CONSTRUCTING GENOGRAMS Genograms are part of the more general process of family assess- ‘ment, In this chapter we will describe how to both construct @ geno- ‘gram and elicit relevant genogram information from a family during, ‘assessment. CREATING A GENOGRAM Creating a genogram involves three levels: 1) mapping the family structure, 2} recording family information, and 3) delineating farly relationsi ‘Mapping the Family Structure ‘The backbone of a genogram Is a graphic depiction of how dif- ferent family members are biologically and legelly related to one an- ‘ther from one generation to the noxt. This map isa construction of figures representing people and lines delineating thelr relation- ‘ships. As with any map, the representation will have meaning only ifthe symbols are defined for those who are trying to read the geno- gram. Not surprisingly, there is a great deal of diversity in tho way linicians draw genograms. Different groups have their own favorite symbols and ways of dealing with complicated family constellations, ‘hich often leads to confusion in roading other clinicians genograms. Recently a group of family physicians and family therapists (a'Pask Force of the North American Primary Care Research Group), chaired ‘by McGoldrick, has collaborated to standardize the symbols and pro- °Genograms ix Family Assesament vee 2] remit) Dinar nee sy sat eB Fence © Diagram 22 Index person symbals ~ Dethie e Dingram 23 Bithdates and denthdates ‘cedures for drawing the genogram. These procedures form the basis {for the guidelines presented here. ‘The famlly structure shows different family members in relation to.one another, Bach family member is represented by a box or eirclo ‘according to his or her gender (Diagram 2.1). For the index person (or identified pation) around whom the genogram is constructed, the lines are doubled (Diagram 2.2). For a person who is dead, en. Xia placed inside the figure. Birth and death dates are indicated to the left and right above the figure (Diagram 2.3). The peraoe's ‘age at ceath is usually indicated within the figure. For example the male depicted here was born in 1943 and did in 1962 at the ‘age of 19. In extended genograms that go back more than three ‘generations, figures inthe distant past are not usually crossed out ‘since they are presumably dead. Only relevant deaths are indicated in such genograms.Constructing Cencgrams a Pregnancies, miscarriages, abortions and stillbirths are indicated, by other symbcls (Diagram 2.4). wots pee dt Diagram 24 Symbols for pregnancy miserrage, abortion and stibirth ‘The figures representing family members are connected by lines ‘that indicate their biological and legal relationships. "Taro people who are married are connected by lines that godown, ‘and across, with the husbend on the left and the wife on the right (Diagram 2.5)."M” followed by a date indicates when the couple was ‘married. Sometimes only the last two digits of tho year aro shown (eg, m.48) when there is little chance of confusion regarding the ‘appropriate century. The marriage line is also the place where separa tions or divoress are indicated (Diagram 2.6). The slashes signify ‘disruption in cho marriage—one slash for separation and two for a divoree.2 atsaso soem noes Diagram 27 A husband with several wives muse | mia | masaw Disgram 28 A wife with several husbands ‘Multiple marriages add a degree of complexity that is sometimes ifficutt to depict. Diagram 2.7 shows one way of indicating several ‘ives of one husband, while Diagram 2.8 shows several husbands of one wife, The rule of thumb is that, when feasible the different ‘marriages follow in order from left to right, with the most recent ‘marriage coming last. The marriage and divorce dates should also help to make the order clear. However, when each spouse has had ‘mapping out the complex web of relationships ean be very difficult indeed, One solution isto place the most recent relationship in the ‘center and each partner's former spouses off to the side, asin Dis gram 2.9, mnaman ‘Diagram 29 Two partners who have each had multiple spouses Genograms in Family AssessmentContracting Omogrems inGa? 9 Gad, nae serra ren 7be Diagram 2.10 Rimarragee whee each spouse haa ad several other prtners previous spouses have had other partners, it may be necessary to draw a secand line, slightly above the first marriage line, to in- dicate these relationships. In Diagram 2.10 each spouse has been ‘married twice before. The husband's former wife had been married ‘once before she married him, and she remarried afterwards, The wifes socond husband has remarried since their divorce. Qa io Diagram 2.11 Unsrvadeoople fa couple are involved in love affair or living together but not legally married, their relationship is depicted aa with married cou- ples, but a dotted