If you were fortunate enough to be given instruction in the use of genograms during your graduate training, you can skip this article. If, like some of my early career supervisees, you were not taught this valuable tool, then I do urge you to learn more about them. Genograms are a powerful and sympathetic way to get an overview of your patient’s background and the early conclusions that are now giving him or her trouble.
A genogram is a formalized version of a family tree that provides a visual representation of an individual’s family over several generations. During the 1980s, Monica McGoldrick and Randy Gerson standardized the icons used for construction so that professionals could readily share information. (See: Genograms: Assessment and Intervention; Norton Professional Books.) Constructing the genogram in session with an individual or family helps both therapist and patient take a step back and look at the patterns of interacting that have had, and continue to have, an impact on the people involved.
Most sports events provide us with a scorecard to help us know the players and their positions. A conversation about the players can help spectators (and team members) understand how different individuals typically behave as well as which players are allied with each other, which players don’t get along and where the team needs to change if it is to be successful.
A genogram can be understood as having the same function. The genogram itself is a simple drawing. The conversation while we construct it begins the process of helping individuals make sense of their history (and perhaps their present) in a new way.
Here’s a simple example: Circles stand for females. Squares stand for males. Horizontal lines between show marriage. Vertical lines show children born to the couple. Notes taken during an intake discussion are above each of the parent symbols.
Mary and Mike came for couples therapy. They’d been married for less than a year following a romantic whirlwind courtship of three months. They’ve been fighting about just about every practical matter involved in setting up a home together. Jointly constructing a genogram showed both individuals how much more they were influenced by their families of origin than they had understood.
Mary is the older of two siblings with a powerhouse of a mom who set the rules and kept the family ship afloat. She described her dad as her mother’ss biggest fan who pretty much left the family day to day operation to his wife. Mary was often left in charge of her younger brother. When Mom had to stay late for a meeting, it was Mary who got dinner together and saw that her brother got his homework done.
Mike is the only son following three girls. He was known as the “ittle prince” at home. The girls dressed him up and played with him. Dad set the family rules but kept his distance from all the women by spending time in his workshop or at work. He loved having a son and spent lots of time doing projects with him. Dad felt Mike could do no wrong and bailed him out of both minor and rather major scrapes.
In many ways, Mary and Mike are a good but problematic fit. She is accustomed to being in charge and to seeing men as passive but nice. He is accustomed to being both bossed and coddled. But Mary’s complaint about Mike is that he seems to expect her to do everything. Mike’s major complaint is that Mary seems to think it’s “Her way or the highway.” They have fallen into their accustomed roles without realizing it. They don’t know how to change their relationship to a more egalitarian one, even though they both say that is what they want and neither one grew up with an egalitarian model of marriage.
This is a very simple example as an illustration of what can come from a discussion. Treatment begins from there.
Actual genograms are much more complex than the example of Mary and Mike.
McGoldrick and Gerson provided us with useful symbols to indicate pivotal life events like births, adoptions, deaths, divorces, marriages and remarriages, etc. as well as different types of relationships. There are now even computerized templates available. To see examples of genograms of famous individuals (such as Sigmund Freud or John F. Kennedy) do a simple internet search.
Questioning about the various family members and family events can help both therapist and client develop a renewed or new appreciation for the culture and issues within each person’s family that they bring to their relationships.
The central belief is that families repeat themselves, both positively and negatively. Often, if a problem in a couple or family isn’t solved, it bumps down into the next generation. Such patterns are called the intergenerational transmission of an issue or style.
It’s fascinating to map out a family over several generations. Often discussion does reveal patterns that keep repeating. Infidelity, for example, may be present generation to generation, with the same painful behavior creating pain in each succeeding family. Another example is a family riddled with “cut offs” with various members not speaking to other members for years. Cutting people off is the only way the family knows how to resolve conflict. That dysfunctional approach to problems has been modeled for each succeeding generation.
Sometimes, we see alternating generations expressing a problem with one extreme or another (alcoholism to total abstinence from alcohol to alcoholism, etc.). To watch Monica McGoldrick interview and treat a simulated family using the information generated by a genogram, obtain this wonderful videotape via interlibrary loan: The Legacy of Unresolved Loss. The tape shows how unresolved grief reverberates through three generations of a family.
Taking the time to develop an overview of a family like this helps us be aware of the family context when we are working to understand an individual, couple or family. It sensitizes us to family issues and helps a patient recognize that at least some of his or her beliefs and behaviors were absorbed long ago and now deserve reconsideration.
It’s true that there are some schools of therapy that reject the importance of such an investigation into a client’s family history. Behaviorists, for example, are more focused on current behavior. Cognitive-behavioral therapy is more interested in changing negative thoughts. But those of us for whom psychodynamics is central to our work can make use of the skill as both an assessment tool and as an intervention.
By being curious, empathetic, and kind while constructing a genogram, a therapist can often help a client (or couple or family) develop a more compassionate understanding of themselves and their family members. It’s an excellent place to start treatment.