The purpose of this article is to identify the experience of the patient with a World Health Organization grade III/IV and IV/IV brain tumor, and that of their family, to best understand how to treat them. It is the cumulative input of hundreds of patients and family members seen over a 20-year career of specialization at two teaching hospitals. No patient who has been diagnosed with a brain tumor, whether low grade, high grade, or benign, escapes totally unharmed because tumor existence, surgical removal, and/or toxicity of treatment combine to cause varying degrees of brain injury. Additional considerations are the variables of tumor location within the brain, the age of the patient, their premorbid intellectual capacity, and their fear and anxiety, for full understanding of the impact and the complexity of the tumor and treatment on the individual patient. The mental health provider's mandate in caring for this population is threefold: first, provide hope in what patients feel is a hopeless situation; second, serve as witness to their experience and acknowledge and validate the changes and loses that occur; and third, create empowerment in what seems a helpless situation. For the purposes of this article, further reference to brain tumors will be World Health Organization grade III/IV and IV/IV.