line is used (Diagram 2.11), The important date hore is when they met or started living together. (This may also be important information for married couples, iat > youre Diagram 2:12 Birth onder fs couple has children, then each child's figure hangs down from the line that connects the couple. Children are drawn left to right ‘going from the oldest to the youngest, asin Diagram 2.12. If thereTe Diagram 218 Alternative method for depleting fly with many children ‘are many children in a family, an alternate mothod (Diagram 2.18) ay be used to save space. A dotted lin is used to connect a foster ‘or adopted child tothe parents’ ine (Diagram 2.14), And finally, com ‘verging lines connect torins to the parental lin. Ifthe twins areiden- tical, a bar connects tham to each other (Diagram 2.15).aRR ‘Dotted lines are used to encirele the family members living in the {mmodiete household, This is especially important in remarried fam ilies where children spend time in various households, as in the geno gram shown in Diagram 2.16. ‘Now that we have the basic symbols and procedures for mapping ‘the family structure on a genogram, let us put them into practice ‘by using the family of a well-known celebrity of the psychiatric ‘world: Sigmund Freud, Neither Freud nor his biographers ever did ‘extensive research into his family and the details of his family fe re skotchy, Nevertheless, we do know the basic structare of the Froud family, ‘First, we draw Sigmund's marriage to Martha and their children (Diagram 2.17). a. 2 sa 967 1671078 aon eon eo) ‘Made Mtn Olver Brit agra 2.17 Frood mucin flyNext, we go back a generation and include both Sigmund's and ‘Marthe's parents and siblings (Diagram 2.18) In fact, we usually ‘go back to tho grandparents ofthe indox person, including at least three generations on the genogram (four or even five generations if the index person has children and grandchildren) a0 pe Lee ‘To highlight their central importance, the figures for Sigmund and | Martha are lowered out of the sibling line. As can also be seen on(Constructing Genograms ” this diagram, the spouses of siblings are also usually placed slight ly lower than the siblings themaelves, to keep the sibling patterns clear. “After the family structure has been drawn, the members of the household are encircled. Diagram 2.19 shows the Freud household {in 1896, the year after their last child, Anna, was born, and the year that Sigmund® sister-in-law came to live with them. ‘The date inthe bottom righthand corner tells the year when this ‘genogram snapshot was taken. A clinician might use the genograz to freezeframe a moment in the past, such as the time of symptom ‘onset or critical change in a family. When we choose one dato in a person's life other information, deaths, ages and important events are calculated in relation to that set date. It is then useful to put etch person's age inside his or her figure. Ifthe person is dead, the8 Genograms in Family Assessment ‘age at death is used instead. In Diagram 2.20, for example, we have ‘somewhat arbitrarily chosen 1900, the your when Freud's first major ‘book, The Interpretation of Drearns, was published. At that date there had been only a few deaths in the family ~Sigmund's father, his brother Julius, and Martha's brother Tsaac. “= iagrm 220 Froud family with demographic fonctioning and crtcal event information,a rape apt a t Construting Gengrams » ‘When only partial information can be uncarthed, that is included, For instance, Sigmund's father was married three times. We know ‘that he had two children with his first wife, but little is known about his second wife, Rebecca (Clark, 1980; Glicklhorn, 1968), The third wife, of course, was Sigmund's mother, Amalia Nathanson, Freud's is a relatively simple family to map. Unfortunately. not ‘ll families are co easy to show in simple graphic form, The numerous divorces and remarriages of many modern families and their com- plex biological and legal family relationships make drawing family Structures a challenge. Later in this chapter we will discuss more ‘complex family structures. Recording Family Information ‘Once we have drawn the family structure, the skeleton ofthe geno- ‘gram, we canstart adding information about the family, particularly: f) demographic information; b) functioning information; and) cxt- ical family events ‘Demographic information inchudes ages, dates of birth and death, locations, occupations, and educational level ‘Functional information includes more or less objective data on ‘the medical, emotional and behavioral functioning of different family ‘members. Objective signs, sich as absenteeism from work and drink {ng patterns, may be more useful indications of person's function- ing than vague reports of problems by family members. Signs of highly successful functioning