2018.
Caron Gan is an Advanced Practice Nurse, Registered Psychotherapist, and Registered Marriage and Family Therapist with the Ontario and American Association for Marriage and Family Therapy (AAMFT). She has worked with clients with brain injury, providing psychotherapeutic intervention to youth, adults, couples, and families.
Produced by Victoria Tilney McDonough and Brian King.