A Conversation with Taryn Stejskal
A Conversation with Taryn Stejskal by Barbara Stahura
November 8, 2012
Brain injury can change intimacy and sexuality among couples.
One major aspect of life typically ignored by traditional therapies after brain injury is family and couple relationships, particularly intimacy and sexuality. Yet, when something as devastating as a traumatic brain injury (TBI) is sustained by one member of a family, relationships can’t help but change. While post-TBI divorce statistics vary among sources, it is nevertheless true that adjusting to life with a brain injury, for both the individual and partner, can be extremely difficult. Many couples and families are left to decipher this new relationship on their own. Many of them flounder, and even more could forge a better relationship if only they had a knowledgeable expert with whom they could discuss these issues.
Fortunately, some therapists are beginning to meet the needs of these couples and help them understand and cope with their “new normal,” including intimacy, sexuality, and sex after brain injury. One of them is Taryn Stejskal, Ph.D., LFMT, who has devoted her study and service delivery to meeting the unique needs of individuals, couples, and families after one person has sustained a TBI or spinal cord injury (SCI). Her major clinical interests revolve around family and couple relationships after injury and illness, and in applying a systems perspective to recovery from injury, trauma, grief, and loss.
Stejskal has written several tip cards on this subject for Lash & Associates Publishing/Training: Couples: Hope and Intimacy After Brain Injury and Intimacy, Sexuality, and Sex After Brain Injury. Meant to be used by families, couples, caregivers, and counselors, these tip cards address an important, yet often neglected, part of life after brain injury.
How did you first become interested in this particular area of study?
I became interested in the intersection of acquired injury or ABI, TBI and SCI, after a friend and fellow competitive swimmer sustained a SCI. All of his friends saw how the structure of his home changed, how depressed he was, and how his drinking increased. But we didn’t have the language to talk about what was happening at that age, and we couldn’t find professionals to help who understood both the physical nature of the injury and the relational aspects of the injury.
What are some of the ways that relationships between spouses or partners can change after a brain injury?
I hear so often that almost everything changes—ability levels, what they enjoy, cognition. Typically, one person becomes a caregiver, which creates an imbalance. The caregiver generally has to make many adjustments, such as changing hours at work, in home life, going from a dual-functioning relationship to one person providing care for another. People sometimes say, “I had three children and a spouse, and now I have four children.” It’s emblematic of their experience, although it’s not productive to think that way.
The ways that couples relate sexually or intimately can change after brain injury, too. Why aren’t those issues addressed in the traditional rehab and therapy?
It has to do with our professional training. Typically, people involved in rehabilitation are physicians, physical therapists, neurologists, and neuropsychologists, and they’re trained to get the body physically back together and improve cognitive abilities. Few of them think of the impact of a brain injury on the couple and family relationships. There are no training programs for people who are marriage and family therapists to work with people with brain injury. So, people who know brain injury have no training in marriage and family counseling, and few or no counselors have training in brain injury. It’s one more thing that couples have to look for on their own.
What are some of the sexual difficulties that can occur after brain injury?
Simply put, after a brain injury, people fall into two categories. Either they return from the hospital and have no interest in sex, or they want to have sex and be intimate all the time. Both are difficult for their partners. Sometimes partners want to reconnect, but there can be physical issues. I’ve had couples come in, where the survivor looks at porn a lot and then asks his wife’s best friend to have a threesome. The wife is mortified, and the friend is shocked. But other couples have shared with me that the only time they feel whole again is when they’re intimate. It’s hard to create an umbrella that encapsulates the experience of multitudes.
Explain the difference between sexuality and intimacy, and how they get confused.
In my work, I tell people you can be intimate with someone without having sex, and you can have sex with someone without being intimate. Intimacy is about shared understanding, support, connection, feeling known and loved. Sex is about two people connecting physically, but not necessarily cognitively, emotionally, or spiritually.
From a cognitive perspective, intimacy can be upset after brain injury if the injured partner is having difficulty with memory, can’t remember what the partner said, what he or she did at work, birthdays, anniversaries, and so on. It’s hard to feel connected to someone who doesn’t remember or understand what is important to you. Also, some people have a flat affect, which means no emotionality. They can’t show or express emotion, and this experience also wrecks havoc on relationships as well.
How can couples restore not only their sexuality but their whole relationship?
Part of it, typically, is recognizing that the brain injury wasn’t anyone’s fault and that both partners have been irreparably changed by this injury. Both people do well when they take the opportunity to get to know this new person; really, they both need to get to know who they both are now after their experience with the injury.
This takes a lot of time and patience and grit. Not everyone’s up for that, and there’s no shame in that if you’re not up for the journey. Sometimes, there’s a lot of water under the proverbial bridge, too many other things are not working in the relationship, or too much distance between the partners already existed before the injury, and the relationship can’t be sustained. Divorce statistics vary, but they do present the opportunity for people to be hopeful. Yet, people with brain injury and their partners still get divorced. I don’t like to see people stay together out of duty, shame, or obligation alone. I don’t think this does anyone any good.
Finally, in your tip cards, you address the issue of hope and tell survivors and their partners that it’s important to maintain hope after a brain injury. Why?
We have a lot of capacity for strength, resiliency, and healing. Research shows that typically five to seven years after the brain injury, there is still a degree of difficulty and stress, but also that there is still the opportunity for life to get better, for people to rise to the occasion in ways they never thought they could. Brain injury can be a monumental teacher, and people can still live healthy, positive, generative lives. Typically, people who have hope have better lives even in the face of great catastrophe. I tell people to never give up, never stop trying, and to work hard to achieve the life they want every day.
By Taryn Stejskal, Ph.D., LFMT
By Taryn Stejskal, Ph.D., LFMT
Stress and Anxiety after Brain Injury
By Taryn Stejskal, Ph.D., LFMT
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