should also be included, The informa- tion collected on each person is placed next to his or her symbol on the genogran, ‘Critical family events include important transitions, relationship shifts, migrations, losses and successes. These give a sense of the historical continuity of the family and of the effect of the family history on etch individual. Some of those events will have been noted ‘as demographic data, eg, family births and deaths. Others include marriages, reparations, divorees, moves and job changes. Critical life events are recorded either in the margin of the genogram or, i necessary, on a separate attached page. ‘We generally keep a family chronology with the genogram. This, is a listing in order of occurrence of important events in the family history that may have affected the individual. At times we make ‘special chronology for critical time period, for example, to track» GGenograms ix Family Assessment family members illness in relation to other significant events. An individual chronology may also be useful for tracking a particular ‘anily member's life course (symptoms, functioning) within the con taxt of the family. Both the year and a brief description of each occurrence should be listed. For example, the following shortlist of critical events might appear on the Freud genogram: 1860 Jakob moved family to Vienna. 1895 Anna Froud was born (last chil. 1896 Minna, Sigmund’s wife's sistor, moved in. 1896 Sigmund's father, Jakob, died. 1900 Interpretation of Dreams published. ‘When family members are unsure about dates, approximate dates should be given, proceded by a question mark, eg, 784 or “84. ‘Amore extansive chronology of family events could then be placed ‘on a separate sheet of paper: 1855 Jakob Froud and Amalia Nathanson marry. 2/21/1856 Schlomo Freud (Jakob's father) dies. 5/6/1856 Sigmund Freud is born in Freiberg, 4/1857 Julius Freud is born. | 12/1857 Julius Freud die 1658 Anna Freud (Sigmund’s sister) is born. 1860. Jakob moves his whole family to Vienna 1866 Sigmund enters gymnasium (age 10). 1866. Alexander Freud is born (ast chil) 1873 Sigmund begins medical studies (age 17). 1879 Sigmund serves in military for 1 year 1881 Sigmund recaives modieal degroo (ago 24). 1882. Sigmund becomes engaged to Mertha Bernays. 1884 Sigmund publishes paper on cocaine. 1885. Sigmund attends Charcot lectures in Pari 1886. Sigmund and Martha marry 1889 Jean Martin Freud is born (first child 1894. Sigmund's self-analysis begins. 1895 Anna Froud is born (last child). 1895 Sigmund publishes Studies on Hysteria. 1896 ister, moves in.CConsrcting Genograms 1898 Jakob dies. 1900 Sigmund publishes Interpretation of Dreams. 1900 Sigmund ends self analysis, 1002. Sigmund becomes Extraordinary Professor. (Clearly, « family chronology can vary in length and detail depending, ‘on the breadth and depth of the information available. ‘Let us look again at the Froud family genogram, with informa tion on demogrephies, functioning, and critical events (Diagram 2.20, p. 18). Showing Family Relationships ‘The third level of genogram construction is the most inferen tial This involves delineating the relationships between family mem- bers. Such characterizations are based on the report of family mem- ‘bers and direct observations. Different lines are used to symbolize the various types of relationship between two family members (Dis- gram 2.21). ‘such commonly used relationship descriptors {Tr “fused” or “conflictual” are difficult to define operationally and have different connotations for clinicians with various perspectives, these aymbols are useful in clinial practice. Since relationship pat- {tems can be quite complex, itis often useful to represent them on ‘a separate genogram. PARDEE wns Sth amt ‘Diagram 221 Flatonship Lines ‘Again, the Freud family will be used to illustrate, Speculating on. ‘he elatfonship patterns of historical figures is a chancy business.2 Genograms in Family Assessment Without trying to justify our speculations, the genogram in Diagram 2.22 presents some of the possible relationship patterns that the available family background information on Freud suggests to us. ae eomazoel PO, Sigrfund Matilde Maine Ea Sie AS ingram 222 Freud fanlly relationship patter COMPLEX GENOGRAMS ‘Genograms can become very complex and there is no set of rules that vill cover all contingencies. We will show some of the ways we hhave dealt with a few common problems, First, how do you plan abead? Obviously, if you fil three-fourths cof the page with father’s three siblings, you will be stuck when you iget to the mother and find she isthe youngest of 12. It helps to gotConstrasting Gencgrams a ‘an overview of the number of siblings and marriages in the paren- tal generation before starting. The following questions wil help you ‘plan and thus