Therapy with a TBI

Should the approach change?

I’ve been learning about Internal Family Systems Therapy, or IFS, and I love it. Many neurodivergent people, myself included, have developed a system for understanding intellect and emotions that we describe as similar to having a crowd of people in our heads. IFS not only explains this phenomenon, but is a full therapy approach to help people get to know those internal parts better and create a more functional system.

There is a big difference between identity disorders and an “internal family.” Those of us who use characters to describe our emotions do not believe there is a real extra person in our identity. It’s just how we process the different ways in which we think and feel. For me, I also describe my mental world as populated with cats and monkeys, but I don’t actually believe there are real cats and monkeys in my mind. It’s just a way to describe how my brain functions and feels.

Internal Family Systems Therapy is a great approach for people with trauma. It helps us understand how we may be repressing, covering up, and reacting to what happened. We are likely to have parts of ourselves that try to protect us from the memories, and other parts that may hide and try not to be seen. IFS helps us understand our different parts in ways that creates more inner understanding and cohesiveness.

But what happens when someone, like me, suffers a significant TBI? Might there need to be a different approach? I don’t know the answer to that, yet, but what I do know is that all of my internal parts, in the blink of an eye, had to learn new jobs. The parts that were protecting me from past trauma had to quickly pivot to something new. My traumas have all been about people hurting me. Even the TBI was caused by someone external to me hurting me, but the TBI itself is internal. This new threat, this new trauma is part of me. And I feel so lost as to how to proceed with healing.

I’ve been told by my PT, OT, and Speech therapists that we will continue to work in the hopes of getting better but that we all need to manage our expectations. I may not get much, if any better. I may just have to keep working the rest of my life so that I at least don’t get worse. I’m exhausted, constantly. I have migraines, constantly. Just the process of making thoughts and words makes all this worse. So, I now feel like my brain is holding me hostage. The abuser is no longer external. It’s the TBI.

Like I said, I don’t have answers right now, but I’m looking for them, and I’ll write about them when I find them. A TBI can change everything, to the point that you may not even feel very much like yourself anymore. The changes I am having to cope with have made me feel vulnerable, scared, anxious, and so sad. I will absolutely continue to work. Even if I’m just maintaining my new normal, it’s worth the effort. But it is so hard.

If you are dealing with a TBI, and you are in therapy of any kind, it may be a good idea to ask if your therapist knows about how a TBI impacts a sense of self, the processing of emotions, and other aspects of therapy. Our brains are different from before the TBI. So, maybe our therapy should be as well.