Genogram as a tool for Family therapy

Using Genogram as a tool for family therapy

Introduction

Family therapy is a structured form of psychotherapy that seeks to reduce distress and

conflict by improving the systems of interactions between family members. It is an ideal

counselling method for helping family members adjust to an immediate family member

struggling with an addiction, medical issue, or mental health diagnosis. Specifically, family

therapists are relational therapists: They are generally more interested in what goes on

between the individuals rather than within one or more individuals. Depending on the

conflicts at issue and the progress of therapy to date, a therapist may focus on analysing

specific previous instances of conflict, as by reviewing a past incident and suggesting

alternative ways family members might have responded to one another during it, or instead

proceed directly to addressing the sources of conflict at a more abstract level, as by pointing

out patterns of interaction that the family might not have noticed.

Usual goals of family therapy are improving the communication, solving family problems,

understanding, and handling special family situations, and creating a better functioning home

environment. In addition, it also involves:

1. Exploring the interactional dynamics of the family and its relationship to psychopathology

2. Mobilizing the family’s internal strength and functional resources

3. Restructuring the maladaptive interactional family styles (including improving

communication)

4. Strengthening the family’s problem-solving behaviour.

Types of Family Therapy

Bowenian
Genogram as a tool for Family therapy

This form of family therapy is best suited for situations in which individuals cannot or do

not want to involve other family members in the treatment. Bowenian therapy is built on two

core concepts: triangulation (the natural tendency to vent or distress by talking to a third

party) and differentiation (learning to become less emotionally reactive in family

relationships)

Structural Family Therapy

Structural family therapy is a therapy of action. The tool of this therapy is to modify the

present, not to explore and interpret the past. Since the past was instrumental in the creation

of the family’s present organisation and functioning, it is manifest in the present and will be

available to change by interventions that change the present (Minuchin 1974). The structural

family therapist engages with the family system and then sets out to transform it. The main

focus of this approach is the family structure with the underlying assumption that the

problematic behaviour is related to a fault with the functional normative family structure.

Structural family therapists believe that by changing the family structure they can change the

position of family members and therefore alter their subjective experiences.

Narrative therapy

Narrative therapy is different because of how it enables clients to become their own

entities and then use their own abilities to address the problem and reduce the tiny problems

in the real world as well. The concept of narrative therapy is that people build constructive

life experiences that help them identify who they are really and what they’re doing, and have

the finest resources to address their lives. Narrative therapy aid individuals in clarifying,

developing, and supporting life narrator and help in directing their journey.

Strategic Family Therapy

One of the guiding principles in strategic family therapy is that problems apparently

residing in one individual are frequently associated with the difficulties resulting from a

family’s need to change and reorganise at transitional stages. These can occur at times such

as the birth of a baby or when a young person is considering leaving home (Dallos & Draper

2000). This is particularly the case with older adolescents who present with mental health

problems or a history of school refusal. This can indicate a family dynamic whereby the

young person becomes symptomatic in order to help parents avoid conflict in their

relationship. Thus attention is focussed on the young person rather than the parents.

Systemic Family Therapy

The goal of this therapy is to discover the current systemic rules and traditional myths

which sustain the present dysfunctional patterns of relating, and to use the assumed resistance

of the family towards outside help as a provocation to change. Change is achieved by

clarifying the ambiguity in relationships that occur at a nodal point in the family’s evolution.

Systemic therapists do not work to a normative blueprint of how an ideal family should

function (Burnham 1986). This approach furthermore emphasises the importance of the

underlying beliefs held by family members about the problem which affected behaviour. It

avoids being perceived as blaming the non-symptomatic members of the family by working

on the basis that the actions of various family members are the best they can do (Dallos &

Draper 2000).

Solution focused Therapy

The mantra of practitioners using this way of working is ‘focus on solutions not

problems’. For example, a family or parents often discuss a child or a parent in sweeping

generalisations when explaining their problems. ‘He’s always getting into trouble with

teachers’, or ‘she never does as she is told’. These are recognisable complaints and express
Genogram as a tool for Family therapy

less the reality than an over-emphasis on the negative, as if the parents are trying to convince

you of their case for help and their desperation. Solution-focused therapists turn this idea

around and carefully enable the complainants to recall an exception to this general rule about

the troublesome child (de Shazer 1982, Berg 1991).

A genogram resembles a “family tree” however the information gathered includes both the

simple structure of the family and the emotional patterns and processes present in the nuclear

and extended family system. Genograms/family trees- are a neat, cost-effective, and engaging

way of introducing the family to a different type of social work practice. Used appropriately

at the right time and in the right place they can help focus the whole family in a collaborative

exercise that reveals a great deal of information in a non-threatening way. It is a way of

addressing issues that are difficult to verbalise by physically drawing a picture or diagram of

several generations of the family. Older family members as well as quite young children can

join in. Deaths, divorces, separations, births, marriages can all be illustrated and committed to

a large sheet of paper that can serve as a map of the family process for use in future sessions.

Genograms can give families their first understanding of intergenerational family relationship

patterns. Sibling relationships can be described and discussed in a detached way without

forcing a confrontation between two rivalrous young people or colluding with an exclusive

and problematic closeness. The opportunity for the family themselves to generate hypotheses

or narratives to explain the impact of various events can be offered by a detailed and carefully

constructed genogram. Beware the attraction of predicting pattern repetition though, as this

may result in further individual scapegoating. The value in noting pattern is in the meaning

this has for the family concerned (for example, are they actively resisting the repetition of

early divorce or child care proceedings, or do they feel that their fate has already been

sealed). Genograms are thus a relatively emotion-free way of collecting information that
Genogram as a tool for Family therapy

makes sense to the family and connects them to the therapeutic exploratory process

(Goldenberg & Goldenberg 2004).

