This video demonstrates the creative power of genograms to map family patterns in history. We will show you how to create a genogram using the symbols that have been standardized and are used in our books Genograms Assessment and Intervention, the Genogram Casebook, and the Genogram Journey You Can Go Home Again. We think of a genogram as a one-page story about a family, including the basic legal and biological structure, as well as informal kin over three or more generations, and basic demographics about family members, names, ages, and other dates, location, health, and relationships. But genograms can easily become so crowded that they become hard to read, and we must always make choices about what to include. Once the graphic becomes too busy to follow, it ceases to be useful.
Computers will soon make this easier, because we will be able to save information into a database and show only certain information on the graphic at a given moment. But for this video, we will be emphasizing the basic one-page graphic. We want to emphasize also the importance of using the standardized symbols and structure for creating a genogram. This is the only way that genogram mapping can become a shared language we can all read.
Thus, it is important to use the agreed-upon symbols, although anyone doing specific research on their own family or any other research may want to develop a special key to add particular symbols to show patterns they want to emphasize for that group of people. The genogram is a practical visual tool for assessment of family patterns and context, as well as a therapeutic intervention in and of itself. Genograms allow clinicians to quickly conceptualize the individual's context within the growing diversity of family forms and patterns in our society. Clinically speaking, gathering family information and constructing a genogram should always be part of a more general process of joining assessing and helping a family.
Information is gathered as family members tell their story in the context of their discussing the problem for which they are seeking help. While basic genogram information can be collected in a structured format as part of a medical record, the information should always be gathered for a purpose that the participant understands and treated with greatest respect. Sharing a family's history is an intimate process, not a mere technical fact gathering. Any question you ask may lead to the most sensitive, embarrassing, or traumatic experience, so it is never something that can be manualized as a list of questions or managed by just collecting the facts.
The genogram we are using for this video is for John Rodriguez, who sought help in 2018 for free-floating anxiety to the point of feeling panicky and almost incapacitated. His anxiety focused particularly on his wife's pregnancy. Our presumption is that the genogram may help us develop some hypotheses about this anxiety to help him. He was having trouble sleeping and kept worrying that something would happen to the baby and he would not be there.
We showed John as the index person index patient or IP by making his symbol larger and lower than his siblings when we later add them and he becomes the central focus of the genogram. By beginning with the genogram template, we have John's parents and grandparents sketched out before we begin. John's symbol, a square, hangs down from the line which joins his parents. The square shows that he is male.
We add his age, 28, inside the square, his name, written below, and his birth date, 1990, written above and to the left of his symbol. His location then goes above the birth date and his occupation wherever we can fit it. We add also his cultural heritage. His father's family was from Puerto Rico and his mother's family was Italian. All children of a couple are hung down from the couple line in order of their birth, left to right, from oldest to youngest.
Once the basic family structure and skeleton of who is in the family are drawn, we will start adding information about the family, particularly regarding demographics, functioning, relationships, and critical life events. But we will begin here by adding John's immediate family. since that is his primary focus, and come back to add his siblings and family of origin later.
We will add John's wife Katya, a Russian-Jewish immigrant and an only child, who is 27 and works as a medical technician. They've been married for two years and are expecting their first child, who is apparently a girl, as we can tell from the triangle pregnancy symbol with a circle inside. A circle representing a girl.
Next, we add John's siblings, whose symbols, as mentioned, are made smaller and higher than his own. Spouses of siblings are shown even lower and smaller than the siblings themselves so that the birth order of siblings remains clear and the spouses of siblings are not mistaken for siblings themselves. This will allow you to develop hypotheses related to the structure of the family including birth order, gender, and distance in age between siblings.
We never know whether our hypotheses about a particular family are accurate, but checking out hypotheses about patterns on a genogram is a basic way to learn about the family's history. We see that John Rodriguez is the second of four siblings, having an older brother, Jorge, and twin younger siblings, Peter and Marie. Converging lines connect the twins to the parental line. The three younger siblings appear to have more education than Jorge, who is working in construction, which raises a question about his role as the oldest relative to the others. Given the distances apart in age, we might assume that John and his one-year-older brother would grow up as a pair, and that the twins, being four years younger, would be another pair.
Or it might be that the three brothers would be a group and the sister would end up in a kind of outsider position. In any case, we wonder what family dynamics might have led the younger siblings to receive more education and what impact educational and occupational differences may have on family relationships. We also see that John's older brother, Jorge, has a partner, Tina.
Their connection lines indicating not a marriage. but a committed relationship shown by two couple connection lines, one solid and one dotted. They have identical twin daughters, indicated by the line connecting their converging twin lines.
They also experienced a miscarriage, indicated by a small line with a dot at the end, and then a stillbirth of a son, shown by the small square with an X, indicating these losses came before the twins'birth. Looking back at John's own family, we can see that his parents also experienced a miscarriage before their first son, Jorge's, birth. We now expand the genogram upwards to show the father's family of origin. For a person who is dead, an X is placed inside the symbol, as you can see for the paternal grandparents, a square for the grandfather, and a circle for the grandmother.
