Genogram key example

It is convenient to study family history with the help of a genogram. A genogram is a form of family pedigree that records information about family members for at least three generations. Genograms show familial information graphically, allowing complex family patterns to be quickly seen, and are a rich source of hypotheses about how clinical problems may be related to family context and development. In addition, the genogram is a concise summary and allows the counselor, unfamiliar with the case, to quickly absorb a large amount of information about the family and get an idea of ​​its potential problems.

Fig. 1. The main designations of the genogram (on the genogram, next to the persons to whom this applies, there may be short information: names, education, serious illnesses, current place of residence, etc.).

The genogram, unlike other forms of research records, allows you to constantly make changes to it at each meeting with the family. It makes it possible to keep in mind a large number of family members, their relationships and key events in family history.
The genogram is not a test and does not contain clinical scores. Rather, it is a subjective tool for generating clinical hypotheses and analyzing family history.
The systems approach assumes that people organize their behavior within the family in accordance with generation, age, sex, structural and communicative parameters of the system. The structure of the family of origin influences the patterns of relationships and the type of family that the next generation creates. According to the main hypothesis, the relationship patterns of previous generations provide models for family functioning in the next generations.
A systematic approach allows you to combine the current and historical context of the family. The genogram helps the therapist trace the "current of anxiety" through the generations and its intersection with the current family context.
When reviewing family history, the counselor relies on the following main categories:

Birth order, gender and age difference between children.

People's behavior patterns are largely determined by whether they were older, middle, younger, or only children in the family. People who occupy the same position in the parental family in the order of birth have very similar patterns of behavior in their own family.
There is a limited number of possible role positions in the family, depending on the number of children, their sex and the interval between their births. Although birth order behaviors are currently undergoing changes due to social change, birth control, women's movements, and a large number of remarriages, there are some persistent differences in the role positions of children. So, the characteristics and their impact on marital relationships.
The eldest child in the family is usually more responsible, conscientious, striving for achievements, ambition. He often takes on part of the parental functions, taking care of the younger children in the family. He can feel responsible for family well-being, continuation of family traditions, often becomes a leader. The birth of the next child leads to the deprivation of his exclusive right to the love and care of his mother and is often accompanied by jealousy for a rival.
For the younger child, carelessness, optimism, readiness to accept someone else's patronage are more characteristic. For members of his family, he can stay like that forever and always be a baby. His parents, as a rule, are less demanding of his achievements. If the older children in the family do not die or become seriously ill, he will dedicate himself less to continuing the family's business.
The average child can show characteristics of both younger and older - or a combination of both. Often, however, the middle (but not the only) child has to struggle to get noticed and get a role in the family.
The only child is both the eldest and the youngest. As a result, such children have many of the characteristics of an older child, but may retain their childish qualities until adulthood. More than any other child, an only child inherits the characteristics of a parent of the same gender. Since parents tend to have high expectations for an only child, as well as for an older one, he usually excels in school and in subsequent areas where achievement is important. Being the center of attention, only children are often too closely attached to their parents throughout their lives. With fewer opportunities to play with other children, he may already resemble a small adult as a child. In addition, he will feel quite comfortable alone.
A child with special abilities may not meet typical characteristics. The second child may function as an older child if he has special talents or when the older child is sick. On the other hand, the position of the child in the family is strengthened if the parent of the same sex coincides with the child in the order of birth.
Parental attitudes regarding the sex of the child are of great importance. In most cultures, sons are preferred. The older sister in the family may take part in the upbringing of younger children and take on some of the parental responsibilities, while the next brother takes on the glory and burden of parental expectations. Research indicates that while son preference is decreasing, families with one girl are more likely to "keep trying" to have someone else, while families with only sons will end up with fewer children.
As for the difference in age, if it is more than five to six years, then each of the children will approach in their characteristics to the only child, although some qualities of the position to which he is closer will be added to them. For example, an older sister who is eight years older than her brother will be more of an only daughter, which she has been for eight years, but the features of an older child will also be noticeable in her behavior. The smaller the age gap, the more likely children are to compete for achievement. For example, if the difference between an older brother and a younger sister is only a year, then there will come a time when he will be afraid of the rivalry of a girl whose development is going faster.
For a stable marriage, it is of great importance to what extent it repeats the position in the order of birth that each spouse occupied among brothers and sisters.
In this regard, we can distinguish complementary, non-complementary and partially complementary marriages.
In the marriage of older and younger children, it is easier for spouses to agree and adjust to each other, as they reproduce the experience of relationships with brothers and sisters (Fig. 2).
They occupy complementary roles in marriage - one cares, the other takes care; one wants to go to work, another prefers to stay at home, and so on. Their connection is the stronger and longer, the more the relationship of both partners resembles their position in the parents' family ("theory of duplicates").

Fig. 2. Complementary marriage of the youngest daughter and eldest son.

A non-complementary marriage is a marriage of partners with the same ordinal position in the parental family. Other things being equal, they need more time and effort to agree and act in concert. When two older children are married, they may compete for power and compete in relationships. The two younger ones, on the other hand, can avoid responsibility and compete over who is younger (Fig. 3).

