Brain injury has a profound effect on the family system. When the survivor is a spouse, the impact is especially devastating. Roles in the family are changed, responsibilities are shifted and economic stability is often challenged. The noninjured spouse frequently faces these difficult circumstances without the customary support of his or her marriage partner. The cognitive and behavioral changes which are associated with brain injury alter the survivor as a person. This creation of a "new" member of the family system necessitates major adjustments as this individual is reincorporated into the family. It is not unusual for friction to develop between the noninjured spouse and the in-laws. Because the experience of spouses is different from the experience of parents of persons with brain injury they may benefit from a mutual support group exclusively for spouses.