Birth and death dates are always placed above the person's symbol and separated by a dash. The person's current age or age at death is indicated inside the symbol. On genograms that go back more than three generations, symbols for individuals in the distant past are not usually crossed out, since they are all presumably dead.
On such genograms, only untimely or traumatic deaths are usually indicated with an X. The father, Jorge, is placed lower than his siblings to make clear his place on the sibling line, where he grew up as the younger of two brothers, an oldest brother having died early. Looking carefully, we can see that John's father was also named Jorge for that oldest brother who died at age four, the same year the father was born. That gives added meaning to the father's naming his own son with the same name. Jorge.
Exploring family patterns of naming and birth order can reveal a great deal about relationships, as we will see. The second son, Nick, is divorced and has two children. As we shall see later, he also had an active alcohol problem and a long cutoff from his father Diego, although it was repaired before the father died.
The grandmother's abortion of the final pregnancy in 1961 occurred because she had been so overwhelmed by the death of her oldest child that she felt she could not bear to risk having another child whose loss would break her heart again. We now move to the mother, Carmela's side of the family. Carmela came from an Italian family that had also had a miscarriage and then twins who died at birth. Following these losses, they adopted a daughter, Anna, shown by a dotted and a solid line connecting to her circle symbol.
The same year, the grandmother became pregnant and had Carmela. The couple then had another biological son, Matt, who defines himself as non-binary, shown by a modified symbol that combines a square at the bottom and is rounded at the top. Matt now lives with his partner in California.
The parents then took in a foster son, Joe, who has never married and lives in Chicago. Joe's connection as a foster child is shown by a dotted line down to his symbol. Apparently, the father was emotionally abusive to his wife.
and the couple separated soon after they took in their foster son, Joe. Finally, we want to include on the genogram key issues of functioning and relationships. Two important supports for John were his best friends from high school, Tom and Sam, who still live nearby and to whom he is still close.
While neither of them is married or a parent yet, he has been able to talk to both of them about his anxiety. Other than his uncle Nick's alcoholism and his aunt Anna's depression, family members'health seems generally to be good. John wished he could feel closer to both his mother and his brother Jorge, but was not sure how to improve their relationship.
The parents'key connection to their dog Boxer was also apparently a major support for the whole family, as is so often true about pets. We now add lines around the household showing John and his wife and another line around the parents, the two youngest siblings Peter and Marie, and the family dog. And then we add the various relationships among family members that John conveyed. Now that we have drawn the basic genogram, we might conclude that it is not surprising that John became anxious shortly before the birth of his first child.
We see from the genogram that there was a loss of the first child for the past three generations. His father's oldest brother died at four. His mother's parents lost their first three children, a miscarriage, and then the stillbirth of twins. His parents had a miscarriage before the birth of their oldest son, Jorge, and Jorge and his partner experienced the miscarriage and stillbirth before the birth of their twins. Such coincidental stresses are not always the case, but it is surprising how often factors in our history play a role in our current lives and stresses.
In this case, other factors may have been operating as well. John's father, Jorge, was named for his older brother who had just died at four, had just turned 59, just passing the age of 58 that his father, Diego, was when he died. John's mother, Carmela, is just turning 60, also just passing the age her mother was when she died. Could the parents have been passing down their own anxieties about outliving the same-sex parent? Something we know that people generally worry about.
Could the parents be passing along the anxiety to their son as he is about to start a new generation of his family? Could there also be a connection between Carmela's conflictual relationship with her older sister, Anna, since childhood, and the conflict of her two oldest surviving children, Jorge and John? Jorge was described as athletic and good-looking, while John was short and not too coordinated.
Though John has now become successful, and his height and lack of skill in athletics no longer play much role in his life. Meanwhile, his brother Jorge is apparently struggling financially and his relationship with his partner does not seem to be going very well. There are also signs of resilience on the genogram, which we always seek.
First is the fact that John sought help for his anxiety, a good sign that he was willing to acknowledge a problem and find a way to deal with it, which is less common for men and perhaps even more so for those of Puerto Rican or Italian heritage. Other positive signs would be the repair in the grandparent generation, of Uncle Nick's cutoff from his father before the father died. On the mother's side, we note her parents'creativity in seeking first to adopt and later to take in a foster child after their obvious struggles with having children.
It didn't save their marriage, but the indications are that both parents maintain positive relationships with all their children, even though Anna has suffered frequent depression. and she and Carmela are in frequent conflict, and Carmela did not feel as close to her mother as she now wishes she had been. In most cases, we do a genogram like this in the first session and correct and add to it as we learn more about the family. In this case, John felt amazed to see the number of stresses others in his family had experienced and thought that might be a factor in his anxiety.
He was opposed to any idea of taking medication for his anxiety and chose to meet again for a second session with his wife, during which we explored their relationships with their families and their anticipation of the new baby. Meanwhile, John had taken the opportunity to reach out to both his mother and his brother Jorge to discuss their experiences of miscarriage and the other losses in the family. After the second session, the door was left open to John for more therapy if he felt he needed it.
But he felt he was in a much better position to manage his anxiety and that his family had his back. He said it was also reassuring that he could return to therapy if he needed it.