Investigations of Friendship Following Traumatic Brain Injury

Abstract

This research is comprised of two studies, both conducted with the overarching aim of investigating friendships following traumatic brain injury (TBI). The first investigation was a survey study. Sixty-eight speech pathologists who work with clients who have sustained a TBI were surveyed. The survey aimed to answer specific queries surrounding the current perspective of speech pathologists when working with friends, the reason that speech pathologists work with friends, barriers to working with friends and why speech pathologists perceive that some friendships succeed post TBI. Responses were analysed using a combination of descriptive statistics and content analysis of the open-ended responses. Results showed that 39.71% of speech pathologists work with friends. In comparison 60.29% speech pathologists do not work with friends. Indirect work is the main type of work that is conducted surrounding friendship. Education is provided to friends more so than training. Speech pathologists worked on friendships for a variety of reasons. These reasons fell into two broad categories, including providing therapeutic benefits which positively affected the work conducted by the clinician and it benefiting the person with TBI directly in some way. Numerous barriers were identified to working with friends, however the major barriers included time constraints, difficulty accessing friends, the suitability of pre-injury friends for the person with TBI to be interacting with post TBI and the person with TBI choosing not to engage with friends. The reasons that speech pathologists attributed to success in the area of friendship post TBI could be considered within the framework provided in the International Classification of Functioning (ICF) (WHO, 2001). The responses that speech pathologists provided in this question mapped on to the ICF, providing a framework to report on these. Body structures and functions, activities and participation and environmental and personal factors were all considered to be important in the maintenance of friendship post TBI. The second study was a qualitative study. This study addressed the question, why do some friendships succeed post TBI? Nine individuals, who were identified as friends by four adults with TBI, were interviewed. Data collected via semi-structured interviews were analysed using a grounded theory approach. Open coding, focused coding, followed by theoretical coding was conducted to develop the proposed theory: Actively placing the self in the friendship. The model proposes that two processes exist simultaneously. These two processes are: making sense of the TBI and its consequences and maintaining normality in the friendship. It appears that friends engage in both of these processes, which allows them to actively find where they fit in the friendship once their friend with a TBI has sustained their injury. The proposed theory provides details of the types of consequences that friends find out about and how they engage in learning about these consequences. It also illustrates how normality is maintained in the friendship post TBI. Together, these studies provide a thorough and rich description of friendship post TBI from the perspective of both speech pathologists and friends of those who have sustained a TBI. The results provide building blocks to enable a more systematic approach to the current work that is conducted surrounding friendships post TBI. Importantly, the firsthand ideas and experiences of friends who have maintained their friendships with people with TBI are considered and can now be used when developing approaches to working with friends.