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• I was interested in this excellent article in the March edition which highlighted many of the complexities of working with brain damaged clients. I have worked as a counsellor with individuals and families affected by stroke (an attack to the brain) for the past 14 years and during that time have fought hard to convince other health and social care professionals of the importance of offering counselling as part of the rehabilitation journey. The Stroke Strategy has recognised the need for psychosocial (emotional, practical and social) support post-stroke for affected families in conjunction with physiotherapy, occupational and speech and language therapy.
  
  Like most brain injuries, onset is sudden, often without any warning and for the survivor and family this can be traumatic. Losses ranging from mobility, speech, perception, change of role, self image, personal and social relationships, to name but a few, can have a profound impact on those affected. For these reasons and many others, counselling is a vital part of the stroke care pathway. As the article points out, counselling is challenging, particularly with clients with severe communication problems (aphasia), but often essential. Feelings still need to be explored, even if the words cannot be found, and creative ways using gesture, artwork and poetry need to be in the counsellor’s toolkit.
  
  Working with the partner who becomes the ‘caregiver’ is also important to help them understand and manage the physical and cognitive changes they face. As the article describes, a collaborative approach with other therapists is essential to achieve the best outcomes for the client, but this does raise issues of confidentiality and often stretches and challenges counsellors’ ethical standards.
  
  Many people who suffer brain injury or brain attack can, at some stage during rehabilitation, feel suicidal, and counselling offering containment through this difficult period is important. It is hard for a survivor to tell their loved one that they wish they hadn’t survived, but it often needs to be voiced, and a counsellor can receive and handle that information appropriately. But this is difficult and demanding work for the counsellor, work that cannot be hurried or time-limited. Progress can be slow but, from my experience, rewards are great and many families learn to live with their disabilities and can move on with their life. I would like to add to this article the benefit of using groupwork to enhance the counselling process. I have found that stroke survivors and carers have valued the opportunity to join a group following individual counselling. The opportunity to meet others who share the commonality of stroke is both supportive and empowering and is an important part of recovery.

• Sally Lockwood
  Bristol Area Stroke Foundation