[Psychological counseling of the family of patients with craniocerebral injuries (psychological family counseling of severely ill patients)].

Relatives of 235 brain-injured (BI) patients were observed by trained (psychiatric) staff for psychological coping. This was practiced since 1984 in a BI-rehabilitation ward at a regional psychiatric hospital with 450 beds, serving a catchment area of 330,000. In semi-structured observations patterns of emotional behaviour were registered, which resemble those presented by Kübler-Ross for relatives of the dying. Nevertheless important differences were noted: 1. Unrealistic expectations on the relatives' side: caused by insufficient information on differences of physical and cerebral rehabilitation and unfounded belief, transfer from the intensive care section itself signifies the patient's restitution. 2. Unrealistic evaluations: individual consequences of BI may be underrated by relatives, more so if no additional injuries illustrate the patient's severe condition. 2.1. Coma--interpreted as "pseudosleep". Frequently the next of kin are uninformed on the aetiopathology or consequences of coma. Restitution of cerebral functions in various stages of impairment cause confusion, anxiety, resignation even rejection on the side of the relatives. 3. Personality changes: disruptions of personal traits or characteristics as outcome of severe BI are widely known and regarded as formidable consequence. 4. Fear of reintegration; therefore this fear is not infrequent in the next of kin. Additional factors caused by personal history or psychopathology may complicate the issue. Attitudes to rehabilitation are determined by psychological reactions of relatives and may be crucial for the outcome. Recognition of pathological traits and management of psychological attitudes ensures optimal effect of rehabilitation. We noticed several phases in the relatives' psychological changes: acute, initial, protracted and final stage.(ABSTRACT TRUNCATED AT 250 WORDS)