anticipate complexities from the start: How many tines was eech parent married? {How many siblings did each parent have and where was hoor she fn the bith order? For example, if you mapped the structure of Jane Fonda's fami ly of origin, the basic framework would look lke Diagram 2.25. The {genogrem shows Jane's parents and grandparents. Each of her par- nts had hed previous marriages and her father, Henry, had subse- ‘quent marriages. The other marriages are shown tothe side of each ‘parent and are dated to indicate the order. ie4 Gonograms in Family Assessment Generally, the focal peint of the genogram is the index person and. ‘details about others in the genogram are shown as they relate to this person. The complexity of the genogram will thus depend on the ‘depth and breadth ofthe information included. For example, if we ‘were to include Jane's nuclear family, more detail on her mother's, athe’, and sibling's various marriages, as wall asthe patterns of ‘suicides, psychiatric hospitalizations and traumatic events, the geno ‘gram would look something like Diagram 2.24 cr ee wt sant = bel SEs en Te ee Cage “2 es cae Toe pee Diagram 224 Fonds fanily with dette tals complex and crondod gonogram reves such important deConstructing Genagrams 2s “+ Muleple marriages are common in this family. {Both of Henry Fonda's frst two wives committed suicide. Heenry Fonda seperated from his second wife, Jane's mother, only ‘afew months before she committed suid, He had already started fan aftr with his third wife, Susan Blancherd, whom he married ight months later. + At the ine ofthe third marrige (in fact, during the honeymoon), Peter Fonds, Jane's brother, shot himself and neerly died + Henry Fonda had two close friends who committed suicide, His sn, Peter, fll n love with Brigit Hayward the year thet she killed herself; and lao had e frlend who committed suicide. "Nevertheless, there are limits to what the genogram can show, particularly regarding multiple marriages. Sometimes, in order to highlight cercain points, tho arrangement ofthe genogram structure is reorganized, For example, the Fonde family genogram has been ‘arranged to Highlight the ongoing rolationship of the Haywards with the Fondas, Henry Fonda was marriod five times. His first wife, Margaret Sullavan, was married four times; Henry was her second husband, Mergeret’s third husband, Leland Hayward (who was also ‘Henry Fonda's agent), was marred five times, Including twice to the ‘same wife, Some of his epouses were also married numerous times, ‘and 80 on. Oe snes marines O- intnectermartag and ites lagram 225 Notation fr atonal formation ‘Some complex family situations may require more than one page of genograrrs, It is important that the different genograms are con- ‘ested in some way. Gerson has developed symbols (Diagram 2.25) to connect different genograms displayed on a computer (see Chapter 5). This notation can be used on any genogram to indicate that in- formation about other marriage(s) and children) can be found on ‘another genogram.Py Gonograms in Family Aasessment Genograms are necessarily schematic and cannot detail all the ‘vicissitudes of a family’ history, For example, the Fonda genogram ‘does not include the following information, + Henry Fonda's frst wife, Margaret Sallavan, lived very near the Ponda ferily in California with her third husband, Leland Hay: ward, Fonda's agent. After she separated from Laland Hayward, the moved with her ehildea to Cannectcut, where sho lived very ‘esr tho Fonds «Jane Fonda and Brook Heyward, Margaret's daughter, reportedly ‘wero best fronds growing up and hoped that their parents would {get back together again (Teichman, 1981, p. 182. «anes mothers death was apparently kept from her and she only later found out about it in a movie magazine + Henry reportedly never diacussod his wife's suicide with Peter and Jase + Henry Fonda and his motherndaw held a private funeral fr Jan's rether, which only they attended. Henry went on stage that same aight. + When Petor shot himself in the stomach during his father's third honeymoon in December 1960, eight months after his mother’s seid, Henry never asked Peter ithe was upset about his mothers desth (which Peter had boen told was due toa heart attack) « During Henry Fonda's fourth honeymoon in 1957, Petar got himself {nto sich abad stato with drugs that his sister sent him this aunts ‘nNebresc, Henry had to return from his wedding trip to arrange for peychiatic treatment. ‘Just after Henry Fonda's fifth honeymoon in 1965, Peter was in- volved in a drug arest. His tril ended in a hung jury. tis dear that Fonda family members have been greatly influ enced by suicides and remarriages and that the Hayward and Fonda {families were closely intertwined. Perhaps the extraordinary strength ‘and fore of personality that