Therapists’ Guide to Overcoming Grief and Loss After Brain Injury This page intentionally left blank Therapists’ Guide to Overcoming Grief and Loss After Brain Injury Janet P. Niemeier • Robert L. Karol 1 2011 1 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2011 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. 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 This page intentionally left blank 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