bio-psycho-social assessment

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The Genogram Format for Mapping Family Systems PDF E-Book

By Monica McGoldrick The genogram has been established as a practical framework for mapping and understanding family patterns. The word “genogram” is just a fancy term for a family tree that maps out who you belong to and some basic patterns of these belonging relationships. It is a language that has been established over the past 50 years to depict for clinicians some of the basic demographic, functioning, and relationship issues in families. Genograms include biological and legal members of a family but also pets, friends, and other kinship relationships. Genograms map out the basic biological and legal structure of the family--who was married to whom, the names of their children, and so on. Just as important, they can show key facts about individuals and the relationships of family members. For example, one can note the highest school grade completed, a serious childhood illness, or an overly close or distant relationship. The facts symbolized on the genogram also offer clues about the family's secrets and mythology, since families tend to obscure what is painful or embarrassing in their history. A genogram includes multiple types of family information: the basic facts: who is in the family, the dates of their births, marriages, moves, illness, deaths; information regarding the primary characteristics and level of functioning of different family members: education, occupation, psychological and physical health, outstanding attributes, talents, successes and failures; relationship patterns in the family: closeness, conflict, or cut off. Once the primary family information is indicated on the genogram, it is possible to examine it from the multiple perspectives of all family members. One genogram might emphasize the relationship patterns in a family, another might highlight the artistic patterns, another the patterns of illness, and so forth. A genogram is generally drawn from the point of view of a key person or nuclear family, going back in time at least two generations and forward to the children and grandchildren of the key person or people. Other genograms may be drawn to show in detail various branches of the family or aspects of their functioning and relationship. This standardized Genogram format is becoming a common language for tracking family history and relationships. Despite the widespread use of genograms by family therapists, family physicians, and other health care providers, prior to the first edition of Genograms: Assessment & Intervention in 1985, there was no generally agreed-upon format for a genogram. Even among clinicians with similar theoretical orientations, there was only a loose consensus about what specific information to seek, how to record it, and what it all meant. The standardized genogram format offered here was worked out in the early 1980’s by a committee of leading proponents of genograms from family therapy and family medicine, including such key people as Dr. Murray Bowen, Dr. Jack Froom, and Dr. Jack Medalie. They became part of a committee organized by the North American Primary Care Research Group to define the most practical genogram symbols and agree on a standardized format. Since the format was originally published in 1985, there have been a number of modifications recommended by different groups around the world. We see this format as a work in progress, Expanded use of genograms will undoubtedly extend the format further. For example, computers have led us to begin development of standard color coding for names, location, occupation, illnesses, etc. The symbols will surely be further modified in the future as they have been modified over the years.

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Biological Child

Foster Child

Adopted Child

Stillbirth

Twins Identical Twins

Pregnancy

Miscarriage Abortion

Children: List in birth order beginning with the oldest on left

‘92- ‘94- ‘95- ‘03- ‘03- ‘04- ‘04- ‘05-

‘97-97 -‘99 -‘01

13 11 10

Standard Symbols for Genograms

LW 98-99 A ‘97

m 1970

AA

Therapist Therapist

Male

written on left above of symbol

‘41-

‘72- $100,000

‘41-

an X through Symbol Age at death in box Death date on right

above symbol

written inside

symbol

Birth Date DeathAge

Pet

Significant

Institutional

Connection

Female

Man to woman

Woman to man

Gay/Lesbian

Transgender People

23

written above birth & death date

1943-2002‘82-

59

Location &

Annual Income

Boston

Bisexual

Immigration

Family Secret

‘41-

Person who

has lived in

2 + cultures

Heterosexual

Marital Separation

met ‘88,, m ‘90 s ’95 m ‘90 s ’95 d ‘97 m ‘90, s 95-96, s 96, d ‘97

remar ’00, rediv 02

Divorce Divorce and Remarriage

Marriage

m 1970

Relationship

LT ‘95

LT = Living Together

m ‘03 m ‘05

Secret

Affair

Affair ‘95

Couple

Relationship

Rel 95, LT 97

Committed

Institutional

Connections:

Buddhist

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Close“spiritual” connection

Physical or Psychological illness

Alcohol or Drug abuse

Suspected alcohol or drug abuse

Physical or Psychological illness in remission

In Recovery from alcohol or drug abuse

In recovery from substance abuse and mental or Physical problems

Serious mental and physical problems and substance abuse

Symbols Denoting Interactional Patterns between People

Symbols Denoting Addiction, and Physical or Mental Illness

Fused

Hostile

Close-HostileDistant Focused On

Fused-Hostile Cutoff Repaired

CaretakerPhysical Abuse Sexual AbuseEmotional Abuse

Cutoff

Egg donor

Sperm donor

Surrogate Mother

Gay Couple whose daughter was conceived with sperm of John and an egg donor, and carried by surrogate mother till birth.

Lesbian couple whose daughter was conceived with egg of one partner and sperm donor.

1943-2002 $100,000

‘75- $100,000

‘73- 35,000

‘81- $45,000

John Jenny C.P.A.

Highland Park, NJ

San FranciscoLondonArizona

H.S.+2 Secretary

Peter M.B.A

Alicia P.h.D

Mark B.A.

ComputersHistory Prof

‘53- $28,000Annual income is written

just above the birth & death date.

Typically you would include the person’s occupation and education near the name and the person’s whereabouts at the top of the line connecting to the symbol.

59 52

32 30 24

m. 1970

In Vitro Insemination

Symbol for Immigration =

Smoker S

Obesity O

Language Problem L

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Siblings of Primary Genogram Members are written smaller and higher. Spouses are

written smaller and lower:

31

62 58

2628 s ‘01

੣���

‘01

‘01

‘01

38 39 31 26

0

0

10

Child Raised from Birth by His

Granduncle and Aunt

Foster Children

Adopted Child

Household

Adopted at 5

Use an arrow to show family into which child moved

Use an arrow to show family into which child moved

A = 1���

62

Symbol for

Immigration

1945- $60,000 Chicago

$40,000 Chicago

1944-

$100,000

$28,000

London

Chicago

BuddhismRoman

Catholic

Ed

Sam

Jolie

Judy

Therapist

LH ’00

‘82 ‘79

Dog-Muff

63

24 27

62 m. 1970

POLISH JEWISH

Household shown by encircling members living together (Couple living with their dog after launching Children)

Siblings are written smaller and higher than IP. Spouses are written smaller and lower.

Served in Vietnam

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m ‘85 d ’89 1st 2nd 3th

1st

1st 1st2nd

2nd 3th

m ‘90 d ’00 m ‘02

m ‘83 d ’88 m ‘89 d ’93 m ‘96

1

2

3

4

Husband, His Current Wife and his Ex-Wives (who are shown lower and smaller). Husband’s wives may go on left to be closest to him. Indicators “1st,” “2nd” etc. make clear the oader of his marriages.

Wife, Her Current Husband and her Ex-Husbands (who are shown lower and smaller). Wife’s previous relationships are shown on left to keep children in birth order, since they remained in her custody.

Couple with 3 year old, showing their previous spouses (smaller) and those spouses’ new partners (even smaller)

Couple living with their joint child and her child from a previous relationship. The other spouses of the partners are shown smaller and lower on either side of the present household, indicated by a dotted line.

