It has been recognised for several decades that a moderate to severe acquired brain injury frequently causes a high level of psychological stress within the immediate family, who often provide long-term care and support. However, although there is an abundance of research evidence for family burden and stress following brain injury, research into the effectiveness of psychological interventions designed to support such families is relatively scarce. This paper will summarise some of the existing research literature and examine the clinical process of working with families following acquired brain injury. After a brief and selective review of the evidence for caregiver stress following brain injury, we will consider some theoretical models and concepts relevant to family work, and the existing research evidence regarding family interventions. We will then focus on our experience of working with families in clinical practice and our approach will be illustrated using a case study.