Peter and particularly Jane have shown in their careers reflect the many traumas they managed to over. ‘come intheir childhood. A comparable force was shown by Eleanor Roosevelt in response to many childhood traumas, as wil be dis- ‘cussed later. Given the toxicity to families of suicide, the most traumatic ofall deaths, the relevant facts surrounding the suicides ‘would be critical to an understanding of the Fonda family. Such ad-Constructing Gerograms 2 ditional family information that does not fit on a genogram should be attached to it and noted by an asterisk. a 2825. \ ia — vitit 4 Diagram 2.26 Frond family interne Other problems arise where there are multiple intermarriages in, the family, e.g, cousins or stepsiblings marrying, or where children Ihave shifted residences many times to foster homes or various rela tives or friends. There comes a point when the clinician must resort ‘to multiple pages or special notes on the genogram to clarify these ‘complexities. ‘Sometimes a genogram may be confusing because of the multi- ‘ple connections between family members, as, for example, in the Sig- ‘mund Freud family (Diagram 2.26). Both Sigmund and his sister ‘Anna marrioé siblings in the Bernays family, and the third living ‘Bomays sibling, Minna, was part ofthe Freud household from 1896 con. Marital lines are necessarily crossed in this genogram. In add tion, the relationship lines show the conflicts and alliances that roflect the merger of these two families. For an example of an even ‘more intertwined family, see the Jefferson family in Chapter 3(p. 68).8 Genograms in Pamiy Assesement Genograms may bocomo complex when children have been adopted or raised in a number of different households as in Diagram 2.27, where the genogram shows as much of the information on the tran sitions and relationships as possible. In such eases let practicality ‘and possibility be your guides. Sometimes the only feasible way to clarify where children were raised is to tako chronological notes on each child 1988 oe al}, awe Ke Bocimn coeieeee" BESTE Diagram 227 Pamily with children ving in other households and foster horns Finally, there may be a problem with discrepant information. For ‘example, what happens if three different farily members give di ferent cates for a death or conflicting descriptions of family relation- ships? The best rule of thumb is to note important discrepanciesConstructing Oenogrent ~” -whonever possible. In Diagram 2.28, each son has given a different report of the date of the father’s death and of who is closer to their ‘other, Bradt (1980) uses eclorcoded genograms to distinguish the source of information, although this method might seem impossibly cumbersome to many clinicians. Oise ‘THE GENOGRAM INTERVIEW Gothering information for the genogram usually oocur in the com text ofa family interview, Unless family members come in specifical- Iy to tel their family history for research purposes, you cannot sim- ply gather genogram information and ignore the family’s agenda for Tho interview. Such single mindedness will not only hinder you in igetting pertinent information, but also alienate the family from {reatment. Gathering family information and constructing the geno- ‘gram should be part of tho more general task of joining and help- ing the family.»” Cenograms in Family Assevamont ‘The Rashomon Etfect ‘Genogram information can be obtained by interviewing one family member or several. Clearly, gotting information from several family ‘members increases reliability and provides the opportunity to com- pare perspectives and observe interactions directly. Often, when we Interview several family members, we get what we call the Rash- ‘omon effect, based on a famous Japanese movie where one event is shown fom the perspective of « number of different characters. ‘Similarly, we find in genogram interviews that family members tell difforent stories about the same events. ‘Of course, seeing several family members is not always feasible, and the interview described here can also be used with one person. ‘The time required to complete a genogram assessment can vary ‘greatly, While the basic information can usually be collected in less than half an hour, a comprehensive family assessment interview in- ‘volving several family members may take from 80 to 90 minutes. ‘Some clinicians profer to spread the interviewing over a number of ‘The Fanily Information Net ‘The process of gathering family information can be thought of ‘as casting out a metaphorical information net in larger and larger circles inorder to capture relevant information about the family and ite broader context. The net spreads out in a number of different directions: from the presenting problem tothe larger context of the problem. ‘fram the immediata household tothe extended family and