Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Relationship Issues - Leadership in a Relationship

Question:

Dear Kathy M.,

My husband and I have been married for about 20 months. He is a survivor of a severe head injury, which happened in 1992. He wants to feel like more of a leader in our relationship, but this is difficult due to his lack of executive functioning and no short-term memory. Do you have any ideas as to how I can help him feel more like he's in control?

Barbara W.


Kathy's Response:

Dear Barbara,

I would like to frame the question in a slightly different way. Instead of "How can I help him feel more like he is in control," it would be, "How can I help him learn to be in more control?" Not only will he feel a greater sense of control when he IS in more control, if you try to help him feel in control when he really is not, you may end up with a short-term solution that backfires on you down the road.

In my view, the key to both being in control and feeling in control is learning basic compensatory skills and strategies. This is best done in steps. You mention "leadership." That implies responsibility. Could the two of you sit down together and explore what areas of the relationship he (and you) would like to work on and build toward more leadership by him taking responsibility for a particular area? If you could start small and work on some basic things, this might be a way to get started.

I'm curious how the household responsibilities are divided? Does he participate in shopping, running errands or paying the bills? Would any of these things appeal to him?

Now, if he doesn't have basic compensatory skills for things related to the work of daily living, it's likely that he does not have the skills he needs for leadership either. I wouldn't be surprised if you are handling all of these things (the checkbook, the shopping, running the house and making most of the decisions!).

Now, if a particular "life area" appeals to him that would be a place to start!

Leadership

I get the sense that when you use the word "leadership," you are really talking about decision-making and planning. Leadership usually implies making decisions or at least participating in them. It can also involve planning.

In the absence of a brain injury, decision-making and planning require memory, judgment and skills related to setting priorities, sequencing, and other things we are generally not aware of in terms of the process (the cognitive steps anybody would take to actually make a decision). When a brain injury is present, and memory is impaired, compensatory strategies need to be in place so the memory problem is not a barrier.

Let's say, for example, as a couple you have decided to take a winter vacation between Christmas and New Years, instead of a summer vacation. If your husband takes on the responsibility of planning the vacation (as a way to exercise more leadership), and then tells you he has booked rooms at the beach for next June, you have a problem (particularly if you have already made arrangements for where the kids will stay during their winter break). While he may want to be in a leadership role for things like this, the fact of the matter is that memory problems, in the absence of compensatory skills, may just set him up for failure and be a source of added tension and frustration. Depending on how impaired his memory is, this scenario could turn ugly: "What do you mean, we agreed to a winter vacation?"

How compensation skills help

All the executive function skills (planning, decision-making, problem-solving and judgment) rely on memory. Either organic memory (the kind of memory persons without brain injury have access to), or prosthetic memory (the kind of memory persons with brain injury have access to when they have learned to compensate). No getting around it!

Planning requires knowing what the goal is, knowing what one needs to execute the plan, being able to estimate time, and being able to do something I call "back planning." (planning steps in reverse, starting from the goal date). Decision-making requires knowing what the objective is, what the options are, and being able to evaluation likely consequences from each possible option. Problem-solving involves knowing how to articulate the core problem, knowing how to figure out possible solutions, and again, being able to evaluate likely consequences of each option. And of course judgement, requires many of the same processes.

Memory (again, either "organic" or "prosthetic") is necessary for all of these things!

I have yet to meet someone with impaired memory who can do these processes well, in the absence of having compensatory skills. My guess is that the reason is that these processes require "holding onto" so many details (seeing how they all fit together), that the process invariably breaks down when the person tries to rely on their impaired memory alone. I find it difficult to hold onto two or three bits of information (in my head) at any given time. Add 15 or 20 other "information bits" to the scenario, and I'm lost in space.

On the other hand, since I have learned paper-based skills for mapping out "decision trees" and the like, I can hold onto many bits of information in order to make decisions, solve problems, and make plans, because they have been transferred to paper and are visually available to me. On paper, they don't "float away" (the feeling I get when I try to hold on to too much in my head).

Teaching strategies for "knowing"

These skills can be learned. More importantly, they can be taught! Even when a severe injury has been experienced, many of these skills can be learned! But this gets us back to my point in the second paragraph of my answer -- these skills are best taught in steps.

Start small. Learn about strategies for "knowing what I need to buy at the store" and help him learn to do this successfully. Note, I did NOT say "strategies for remembering" what I need to by.

Learn about strategies for "knowing what happened yesterday" (again, not "strategies for remembering"). Strategies for "knowing something" helps everyone focus on what is do-able. And it has the effect of "remembering."

This is an important distinction! I can tell you what "Kathy M's" last question was because I have strategies for checking my Memory Notes. I cannot remember these kinds of things. I can tell you what I need to buy at the store, and I will actually come home with what I need, because I have a strategy for writing shopping lists, and finding them when I am shopping. I couldn't tell you what is on the list without looking at it, because my memory is too impaired. Wandering the aisles of a store will not generally "cue" me, either, as would have been the case in my pre-injury life. I can't even tell you what my goals for 1999 are, unless I look at my notes! I know where to find them, and I can read, so I can tell you what they are. I know lots of things! I may simply not be mindful of them at any given moment -- until I look at my Memory Notes! For me, the key to using information (including information I need to see when I'm making decisions and solving problems), is (a) having it be visually available and (b) having the skill to know what to do with it.

Again, I would start by focusing on strategies to compensate for memory impairment. Then write back, and we can talk about specifics related to strategies for planning, which is the next skill I would select for building a foundation. Hope this helps.

Kathy M.

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