One of the hardest things to realize in the wake of a traumatic brain injury is that nothing will ever be the same again.

For married and committed couples, the pain that comes with this realization is often doubled. With one partner focused on healing and adapting – a 24/7 challenge for most – the other is burdened with new roles and responsibilities.

“How can I do all the chores my husband used to do while I still have a full plate of my own?” a distressed wife asked me recently.

“Just helping him get to therapy and medical appointments feels like a full-time job,” she said. “Now I’m responsible for the grocery shopping he used to do, the bills he used to pay and the yard work he used to love so much.”

With weariness and resentment in her voice, she described how family, neighbors and friends were growing impatient with her. “They feel we’re isolating ourselves because we don’t go out much anymore. They just don’t realize how hard all this is for him … or for me.”

She was feeling the terrible mixture of guilt, exhaustion and confusion that virtually all spouses feel as they try to create a “new normal” with their brain-injured partners. Whether the trauma resulted from a car accident, a sports injury, a fall at work or home or a blast suffered during military service, the bottom line is that both partners are suffering as they try to adjust.

Why brain injury triggers a seismic shift in roles and responsibilities

The brain is the command center that governs the body. It’s more than just the center of our thinking and moods. Brain functioning affects our sleep, our speech, our memory, concentration and attention, our movement, balance, sensory input and so much more.

When you think of it that way, it’s easy to see how brain injuries can keep someone from handling the tasks they once did so easily and naturally. Even something as simple as raking leaves or washing dishes can feel like too much.

Having a traumatic brain injury, even a so-called “mild” injury, can keep your very talented and ambitious spouse from returning to work right away. This can lead to discouragement and even clinical depression, since all of us derive a great deal of satisfaction and purpose from our careers.

Fear, anger, frustration: the emotional burdens that come with changing roles

Beyond work, almost all spouses are in charge of dozens of tasks around the home, everything from cooking meals to handling finances and planning how leisure time and vacations will be spent. When virtually all the work within a marriage suddenly shifts away from one partner and lands on the other, there’s bound to be confusion and conflict.

“I can’t help it, but I just get so angry with her sometimes,” said one husband about his brain-injured wife. “It’s been more than a year. I feel she should be trying harder to get well. Then I realize how harsh I’m being and I feel totally ashamed of myself.”

This whirlwind of frustration, anger and guilt is something nearly all spouses feel. If you’re caught in that vicious circle right now, realize that you are not alone. There are skills you can learn that will help you feel more loving and supportive – not only toward your spouse but yourself as well.

5 ways couples can cope with the changes – and keep their love alive

Here are 5 things to keep in mind that will ease the grief and pain you’re feeling and empower you to support each other as you recover together.

1. Realize that healing is the survivor’s primary job — and will be for quite a while.
After a serious accident or injury, the one who’s been hurt needs to focus fully on getting well. The recovery period involves building and practicing new skills and trying to regain skills that were once sharp, but may now be compromised.

Progress is often very slow – and while medical experts can help, no one really knows how long recovery will take. Spouses must remember that their loved ones are rebuilding their brains, one circuit at a time. There’s no telling when s/he will be able to take back some of the duties that have fallen squarely on the shoulders of the healthy partner.

2. Acknowledge that what worked before is no longer practical.
There’s no getting around it. Roles and responsibilities have to change – often overnight. This may be a great source of frustration and embarrassment as the injured spouse visibly struggles to do even the simplest things, and the other staggers under an unmanageable workload.

You will feel better if you focus on accepting the realities in front of you. Everything IS different now; there’s no going back. With this in mind, how can you ease the guilt that the injured spouse feels because s/he cannot contribute as much as before? What chores can you pass along to friends and family members who offer to help? And what activities can you let go for now? Agreeing to map out solutions together in a loving way will keep you on the same page.

3. Give yourselves plenty of time to grieve.
We think of grief as something people face when someone dies, or perhaps when a relationship ends. But brain-injured couples need time to grieve, too. There’s a significant gap between the life you had and the one you’re living now. Allowing yourselves to feel sad and discouraged at times is part of fostering the acceptance and grace it will take to create a new life together.

4. Watch out for polarizing words and judgments that keep you from working as a team.
These can take the form of judgmental thoughts in your own mind or things other people say, often believing they’re being supportive.

“It seems like you’re the boss now,” a friend might remark, seeing all the responsibilities you’ve taken on. You can let that thought settle in, becoming a nagging grievance – Why should I handle all the housework? She SHOULD be helping more! Or you can respond by saying, “This isn’t about who’s in charge. It’s about figuring out a new way together, based on what we both can actually handle.”

5. See this as an opportunity to strengthen your relationship on all levels.
The silver lining inside the cloud of challenges you’re facing right now is that you have the chance to rebuild your marriage from the inside out. It’s tough – but in many ways, it’s also a gift.

You may welcome the chance to rebalance the duties that are part of everyday life. You can begin with a fresh slate – deciding bit by bit how you will share the work of providing an income, running a household and staying close to family, friends and community.

The new life you create may be totally different from the one you were living before. But if you build it together, it can be a positive, enriching and exciting life.

Why a trained couples therapist should be part of your care team

These 5 principles are fairly straightforward, but they’re often hard to embrace.
Look for a marriage counselor or couples therapist who understands the effects of brain injury. Your therapist’s knowledge will help you work together in a compassionate way, keeping your expectations realistic. Finding a safe place where you can say how you really feel will make all the difference for both of you.

There are so many practical skills that can help you along the way. To get your copy of my free guide, 10 Things You Should Never Say to a Brain-Injured Spouse or Partner, visit

Lori Weisman, MA, LMHC, began her health care career as a speech pathologist, learning firsthand from her clients about the painful challenges of living with a brain injury. A talented and caring psychotherapist, Lori has worked with thousands of married and committed couples who are rebuilding their lives in the wake of brain injuries. She is a frequent lecturer and consultant in her field and maintains a thriving practice near Seattle, Washington.