broader socal systems. «from the present family situation to «histories chronology of fami- ly events. «from easy, nonthrestening queries to dificult, naity-provoking guestions. ‘from obvious facts to judgments about functioning and relation spe to hypothesizod family patterns.Constructing Grnograns ‘The Presenting Problem and the Immediate Household Family merabers usually come with specific problems, which should bbe theclinicien’s starting point. At the outset, we tel families thet Re meed some basi information about them to fully understand the [problem Such information usually grows naturally out of explor- ‘ig the presenting problem and its impact on the immediate house hold, Te makes sense to most people for the clinician to ask about aerGamediate family and the context in which the problem occurs: + Who lives inthe household? {How is each person related? ‘Where do other femaly members live? ‘Tho cinician asks the name, ago, and sex of each person in the ‘household in order to sketch tho immediate family structure, Other Tovealing information can be elicited through inquiring about the problem: «Which family members lmow about the problem? {How does each view it, and how has each of ther responded? ‘Has anyone in the family ever had similar problems? ‘Whur solutions were attempted by whom in those situations? ‘This is alao a good time to inquire about previous efforts to get help for the problem, including previous treatment, therapists, hos: pitelizations, and the current referral source. ‘The Current Situation [Next the clinician spreads the information net into the current emily situation. This line of questioning usually follows naturally from questions about the problem and who is involved: «What has been happening recently in your femily? {Hove there been any recent changes in the family (people coming fr leaving ineses, job problems, et? Tis important to inquire about recent life cycle transitions as well as enticipoted changes in the family situation (eopocally exite andGenograms in Family Asteement ‘ntries of family members~birthe, marriages, divorces, deaths, the eparture of family members, ete). ‘The Wider Family Context ‘The clinician should look for an opportunity to explore the wider context by asking about the extended family ofall the adults ‘evolved. At appoint inthe discussion when the family seems at ease, the interviewer might say something like, “T would now like to ask ‘you something about your background to help make sense of your present problem.” When family members react negatively to questions about the ex: ‘tended family or complain that such matters are irelovent, it males ‘senso to redirect the focus back to the immediate situation, until the connections between the present situation and other family rela- ‘The clinician should inquire about each side of the family separato- 'y, beginning, for example, with the mother's side: + Let’ bogin with your mother’s family. Your mother was which one cof how many children? + When was she born? ‘Is she alive? 1 (24 not), when did sho die? What was the causo of her death? + (If alive, where is she now? What does she do? 1 Iu sho retired? When did this happen’ * When and how did your mother meet your father? When did they mary? + Had she boon married before? (If 0), when? Did abe have children by that marrage? Did they separate or divorce or did the sponse die? If 60, when was that? ‘And 20 on. In like fashion, the same series of questions is asked about the father. Then the clinician might ask about each parent's family of origin, ie. fether, mother, end siblings. The goal ato get ‘information about at least thres or four generations, including grad. Parents, parents, aunts, uncles, siblings, spouses, and children of the [P. The information net should extend beyond the biological and legal structure of the family to encompass commen law and cor ‘relationships, miscarriages, abortions, etilborns, foster and ‘adopted children,Consructing Oerograms 2 ‘The Social Context Inquiries should be made regarding friends, clergy, caretakers, teachers, doctors, ate, who are important to the functioning of the family, and this information ehould also be included on the geno- ‘gram, In exploring outside supports for the family, the clinician right ask the following: + What reles have outside people played in your family? {Have yeu gotten help from the community? ‘Who outside the family has beon Important in your life? {Has angone ele ever lived with your family? When? Where are they now! «What hes been your family’s experiance with doctors and other hep {ng professionals or agencies? ‘The Facts In leshingout the nuclear and extended families, the initial con- ‘can should be with getting the “facts” on each family member. These fare the vital statisties of the family, the type of objective