This text discusses counseling interactions that may be used with clients following traumatic brain injury. In order to be effective, counseling must not only facilitate a person's capacity for self-determination in the face of external barriers, but also help clients gain access to and awareness of the inner psychological processes that influence their decisions. It requires that the counselor understand the various ways in which the traumatic brain injury may be manifested and the common cognitive, emotional, and personality disturbances that can occur. Topics covered include psychological disturbances after traumatic brain injury, neuropsychologically mediated and organic problems, emotional reactions to injury, pre-injury personality characteristics, psychological assessment, counseling interactions and the therapeutic relationship, and specific interventions for cognitive and behavioral problems related to vocational rehabilitation procedures and outcomes.