Therapists' Guide to Overcoming Grief and Loss After Brain Injury

201 Pages·2010·0.57 MB·English

by  Janet Niemeier

Therapists’ Guide to Overcoming Grief and
Loss After Brain Injury
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Therapists’ Guide to
Overcoming Grief
and Loss After Brain
Injury
Janet P. Niemeier • Robert L. Karol
1
2011
1
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Copyright © 2011 by Oxford University Press, Inc.
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Library of Congress Cataloging-in-Publication Data
Niemeier, Janet P., 1947–
Therapist’s guide to overcoming grief & loss after brain injury / Janet P. Niemeier, Robert L. Karol.
p. ; cm.
Other title: Therapist’s guide to overcoming grief and loss after brain injury
Companion volume to: Overcoming grief and loss after brain injury / Janet P. Niemeier, Robert L. Karol. 2011.
Includes bibliographical references and index.
ISBN 978-0-19-538896-1 1. Brain damage—Patients—Rehabilitation. 2. Brain damage—Psychological aspects.
3. Grief. 4. Loss (Psychology) I. Karol, Robert L. II. Niemeier, Janet P., 1947–. Overcoming grief and loss
after brain injury. III. Title. IV. Title: Therapist’s guide to overcoming grief and loss after brain injury.
[DNLM: 1. Brain Injuries—rehabilitation—Handbooks. 2. Brain Injuries—psychology—Handbooks.
3. Psychotherapy—methods—Handbooks. 4. Stress, Psychological—rehabilitation—Handbooks. WL 39 N672t2011]
RC387.5.N5432011
617.4'81044—dc22
2010015045
ISBN-13:9780195388961
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
To Betty and Bob for giving me an early life that allowed me to love
diversity and appreciate differences, and to Dave, Carrie, Clay, and
Carolyn, my wonderful family, who love and support me always and put
up with my preoccupations.
—JPN
To Rhona, for whom I will always grieve, and to Gwen, who helps me
survive everything: We are a team forever and ever.
—RLK
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Preface
When people present to professionals grieving loss, providers are often
uncertain as to how to proceed. There are known protocols and treat-
ment pathways for depression, anxiety, etc., both through psychother-
apy and medication. Not so with grief, particularly after brain injury.
People are generally unprepared for hospital rehabilitation. Moreover,
while medical advances are keeping more people alive following brain
injury, health care coverage and lengths of hospital stays are shrinking so
that optimal rehabilitation is not always available for persons with brain
injury and there is not enough time to grieve. People with brain injury
are getting discharged to the community very quickly. Now lengths of
stay are measured in days and weeks and no longer months. There is
insuffi cient time to help people learn to respond to having a brain injury.
Many people are not emotionally ready and are still experiencing sig-
nifi cant grief at hospital discharge. Also, they often arrive back home
with signifi cant levels of impairment in cognition and functional skills.
Furthermore, outpatient services are frequently fragmented or beyond
people’s means to access.
Hence, there are two problems: inadequate time in rehabilitation and
disjointed follow-up care. Both make grieving much harder. This in
turn leaves people with brain injury at a loss to fi nd their emotional way.
The companion book to this one, written for people with brain injuries,
Overcoming Grief and Loss After Brain Injury, was written to help people
respond to brain injury. Therapist’s Guide to Overcoming Grief and Loss
After Brain Injury was written to help you guide the people who seek
your advice.
The intent is to help you convey hope and coping strategies. We believe
that persons with brain injury can respond to brain injury successfully.
Note that we said “respond,” not adjust, since we believe that this is an
ongoing process, whereas “adjust” implies fi nality. Learning to respond
is part of life and we are ardent believers in the capacity of persons with
brain injury to respond.
Janet P. Niemeier
Robert L. Karol
viii
Acknowledgments
I have learned from many hundreds of my clients with brain injury how
little there is out there in terms of practical resources to help people with
brain injury and their families adjust to this complicated and challeng-
ing injury. I hope the book will provide a strong foundation of informa-
tion and coping skills as well as a guide for not only clients with brain
injury but their therapists who want to help them. Thanks to all of you
for giving me the gift of sharing your experiences and selves for a little
of your journey.
I am grateful and want to thank all of my mentors at Virginia Common-
wealth University Health System Brain Injury Unit, Outpatient Neuro-
psychology and Rehabilitation Psychology Services, the Rehabilitation
and Research Center on North Hospital First Floor at VCUHS, and in
Egyptian. I have learned skills, patience, sensitivity, and empathy from
you all. Without your modeling and support I would not have been able
to reach this point.
My deep admiration goes to many wonderful colleagues tackling the
diffi cult issues on the community front line where fragmented services
for persons with brain injury lead you toward creativity, amazing advo-
cacy, and self-sacrifi ce that I have noted and tried to emulate.
To the staff of Oxford, I am grateful for your confi dence in us and sup-
port of this project which will hopefully help many persons and their
families who did not ask for but are trying their best to live with this
injury and its aftermath.
To my brother, Tim, and his family, Mary, Chris, Thomas, Chrystal,
and the new generation represented by Lucas. I am proud of you all and