data that ‘usually could be verified by public record. The goal isto obtain the following for each family member: + dates ofbirth, martinge, separtion, divorce ines, and death in- cluding caus) + sibling postion: ‘ethnic and religious beckground; * oecupation and education; ‘Teurrent wheresbouts ‘The Historical Perspective ‘As the clinician collects more and more “facts” about family events, certain gaps will appear in the history. To get a broad historical per spective on the family, the clinician uses the genogram to map the family’s evolution through time. Ifthe family appears receptive, the clinician may start one or more family members on a project of i historial ressarch in order to expand this perspective. Family mem- bers are encouraged to seek more information by speaking to other relatives, consulting family bibles, or obtaining medical or geneslog- ical records,u Genogram in Family Assessment ‘The goal is not only to track important family events, but also to locate the family’s development in historical time, For example, 2 suicide in 1929 suggests certain hypotheses (depression related to the stock market crash}; a marriage in 1941 suggests other his- torical circumstances which would influence a couple's development (¢he husband's involvement in World War 1). ‘There are certain critical life events that may be important to explore in detail + How did the family react when a particular family member was ‘bern? Who attended the christening ceremony or bris? Who was named after whom and who “should have been"? + How did the family react when a particalar family member died? ‘Who tookit the hardest? The easiest? Who attended the funeral? What was the effect when the will was read? Who wasn't there who “sould have been"? + When and why did the family migrate to tia country? How many ‘generations of tho family have lived here? How wll ithe initial ‘gmerations fare? Which members of the immigrant generation ‘cared the language? ‘Tracking shifts that occurred around births, deaths and other transitions can lead the clinician to hypotheses about the family's adaptive style, Particularly critical are untimely or traumatic death and the deaths of pivotal family members. We look far specifi pat- terns of adaptation or rigidfication following such transitions. As- sessment of past adaptive patterns, particularly families’ response to.and reorganization after losses and other critical transitions, are ‘often crucial in helping a family (McGoldrick & Walsh, 1983). A fami- |y’s past and the relationship family members have to it provide ‘important clues about family rules, expectations, and patterns of organization. ‘The history of specific problems should also be investigated in detail. The focus should be on how family pattems have changed ‘at different periods: before the problem began, atthe time of onset, at the time of first secking help, and at the present. Asking about hhow the family sees the future of the problem is also informative, Questions include: + When did the problem begin? Who noticed it first? Who thought it was serious not serious?Constructing Genograms % + Werefemily relationships diffrent before the problem bogen? What ‘other problems existed? «Doss the family se th problem ss having changed? Tn what ways? For betta or for worse? + What will happen in the family ifthe problem continues? If it goos sway? What does the future lok like? What changes do family ‘embers imagine are possible inthe future? Seeing the family in ite historical perspective involves linking past, present and future and noting the family’s flexibility in adapt- ing to changes. ‘Tracking Family Relationships and Roles ‘While mapping on the genogram the nuclear and extended fami- ly and gathering facts on different family members, the clinician should aleo begin to make inquiries and judgments about the di ferent types of relationships family members have and the function- if and reles of each person in the family. This involves going beyond the bare facts to clinical judgment and acumen. Inquiries about family relationships, funetianing and roles can touch sensitive nerves inthe family and should be made with eae. Questions on rela tionships include: + Are there any family members who do not speak to eachother or ‘who have ever hed period of not speaking? Are there any who Irerelare in serious conflict? «+ Are there any family members who are extremaly close? Who hips tout when help is needed? In whom do family memives confi + All couples have some sort of marital dificulties. What sorta of problems and conflicts have you encountered? What about your parents’ and siblings marriages? + How do you each get along with each child? Have any family mem- bers had particular probleme dealing with thelr children? ‘The clinician should get as many perspectives on femily relation- ‘ships as possible. For example, the husband may be asked, "How ‘lose do yeu think your mother and your older brother were?” Then the wife ia asked for her impression of that relationship, The goal isto uncover differences, as well as agreements, about family rela: tionships snd to use the different perceptions ofthe family to enrich the genogram picture for both the therapist and the family.