Continuity Therapy

A new approach to helping couples maintain a good relationship following brain injury

Brain injuries such as traumatic brain injury and stroke can put a strain on a partnership/marriage.

A team of researchers has developed a new psychological therapy for couples to help them maintain a good relationship. The team is led by Gerry Riley at the University of Birmingham in the UK.

This website tells you:

  • what the therapy is about

  • what we have done so far to develop and evaluate the therapy

  • what we plan to do next

We’ve made a video about the therapy and what we have done so far. You can watch it here or on YouTube: https://www.youtube.com/watch?v=a5H2TnCW6lg

What is Continuity Therapy?

The couple meet with a therapist for about 10 weekly sessions to discuss how their relationship has changed and what they can do to make things better. The therapist will also encourage the couple to develop a more positive story about themselves and their relationship. You can read more about these aspects of the therapy by following the links.

  • The therapy is based on research about the different ways in which brain injury can undermine relationships.

    • With the therapist, the couple explore these issues, thinking about how the relationship was before the injury and how it is now.

    • Issues that the therapy explores include such things as getting stuck in care-giver and care-receiver roles, changes in how the couple spend their time together, and changes in how they communicate.

    • When the couple identify an aspect of their relationship that has changed for the worse, they think about how they would like it to be - using how it was before the injury as a guide to their thinking.

    • The couple then set themselves some goals to work on to repair the damage, making changes in how they interact with one another in their everyday life together.

  • The stories we tell about our lives influence how we feel. Stories about living with brain injury are often very negative. The therapy encourages the couple to reflect on the positives in their relationship so that their story is not a completely negative one.

    With the help of the therapist, the couple reflect on:

    • What is really important about their relationship, what really matters

    • What hasn’t changed about the relationship since the injury

    • The strengths of the relationship that have helped it deal with the challenges of the injury

    • How the relationship may have grown and developed in a positive way in response to the injury

    • Their past and their future together, and how the brain injury fits into the story of their life

    To help couples develop a more positive story, they are encouraged to do something creative that captures some positive aspect of their relationship. Couples have done things such as making a video or slide show, or working together on an art work.

“Really glad that we took part. What it has achieved is fantastic…I read that people who are the partner of a brain injury survivor, had, I think it said a 60% chance of being divorced, and that really worried me. But I’m not worried by it now - the therapy has helped. Probably stopped me from getting a divorce.”
— Amy

What we’ve done so far

We’ve carried out a pilot study. Feedback from the couples who took part has enabled us to improve the therapy. We also looked at how useful the couples found the therapy and the results were very promising.

  • Fifteen couples living with brain injury took part. 

    Questionnaires:  Couples completed questionnaires about their relationship and their psychological wellbeing – before therapy, immediately after therapy, and at 3-month follow-up. 

    Ratings:  They rated the therapy in terms of how useful they had found it on a 7-point scale. (from 1 = not at all to 7 = very useful)

    Interviews:  They provided feedback about what they found useful (or not) about the therapy, and suggestions about how the therapy could be improved.

    • Questionnaires: On average, the couples showed large improvements in their relationship, and moderate improvements in their mental wellbeing. These improvements were still there 3 months later.

    • Ratings: Participants gave an average rating of just under 6, on a scale from 1 (‘not at all useful’) to 7 (‘very useful’).

    • Interviews: Couples made useful suggestions about how the therapy could be improved. Most of them also gave very positive feedback about how helpful the therapy had been.

    • Not everyone benefitted: The therapy requires couples to change how they interact in everyday life. For various reasons, some couples struggled to make these changes and benefitted less from the therapy. Timing of the therapy was also an issue, with some feeling that the therapy had come too soon or too late for them.

What’s next?

Although the results of the pilot study were promising, the therapy needs to be properly evaluated before it can be recommended for use.

We applied for a research grant to fund this evaluation but, unfortunately, we weren’t successful.

Instead, we will be evaluating it in a smaller-scale unfunded study. We plan to start this at the beginning of 2027.

Interested in finding out more?

You can contact Gerry Riley by email at: g.a.riley@bham.ac.uk

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This work has been supported by a grant from the National Institute of Health Research, by Birmingham Community Healthcare, NHS Trust, and by the University of Birmingham, UK