Letter writing helps families process brain injury grief

Writing letters to loved ones as they were before their brain injury may help families understand and cope with the complex grief that often follows, researchers have found.

A pilot study explored how a structured writing exercise could support families dealing with “ambiguous grief” – a form of grief experienced when someone is physically present but psychologically changed after injury.

Researchers from the University of Plymouth studied three mothers of teenagers living with acquired brain injury (ABI), which refers to brain damage occurring after birth, typically as a result of illness or accidents.

The intervention, called the “Hello Again” method, involved writing an initial letter to the loved one as they were remembered before the injury.

Participants were given prompts and grounding techniques to help them navigate difficult emotions during the process.

Two weeks later, they met with researchers to reflect on the experience before writing a second letter – this time from the imagined perspective of their pre-injury loved one responding to the first.

A follow-up discussion took place two weeks later.

Four key themes emerged in the analysis.

The first, ‘acknowledging grief’, captured how writing the first letter brought hidden feelings of loss to the surface.

One mother described the moment as an “epiphany”, while another reflected on being told she was “lucky” her child had survived, which made it difficult to express sadness.

One participant said: “The first time I was really aware about how difficult it is to talk to other people about it.”

The second theme, ‘finding space to mourn’, reflected how the intervention provided time to grieve.

One mother described the sense of always being in motion: “You’re on a permanent mission fighting some kind of battle.”

Another noted: “It’s really hard to keep it together when you’ve got this weighing down on you all the time.”

The third theme involved placing the injury within a wider life story.

One mother said writing helped her rediscover her identity beyond being a carer: “I so desperately just want to be your mum again. Not your carer… I just want to be your mum.”

Revisiting memories could be painful – “photos from that time feel unreal… a cruel taste of how life should be” – but helped integrate the past with the present.

One participant said the first letter revealed “what she had lost” and the second “what’s still there”, adding: “He’s fundamentally the same person in a different package.”

The final theme highlighted how writing itself, while emotionally demanding, was therapeutic.

It allowed for honesty: “completely honest… without being tactful or diplomatic.”
One mother said it led to “the most conversation we’ve had about it for a very long time.”

Researchers described the process as a ‘continuing bonds’ approach – encouraging connection with both pre- and post-injury versions of the person.

Feelings of guilt about missing the earlier version were acknowledged as a valid part of the grieving process.

The study involved a small sample of parents. Researchers suggest future trials could explore how the approach works across different types of relationships.