m ‘77 d ‘80

‘55- ‘65-

m ‘81 d ‘86

m ‘87 d ‘90

m ‘92 d ‘97

‘94-‘82- ‘84-

m ‘85 d ‘89

m‘ 90 d ‘93

m ‘95 d ‘97

m ‘99 d ‘01lo. m ‘02

223 21 11

50 40

10 ‘95-‘03-

m ‘94 d ’99 m ‘02 m ‘94 d ’98 m ‘90 d ’92

3

81318

98 14 02-97- 96- 91-

3

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Genograms record information about family members and their relationships over at least three generations. They display family information graphically in a way that provides a quick gestalt of complex family patterns; as such they are a rich source of hypotheses about how clinical problems evolve in the context of the family over time. Once you master this format you will want to learn the interpretive principles upon which genograms are based (see Genograms: Assessment and Intervention, W. W. Norton, 2008), and possibilities for software, which can record genogram information and store it for retrieval for research purposes. In our view the symbols make genograms the best shorthand language for mapping and summarizing family information and describing family patterns. Genograms allow you to map the family structure clearly and to note and update the map of family patterns of relationships and functioning as they emerge in a clinical session. For a clinical record, the genogram provides an efficient summary, allowing a person unfamiliar with a case to grasp quickly a huge amount of information about a family and to scan for potential problems and resources. While notes written in a chart or questionnaire may become lost in the mass of information, genograms are immediately recognizable and can be expanded and corrected at each clinical visit as one learns more about a family. They can be created for any moment in the family’s history- showing the ages and relationships of that moment to better understand family patterns as they evolve through time. Genograms make it easier for us to keep in mind the complexity of a family’s context, including family history, patterns, and events that may have ongoing significance for patient care. Just as our spoken language potentiates and organizes our thought processes, genograms, which map relationships and patterns of family functioning, help clinicians think systemically about how events and relationships in their clients' lives are related to patterns of health and illness. Gathering genogram information should be an integral part of any comprehensive, clinical assessment, if only to know who is in the family and what are the facts of their current situation and history. The genogram is primarily an interpretive tool that enables the clinician to generate tentative hypotheses for further evaluation in a family assessment. It cannot be used in a cookbook fashion to make clinical predictions. But it can sensitize the clinician to systemic issues, which are relevant to current dysfunction and to sources of resilience. Scanning the breadth of the current family context allows the clinician to assess the connectedness of the immediate members of the family to each other, as well as to the broader system- the extended family, friends, community, society and culture, and to evaluate the family’s strengths and vulnerabilities in relation to the overall situation. Consequently, we include on the genogram the immediate and extended family members, as well as significant non-blood "kin" who have ever lived with or played a major role in the family’s life. We also note relevant events (moves, life cycle changes) and problems (illness, dysfunction). Current behavior and problems of family members can be traced on the genogram from multiple perspectives. The index person (the “I.P.” or person with the problem or symptom) may be viewed in the context of various subsystems, such as siblings, triangles, and reciprocal relationships, or in relation to the broader community, social institutions (schools, courts, etc.), and socio-cultural context.

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Genograms "let the calendar speak" by suggesting possible connections between family events over time. Patterns of previous illness and earlier shifts in family relationships brought about through loss and other critical life changes, which alter in family structure and other patterns can easily be noted on the genogram. Computerized genograms will soon enable us to explore specific family patterns and symptom constellations, which provide a framework for hypothesizing about what may be currently influencing a crisis in a particular family. In conjunction with genograms, we usually include a family chronology, which depicts the family history in chronological order. A computerized program for gathering and mapping genogram information with a data base will in the future make it a lot easier for the clinician to track family history, because a chronology will be able to show events for any particular moment in the family’s history. Genograms need to show not just the biological and legal members of a family, but also the network of friends and community essential for understanding the family. This includes current relationships, but also the relationships that came before and live in the person’s heart, giving hope and inspiration in times of distress. It is also important to show the context around the biological and legal family in order to understand a family in context. Such people include those who live in one’s heart, some long dead, and some in daily life, who could offer a loan, your husband or children out, or give you strength and courage, you are in a crisis. It is this kinship network, not just the biological relatives, and not just those who are alive now, who would be relevant to know about if you want to understand clients or access their resources. Such genograms are important to illustrate in greater depth the context around the immediate family.

Family history always evolves in the context of larger societal structures: cultural, political, religious, spiritual, socio-economic class, gender, racial and ethnic structures, which organize each member of a society into a particular social location. It is important always to think of the genogram in its broader context. At times we actually define the resources and institutions of the community to highlight families’ access or lack of access to community resources (which can be noted around the genogram). Many have been attempting to expand genograms to take these larger social structures into account in understanding genogram patterns.

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We look forward to the continued evolution of genograms to enable us to better illustrate the larger cultural levels along with the specific individual and kinship dimensions of family patterns.