Historically, professionals in family medicine and family therapy were the first to utilize

genograms to record information about families in their practices and to call for the

standardization of symbols so other clinicians could read and interpret the family graphic

(Jolly, Froom, & Rosen, 1980). Family systems therapies, based on Bowen Theory (1978;

Kerr & Bowen, 1988), often use the genogram as the primary organizing tool for drawing the

family constellation across multiple generations to discover clues about family functioning

and to resolve struggles in order to promote healthier functioning. Bowen Theory focuses not

simply on the client or the client’s nuclear family, but on the entire family emotional field,

represented pictorially by a genogram drawing of at least three generations. Therapy

addresses the clients’ relationships in their nuclear family and family of origin and as

participants in patterns of interaction across multiple generations. Genograms of clients’

families across generations capture the richness and complexity of extended family systems.

Bowen Theory purports that there are forces within families pulling people toward

togetherness and connection and opposing forces pushing them toward separateness and

independence. When individuals have difficulty balancing these two forces, or get caught in

emotional struggles related to these forces, dysfunctional relationships may result.

Problematic relationships are those that are fused, distant, conflictual, cut off, triangulated, or

even abusive. Fused relationships are those in which one person becomes so emotionally

attached to another that he or she reacts in response to the actions or emotions of the other;

this is the opposite of differentiation (Bowen, 1978).

Triangulated relationships occur when a third person is introduced into a dyadic

relationship to balance either the excessive intimacy or distance and to provide stability in the

system (Bowen, 1978). A common triangle involves two parents and a child, and each parent
Genogram as a tool for Family therapy

attempts to have the child side with him or her against the other parent. The genogram

graphic portrays these different types of relationships using symbols. These symbols reveal

relationships in which struggles may be resolved through differentiation, which, in turn, may

lead to less tension or anxiety in the system and healthier family adaptations. Differentiation

is characterized by acting with autonomy and without responding to pressure from others in

the system.

In the field of counselling psychology there is growing interest in exploring the systemic

family context to determine how individuals function (Becvar & Becvar; Nichols &

Schwartz, 2001). This increased interest in family contexts has led to growing use of family

therapy among counseling psychologists in order to promote greater well being among

individuals and their families. As a result of the increasing interest in family intervention and

case conceptualization, there is a growing need for empirically demonstrated, reliable, and

valid family assessment measures that can be used in both clinical and research settings

(Coupland, Serovich, & Glenn, 1995, Cook & Kenny, 2006).

The conceptualization and treatment of individual and family psychopathology from a

systemic perspective has gained increasing support in empirical studies (Gurman, Kniskern &

Pinsof, 1986; Shadish & Baldwin, 2003). In particular, there is increasing evidence that

intervention grounded in an understanding of the family system can be effective in improving

individual functioning, reducing symptoms, and is important in comprehensive assessment

(Heatherington, Friedlander, & Greenberg, 2005). It is believed that effective family therapy

requires thorough systemic assessment and conceptualization (Kerr & Bowen, 1988; Becvar

& Becvar, 2000) because the family context, patterns, and relationships influence individual

and family functioning. In this regard, the assessment of family relationships and emotional

processes that influence individual functioning is believed to be an important area of attention

for both family clinicians and researchers (Nichols & Schwartz, 2001). Many clinicians
Genogram as a tool for Family therapy

consider it important to assess at a systemic level because important contextual or

contributing factors in individual functioning may be missed otherwise, leading to an

incomplete understanding in the 2 clinical case conceptualization. Such assessment often

includes understanding family patterns, the nature of family relationships, and the ways in

which the family communicates and functions (McGoldrick & Gerson, 1985). Although there

is recognition of the importance of systemic assessment among family clinicians, there is less

empirical knowledge about the clinical and research application of systemic assessments. In

particular, there is a need for an empirically demonstrated, reliable and valid means of

assessing family system functioning both the nuclear and multigenerational families.

Currently, the family genogram interview is the most widely used means of assessing

relationship processes in nuclear and extended family (McGoldrick & Gerson, 1985). A

genogram is a pictorial diagram of a family using data gathered during a semi-structured

interview.

Rogers and Durkin (1984), family physicians, describe the "other benefits" of genogram

construction: "The act of taking a family history may contribute to the establishment of

rapport between doctors and patients, thereby building a foundation for productive doctor-

patient relationships"(p. 17).

Their observation is unique in the scant literature on the genogram appearing in family

medicine. It underscores the implications for attention to process in psychotherapy where the

client-therapist relationship is of particular importance. The literature points to a wide variety

of applications of genogram construction with individuals and families, including:

1. A tool for engagement in treatment;

2. A vehicle for building the therapeutic alliance;

3. A bridge to the client and therapist's mutual understanding of the goals of treatment;
Genogram as a tool for Family therapy

4. A diagnostic tool;

5. A tool for subliminal learning to enable the client(s) to begin to work toward self-

understanding;

6. A data-gathering device; and

7. A structured beginning in treatment.

Most Indian families are functionally joint families though they may have a nuclear family

structure. Furthermore, unlike the Western world more than two generations readily come for

therapy. Hence, it becomes necessary to deal with two to three generations in therapy and

also with transgenerational issues. Our families also foster dependency and interdependency

rather than autonomy. This issue must also be kept in mind when dealing with parent–child

issues. Indians have a varied cultural and religious diversity depending on the region from

which the family comes. The therapist has to be familiar with the regional customs, practices,

beliefs, and rituals. The Indian family therapist has to also be wary of being too directive in

therapy as our families may give the mantle of omnipotence to the therapist and it may be

more difficult for us to adopt at one-down or nondirective approach. Hence, while systemic

family therapy is eminently possible in India one must keep in mind these sociocultural

factors so as to get a good “family-therapist fit.”