LIVE, LOVE and CELEBRATE MARRIAGE (& Relationships) After Brain Injury

1. LIVE, LOVE and CELEBRATEMARRIAGE (& Relationships)After Brain Injury This presentation is based on TBI Model Systems research and was developed with support from the National Institute on Disability and Rehabilitation Research (NIDRR). Additional material added by BIA-MA, 2014.

2. COUPLES’ RELATIONSHIPS AND BI BI can significantly change a couple’s relationship. The following life changes typically affect intimate relationships after BI : • Changes in responsibility • Changes in relationship roles • Changes and challenges in communication • Changes in physical intimacy • Changes in financial status

3. How do responsibilities typically change? • As BI survivors focus on getting better, they often give up work and household responsibilities. • Partners assume responsibilities formerly managed by the survivor, such as: Household management Yard work and home maintenance Managing household finances Planning and organizing family activities • There are new tasks for both survivors and their partners, such as: Managing the health care of the survivor Planning, organizing and remembering tasks

4. What happens when responsibilities change? • The person with BI experiences more stress when responsibilities change. • The stress of this change can increase tension between partners. • Partners with more responsibility have less time for other things, which affects how much time partners have to spend together. • The impact on one’s self is often ignored. • Each partner needs time for self care.

5. Tips to Improve Relationship Issues Related to Responsibility Changes • Be understanding about each other’s new responsibilities. • Take time and effort to note all the responsibilities your partner is managing. • Notice and talk about these challenges to reduce tension in your relationship. • Say “thank you.” • Make a commitment to thank your partner for attempting to manage new responsibilities.

6. More Tips… • Schedule opportunities to take breaks from responsibilities. • Delegate and use support systems. • Celebrate self care and the care of one another. • Find creative ways to be appreciative.

7. Relationship Roles • In all families, people take on specific roles. • After BI, the challenge of recovery nearly always results in some changes to the role within the family. • The partner frequently needs to make decisions that are usually made by the person with BI.

8. Changes in Relationship Roles • BI results in dramatic role changes that occur instantly and without preparation. • Changes in roles may appear temporary; however, some changes may be permanent. • The partner often takes on more leadership in the relationship.

9. What happens when relationship roles change? • It may be harder for a couple than a single person to adjust to the change. • Couples who have recently begun a new phase of their relationship, such as marriage, having children, or being a new “empty nesters”, may have a more difficult time with changes in roles. • Uncertainty, frustration, fatigue and physical issues can result in increased tension between partners. • People close to the couple (particularly extended family) may not understand the need for role changes.

10. Tips to Improve a Relationship When Roles Have Changed • Openly talk about these changes and how they affect your family. • Be conscious to not criticize the partner who is taking on a new role. Offer help instead. • Support one another in new roles. • Openly communicate and educate your family and friends about brain injury including the changes it brings.

11. Communication • Communication is the foundation of a healthy relationship. • Communication takes place through gestures, facial expressions, and emotional reactions as well as physical interactions. • In studies on relationships after BI, people often report the biggest challenges in the area of communication.

12. Changes in Communication For the partner of an individual with BI, common changes can include: • Talking less/more/louder • Communicating more intensely or urgently • Avoiding communication For both people in a relationship, common changes can include: • Increased stress levels, which affect communication • Fear that sharing negative thoughts or feelings will burden their partner

13. What happens when communication styles and patterns change? • Both partners can feel alone and isolated. • One partner may not understand what the other is thinking or feeling. • Difficulty communicating can cause partners to pull away from their relationship. • Communication struggles can affect all parts of a relationship and make it difficult to adjust to changes together.

14. Tips for Improving Couples Communication • Make a commitment to improve communication with your partner. • LISTEN LISTENLISTEN • LISTEN for points where you can agree rather than focusing on disagreement. • When you disagree, slow down. TAKE A TIME OUT, if you need one. Think about what you might say before you say it. Often people with BI feel they will lose a thought and therefore blurt it out. Memory issues are very frustrating for those with BI and their partners.

15. Tips for Improving Couples’ Communication • When a topic is likely to cause a disagreement, practice what you would like to say in a mirror before you start the conversation: Look at facial expressions, gestures, and body language Choose your words carefully. • When you talk, try to stick to what you practiced. • Consider your timing for difficult conversations. Everyone has a best time of the day.

16. Tips for Improving Relationships • Start with a primary care physician or neurologist who knows BI. • Find a therapist who knows BI. • Try a brain injury support group that helps couples. • Find local information and resources by contacting BIA-MA (1-800-242-0030) • Spend time apart to pursue individual interests such as sports, clubs or the arts.

17. More… Tips for Improving Relationships • Consider web-based support groups and blogs related to BI. • Commit to establishing a positive environment and look for opportunities to have fun as a couple. • Schedule a monthly “Date Night” or special day and write it on your calendar. LIVE, LOVE & CELEBRATE RELATIONSHIPS

18. Considerations in Nontraditional Relationships • The lack of understanding of nontraditional relationships may impact a couple’s ability to obtain care and impact the success or failure of a relationship • Consider counseling if added support and guidance are needed.

19. Concerns about Divorce or Separation • Rather than focusing on the possibility of divorce or separation, couples should focus on improving the quality of their relationship with one another. • In some cases divorce or separation is necessary. • Talk to a therapist who knows BI, your primary care physician, or your religious leader.

20. For additional resources on living with brain injury, please visit:Model Systems Knowledge Translation Centerwww.msktc.orgBrain Injury Association of Americawww.biausa.orgBrain Injury Association of Massachusettsbiama.org

21. LIVELOVEandCELEBRATEYOURRELATIONSHIP!