= Genograms in Family Asses "From the relationships between family members, the clinician also bogine to get a sense of the complementarity of roles in the family. Questions that elucidate the role structure include: « Flas any family member been focused on 0 the caretaker? The prob- Tenmatc one? The sic” one? Tho “bad” one? The "mad" one? «Who in the family is scen asthe etzong one? The weak one? The ‘ominant one? The submissive on + Who in the family i seen as tho successful one? The flue? {Who is seen as warm? Aa cold? As earng? As distant? “Labels ce nicknames used by family members are particularly in- tractive. Often, each family member has a family-wide label that ‘escribes and even cizeumscribes his or her position in the family (ex, the tyrant” the “aupermother,”etc), Labels are thus good clues to the emetional pattern in the system (Papp, Silverstein, & Carter, 1973), ‘Sometimes itis useful to ask how members of the present family ‘would be characterized by other family members, eg.,"How do you {Think your older brother would describe your relationship with your wife?” or How would your father have described you when you were 1b, the age of your son now?" Again, gathering as many perspec- tives as possible enriches the family’s view of itself, and introduc- ing differences provides channels for new information. Difficult Questions About Individual Functioning ‘Assessment of individual functioning may or may not involve much elirieal judgment, Alcohol abuse, chronic unemployment and ‘severe symptomatology are facts that directly indicate poor func- ‘tioning, However, many family members may function wellin some fareas but not in others or may cover up their dysfunction. Often, if takes careful questioning to reveal the true level of functioning. (Questions about individual funetioning may be difficult or pain- {ul for fanily members to anewer and must be approsched with sen sitivity and tact. The family members should be warned that the ‘Questions may be dificult and perhaps told t let the clinician know Fan area is being touched that they prefer not to discuss. The link Can will need to judge the degree of pressure to apply if the family resists such questions,Constructing Genograms a Serious Problems “Has anyone inthe family had a serious medial or peychological problor? Been depressed? Had enxitis? Fears? Lost contro? as “ere been phiysienl or sexual abuse? Are there any other problems that worry you? + When dd that problem begin? Did you seek help? If 20, when? ‘What happened? What isthe status of that problem now? Work History + Hlave there been any recent Job changes? Unemployment? Do you ike your job? Who else works? Do they like it? ‘How much income is here? How does the economic situation com- pare with that of your relatives? Drugs end Alcohol + Do any family members routinely use medicetion? What kind and for what? + Doyou think any members drink too much or have a drug problem? “lao nyono eles ever thought 10? What drags? When? What bes ‘the fenily dono about it? ‘Trouble With the Law “+Have any family members ever beon arrested? For whet? When’ ‘What was the result? What is that person's logal status now? 1 Hlagenyone ever lost his of her drivers lcens0? Setting Priorities for Organizing Genogram Information ‘As we will seein the next chapter, information gathered for the ‘genogram often reveals family patterns which clinicians interpret ‘and utilize in clinical prectce. Inthe process of gathering the infor- ‘mation, the clinician should be aware of the type of patterns that ‘may appesr and probe for further information when such patterns ‘are suggested by the data. ‘One of the most dificult aspocts of genogram assessment remains the problem of setting priorities for inclusion of family information|Genograms in Family Assessment ‘on a genogram. Clinicians cannot follow every lead that the geno- ‘gram interview may suggest. Awareness of basic genogram patterns ‘can help the clinician set such priorities. As arule of thumb, the data ‘re scanned for the following: + Repetitive symptom. relationship or functioning patterns seen across the family and over the generations, Repeated triangles, ‘coalitions. cutoffs, patteras of confit, over- and Under functioning [Being aware of possible patterns makes the clinician more ser sitive to what is missing. Such missing information nbout impor ‘make or fail to make to various events.