The 5 – 6 session program covers between one to three of the following sixteen topics in each session:
Effects of Brain Injury on the Survivor, Partner, and Couple
Topic 1: What is “normal” for couples after brain injury?
Topic 2: How are we different now? Common changes to relationships after brain injury
Session II: Healthy Communication and Managing Stress
Topic 3: Healthy relationship communication after brain injury
Topic 4: Managing stress as a couple
Session III: Setting Goals and Solving Problems
Topic 5: Setting relationally healthy goals as individuals and as a couple
Topic 6: Couples’ problem solving strategies
Session IV: Rebuilding Intimacy
Topic 7: Establishing post-injury emotional intimacy
Topic 8: Renewing physical intimacy
Session V (Optional Session): Parenting: New Challenges, New Strategies
Topic 9: Parenting 101: Post-injury parenting education and skills development
Topic 10: Parenting after TBI has no handbook: Common hurdles and strategies
Session VI: Strategies for Optimal Relationship Healing
Topic 11: Taking care of You; Taking care of You Two
Topic 12: Focusing on relationship gains and looking forward
*Although the TCI is typically administered in this order, the program can and should be tailored to meet the needs of each couple. For example, clinicians may choose to: 1)allocate one topic to each session and extend the program to 12 sessions, 2)extend discussion of a single topic to more than one session when a topic is very salient for a couple (ex. Session 4 – Emotional Intimacy; Session 4.5 – Physical Intimacy), or 3)focus on a subset of topics, to the exclusion of others.
** While Session 5, which focuses on parenting skills after TBI, is indicated as an “optional” session, it is strongly suggested that couples who have young children in the home participate in this module. Parenting after brain injury is a significant source of stress for most couples who have young children and is also an area rarely addressed in traditional rehabilitation programs.
The TCI incorporates a variety of tools to help families effectively address each topic. Family therapy techniques are integrated throughout the program, providing a experiential learning opportunities in every session. The TCI is delivered in the Curriculum-Building (C-B) format which has established efficacy for a variety of post-TBI issues and is built on a framework of psychological support, psychoeducation, and skill building. Additionally, questionnaires and worksheets are used in many of the sessions to facilitate collaborative self-examination. Collaborative self-examination is an intervention tool developed at VCU that relies on asking couples a series of questions to help them explore critical issues. Through this shared, guided discussion, couples are supported in developing a clear, mutually empathetic home environment. Finally, the TCI incorporates homework assignments, promoting adoption of new strategies which support relational health after brain injury.
The TCI was designed to be implemented with couples who are adjusting to one partner’s acquired brain injury, including traumatic brain injury, stroke, anoxic brain injuries, non-progressive brain tumors, and other acquired, non-degenerative neurocognitive impairments. Moreover, many modules may be adapted for use with couples adjusting to any chronic, non-degenerative health condition.
Additionally, many TCI topics, techniques, and materials can be used effectively in a number of different settings, and with a variety of therapy modalities. Settings which can appropriately infuse select TCI topic materials include: couples and family counseling settings, multi-couple therapy groups, support groups, health education classes, and occupational and speech therapy sessions. Clinicians are encouraged to modify and adopt the materials to fit the needs of their specific population and setting.
The TCI address special needs in the following ways:
- Written materials were developed in large print to accommodate visual impairments.
- The materials are written at a fifth grade reading level to accommodate individuals with limited reading skills.
- Information is presented with written, oral, and visual methods / aids to accommodate those with different learning styles
- Many of the important ideas and instructions presented are repeated to facilitate learning and recall. In addition, copies of all materials used in session are provided to both partners in individual binders, to facilitate future review.
- When participants have motor, reading, or writing deficits, surveys and questionnaires should be read aloud and responses recorded by the clinician.
- The program is flexible, allowing the clinician to personalize the program to address couples': emotional needs; specific relational challenges, cognitive impairments; and communicative skill levels.
As a whole, the program is designed to be implemented by licensed mental health clinicians, such as psychologists, counselors, social workers, marriage and family therapists, psychiatric nurses, or psychiatrists, who:
- have completed the minimum degree and certification requirements for their discipline;
- have experience working with patients who have brain injury and their partners;
- are trained to perform marriage or couples counseling/therapy; and
- have training in and understand the special needs of patients with brain injury.
However, there are some modules within the TCI that may be independently implemented by licensed clinicians who do not have systems’ training, or by health educators and non-mental health therapists (i.e. occupational therapists, recreational therapists, etc.). A chart detailing TCI modules and the level of training required to implement each module can be found RAI-BIFI-TCI Qualifications.
VCU offers customized training experiences for organizations or clinical practices interested in training a number of staff members at one time. Trainers are available to visit your organization and provide either two or three day training experiences. If your organization is interested in purchasing a customized training seminar, please visit our Training Info & Registration tab on the left for more information.
Based upon the success of the BIFI, VCU developed the TCI in order to provide clinicians with a framework for promoting healthy, resilient couples’ relationships after brain injury. Topics were identified for inclusion as a result of VCU research which identified a set of frequently cited TBI relational changes which directly correspond with skills that are necessary to generate a healthy, adaptive relational response to trauma (e.g. TBI relationship challenge – unequal distribution of partner’s responsibilities ; relational resilience skill needed – coupled collaboration and task reciprocity.)
Clinicians implementing the TCI should guide their practice by following these important principles:
- Injury causes drastic changes in couples' relationships.
- Most people want their old life and relationship back.
- The losses that follow injury are often ambiguous, challenging a couples ability to effectively manage stress, set goals, and problem solve.
- Well-informed couples do better.
- Each partner is an important part of a relationship and deserves to be treated with respect.
- Each partner has the right to make choices, good or bad.
- In the long-term, spouses often assume primary responsibility for helping the survivor.
- Spouses must take care of themselves in order to effectively help their partner and to maintain a health post-injury relationship.
First, VCU strongly recommends training in implementing the TCI. Trainings include a copy of the TCI Manual and a number of additional resources and materials that are useful in practice with survivors recovering from brain injury. To attend or schedule a training, please visit the TCI trainings page.
However, TCI Kits are available for purchase outside of trainings through the National Resource Center (NRC) website. The TCI Kits and other materials for working with families are available here. Or, visit our store to view other valuable resource materials created by TBI clinician researchers at VCU.
Please contact Jennifer Marwitz at Jennifer.Marwitz@vcuhealth.org.
Please see our recommended qualifications at RAI-BIFI-TCI Qualifications.