Fig. 3. Non-complementary marriage: a) two older, c) two younger children.

A very important question is whether the spouses had experience of relationships with persons of the opposite sex in the parental family. A husband who comes from a family where all the children were boys is likely to perceive a woman as a "foreign being", and he needs to make more efforts to understand his wife than a man who had sisters (Fig. 4).

Fig. 4. Complementary marriage of two older children, complicated by difficulties due to the same sex of children in the family

A distinction should be made between identity and complementarity. In the first case, we are talking about identification, in the second - about interaction. Partners who occupied the same position among brothers and sisters in the parental family recognize each other more easily and reach mutual understanding faster. For example, a younger brother or younger sister knows well what it means to be the youngest compared to other children. Husband and wife, who were the eldest in the parents' family, know well what it means to take care of the younger ones and be responsible for them. They easily understand each other and, if necessary, can replace one another, but they do not cooperate well. Identical partners only maintain full consent in marriage when they work in different fields, provide each other with certain freedom in their personal lives, have different companies and raise different children, for example, sons are raised by a father, and daughters by a mother.
Partially complementary relationships are established when one or both partners in the parental family had several types of ties with brothers and sisters, of which at least one matched that of the partner (Fig. 5).
Only children, due to their greater attachment to their parents, are more likely to look for traits of their father or mother in their partner. The best prognosis for such people is marriage to a partner who had a younger brother or sister (for example, a husband who was an only child and a wife who had a younger brother). Marriages in which each of the spouses was the only child in the family have the worst prognosis.
It is also important to note that the complementarity of marriage is not an absolute guarantee of its stability. It is necessary to correlate this parameter with the nature of relationships in the parental families of the spouses. For example, a husband expects his wife to take care of him, while at the same time rebelling against overprotectiveness, as he did with his older sister. An important model is also the relationship of the parents of the spouses.

Key life events in the genogram include births, deaths, marriages, divorces and separations, moving, serious illnesses, changes in relationships, careers, jobs and schools, major failures and successes, etc. Often seemingly unrelated events occurring at the same time in family history are systemically correlated and have a profound effect on the functioning of the family. It is not assumed that one event causes another and causes it, but rather a combination of events that can influence the development of family patterns. When examining family history, it is necessary to note the time when the family experienced a heap of stress, the impact of traumatic events within the family, and the relationship of family experience with social changes.

The following 4 types of coincidences are distinguished:
1. The coincidence of an important life event in the family with the beginning of the development or exacerbation of a symptom in any of its members. A typical example of this type of coincidence is the age-related aggression of a child after the birth of a younger brother or sister.
2. Grouping important life events into a period of transition between stages of the life cycle. Families are especially vulnerable during this period. For example, the collapse of a father's professional career may overlap with the period between adolescence and the phase of separation of the child from the family and markedly worsen the father's relationship with his son, who is trying to go his own way. Or a woman who has long postponed her marriage marries soon after her father's death. In this case, the relationship of a woman with her father should be examined. The most important question that the consultant must answer for himself is why the family came to see him now, and not earlier or later.
3. Reaction to the anniversary and the coincidence of events according to the type of "age milestone". Some coincidences are reactions to the anniversary of some important or traumatic event. For example, a depressive mood that occurs at the same time every year may coincide with the anniversary of the death of a parent or sibling, and this connection is not always conscious. By a certain age, anxiety can increase sharply in family members. For example, a man whose father died of a heart attack at age 40 may develop a fear of dying of a heart attack when he begins to overcome this age limit. Or a woman becomes especially afraid of divorce when her youngest daughter is the same age as she was when her father left their family. Or, for example, such a case. A woman with a problem teenager of thirteen years old comes to the consultation. During the interview, it turns out that when she herself was thirteen years old, her mother died. Perhaps she is seeking advice right now, as her son has approached the age at which she herself has no experience of communicating with her mother.
4. The coincidence of a series of events with the birth of a child can make his position in the family special. So, a number of circumstances indicate the special position of Sigmund Freud in the family of his parents. In the year of his birth, his father's father dies, a year later a brother is born and soon dies, after which only girls are born in the family for a long time. In addition, a couple of years after the birth of Freud, the eldest sons of the father from another marriage emigrated to England. It is possible that Sigmund became a substitute for all these losses for his parents. On the contrary, a child born “at the wrong time”, when the family was not ready for this, may bear the stamp of hidden rejection. Symptomatic grandchildren are often born within two years of the death of the grandparents. Stressful life events, especially the loss of loved ones, increase the likelihood of accidents. The loss of the eldest child transfers his functions to the next, making him the hope of the family.
Repetition of functioning patterns in the next generations. Many symptomatic patterns, such as alcoholism, incest, physical symptoms, violence, and suicide, tend to be reproduced from generation to generation. Identifying and investigating these patterns can help the family better understand the coping strategies used and find alternatives to avoid recurring unpleasant patterns in the present and in the future. The legacy of "family programs" can influence expectations and choices in the present. So, for example, a woman who comes from a family that has been divorced for several generations may perceive divorce as almost the norm. The choice of life path can also be based on the life experience and interests of previous generations.

