Acquired Brain Injury (ABI) is a leading cause of death and disability, with life-changing consequences for both survivors and their families. Rehabilitation services often focus primarily on the injured individual whilst family needs go unmet, despite evidence of significant adverse outcomes including psychological distress and difficulties within family relationships. This chapter explores how systemic and narrative frameworks can support families living with ABI. A brief account of the research into family outcomes is provided, followed by a summary of the evidence base for systemic interventions for ABI. Narrative models such as the family tasks model and the life threads model are presented as frameworks for understanding the family experiences of grief and ambiguous loss, trauma, identity reconstruction, and resilience. Case material is presented to illustrate a systemic intervention through a Single Session Family Consultation framework, alongside individual narrative therapy, with a young person whose mother sustained an ABI. The chapter reflects on issues of power, diversity, and the emotional toll of this complex and potentially distressing context, and advocates for flexible, relationally informed interventions that validate family experiences and foster narratives of continuity, resilience, and hope within the enduring challenges of living alongside ABI.