Traumatic brain injury (TBI) can cause irreparable harm to individuals and have profound effects on families and communities. In addition to the physical and neurological effects, brain injury creates an intense boundary experience for clients that forces them to confront the existential givens of freedom, death, isolation, and meaninglessness. This article provides an overview of TBI and its existential implications for clients, emphasizing interventions and clinical considerations for mental health counselors working with clients who have experienced TBI.