Despite the enormous complexity and variety of family interactions, which also change over time, the study of family history makes it possible to trace the transmission of certain forms of relationships from generation to generation. It is especially convenient to do this using a genogram. Obviously, the smallest system consists of two people. Analyzing the genogram, one can see the repetition of dynamic relationships. Thus, sons in every generation have a conflict relationship with their fathers and a close relationship with their mothers, while daughters, on the contrary, have conflicts with their mothers and are close to their fathers. All spouses have distant or conflicting relationships with each other. In other words, there is a complementary pattern of marital distancing, conflicts between people of the same sex, and alliance between people of different sexes. It can then be assumed that the son and daughter in the third generation will repeat this pattern of distant marriage, conflicts with children of the same sex and intimacy with children of the opposite.
A more complex level of analysis, corresponding to the systems approach, proposes to connect these dyadic relationships and see them as the function of others, thus exploring family triangles. From this point of view, the distance between father and mother may be a function of the closeness of the father and the mother-daughter conflict. It is possible to put forward similar hypotheses for any three members of this system. The existence of a dyad is unstable, so the couple tends to draw in a third to stabilize their relationship. Triangulation is considered the main mechanism for the transmission of relationship patterns from generation to generation. One of the main therapeutic strategies in this case is to abandon the triangle, work on solving the problems of the dyad directly with each other. Thus, in this example, it might help to establish a close relationship between a daughter and her mother, even if the father, with whom she was close, is in conflict with the mother (perhaps the fear of disloyalty to the father prevents the daughter from doing this on her own). If the daughter could achieve this, the likelihood of her having conflicts with her own daughter (in the next generation) would be greatly reduced. In addition, this would ricochet to change the relationship of the spouses.

Family therapist collects information:
1. About family composition: “Who lives together in your house? What kind of relationship are they? Did the couple have other marriages? Do they have children? Where do the rest of the family live?
2. Demographic information: names, gender, age, length of marriage, occupation and education of family members, etc.
3. Current status of the problem: “Who in the family is aware of the problem? How does each of them see it and how do they react to it? Does anyone in the family have similar problems?
4. About the history of the development of the problem: “When did the problem arise? Who noticed her first? Who thinks of it as a serious problem, and who tends not to attach much importance to it? What attempts were made to solve it and by whom? Has the family consulted specialists before, have there been cases of hospitalization? How have relationships in the family changed compared to what they were before the crisis? Do family members see the change as a problem? In what direction: for better or for worse?
What will happen to the family if the crisis continues? How do you see relationships in the future?
5. About recent events and transitions in the life cycle of the family: births, deaths, marriages, divorces, moves, problems with work, illnesses of family members, etc.
6. On family reactions to important events in family history: “What was the family's reaction when each child was born? Who is it named after? When and why did the family move to this city? Who suffered the most the death of this family member? Who suffered the loss more easily? Who organized the funeral? Assessing past forms of adjustment, especially family reorganization after loss and other critical transitions, provides important clues to understanding family rules, expectations, and response patterns.
7. About the parental families of each of the spouses: “Are your parents alive? If they died, when and why? If alive, what are they doing? Retired or working? Are they divorced? Have they had other marriages? When did your parents meet? When they got married? Do you have brothers or sisters? Older or younger and what is the age difference? What do they do, are they married, and do they have children?” Then you can ask the same questions about the parents of the father and mother. It is important to collect information for at least three generations, including the generation of the identified patient. Important information is information about adopted children, miscarriages, abortions, early deaths of children, other significant people for the family (friends, colleagues, teachers, psychotherapists, etc.).
8. About family relationships: “Are there any members in the family who broke off relationships with each other? Is anyone in serious conflict? Which family members are very close? Who in the family does this person trust the most? All married couples have some difficulties and sometimes conflict. What types of disagreement do you have in a couple? Your parents? In the marriages of your brothers and sisters? How does each spouse get along with each child? You can ask special circular questions. For example, you might ask your husband, "How close do you think your mother and your older brother were?" - and then ask the opinion of his wife. It is sometimes helpful to ask how other family members might describe the people present at the meeting: "How would your father describe you when you were thirteen, which is your son's age now?" The purpose of such circular questions is to identify differences in relationships with different family members. By discovering the diverging views of different family members, the consultant simultaneously enters new information into the system, enriching the family's understanding of itself.
9. About family roles: “Which family member likes to take care of others? Who loves to be taken care of? Who is the strong-willed person in the family? Who is the most authoritative? Which child is more obedient? Who is successful? Who keeps failing? Who is warm? Cold? Distant? Who gets sick the most?" etc. It is important to pay attention to the labels and nicknames that family members give to each other (Super Mother, Iron Lady, Home Tyrant, etc.). They help to understand the emotional patterns in the family system.
10. About difficult topics for the family: “Do family members have serious medical or psychiatric problems? Problems with physical or sexual abuse? Do they use drugs? A lot of alcohol? Has anyone been in jail? For what? What is their status now? etc. Discussion of these topics is sometimes painful for family members, and therefore such questions should be asked especially tactfully and carefully.

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