The power of the genogram Matthew Adam Introduction Vignettes mother, uncertain about how to react. Recently, while working in my professional Family 1 Jessica’s mother stated that while neither context, a Tier 4 inpatient hospital, I was ‘Jessica’, a 16-year-old girl, had been sexually of her girls had heard these stories they struck by a bolt of metaphorical lightning abused by her father when she was 11 years needed to be told and that she explained that drew my att ention to the seemingly old until she was 14 years old. She had been that she harboured guilt and responsibility innocuous tool many family therapists use referred to the inpatient unit for deliberate and for Jessica’s subsequent abuse. Th e on a day-to-day basis, the genogram (Carter severe self-harming behaviour and for having family story had suddenly become & McGoldrick, 1998). made two serious suicide att empts by over- overwhelmingly powerful and frightening Th roughout my clinical training I dosing on paracetamol. Aft er a few months and the young girls visibly withdrew inside understood the genogram’s value as Jessica’s mood lift ed and she developed coping themselves for the duration of the session. an assessment tool, an opportunity to strategies to help her deal with her thoughts of develop an awareness of patt erns or scripts self-harm and it was decided that home leave Family 2 in families, oft en trans-generationally, could begin. Visits home from the hospital ‘Suzanne’, a 16-year-old diagnosed and to use this feedback as a basis for the seemed to coincide with overdoses in the with anorexia nervosa, att ended a family formulation of hypotheses which would, community and the family oft en returned Jes- therapy session with her mother and of course, form the framework for the sica back to the unit distraught and angry. sister. Th e family had att ended one session therapist’s questions to the family. It has For the fi rst session with this family, I before but had not been able to discuss only been while working in a Tier 4 inpatient requested that as many family members as family relationships in that session. Th ere sett ing that I have been witness to the power possible be present and Jessica, her mother appeared to be a gap in the knowledge the of the ‘family tree’. For many families, and younger sister att ended the session. professional system had about Suzanne’s the exercise of telling their stories to the Jessica’s mother’s boyfriend was unable to extended family and they were asked if they therapist is just an information gathering att end the session, but sent his apologies were happy for me to complete a genogram. exercise. But for some, the genogram is and hopes that he could att end subsequent As the session began, Suzanne and her an intervention that can be extremely sessions. Being conscious that Jessica sister, Emily, spoke about how they were powerful, thus negating it as an exercise in and her family were ostensibly meeting a protective of each other because of life understanding and making it an infl uential stranger and may be reticent to speak about experiences they had. Th ey spoke briefl y force upon the therapeutic process itself. sensitive issues related to the reasons Jessica about their parents divorce and that this had In taking a detailed account of a family’s was struggling, I decided to complete a sent Suzanne’s sister ‘off -the-rails’. As the history and the relationships that comprise genogram in the fi rst session in the hope family began telling their family narrative I that system, stories lived can indeed become of allowing the family to acclimate to the wondered if I might also construct a timeline stories told (White & Epston, 1990). In some therapeutic process and to ‘take it slow’. of events, to help me make sense of the instances the stories have been recounted I began by asking Jessica and her family if timings of the signifi cant events in the family. before and serve to defi ne the family they would allow me to complete a genogram, Th ey agreed and were soon telling the story functioning. But at other times some stories explaining the ideas behind the genogram. All of when they began to notice that Suzanne have never before been told to an outsider family members agreed to this form of story- was restricting her diet. Th ese stories were and the impact of elevating these unspoken telling and indicated in no way a discomfort connected to a maternal Aunt who had an narratives may leave a profound and lasting with this method of information-gathering. undiagnosed eating disorder, which lead the impression upon the family as a whole and As the session progressed and the genogram way for Suzanne’s mother to tell her stories. for each individual member (Roberts, 1994). became more complete, Jessica’s mother Th e youngest of three children, Suzanne’s In my work with two complex families, I began telling stories that resonated with mother, Kathy, explained that her birth had introduced the genogram as a way of gett ing Jessica’s history and which neither daughter been an ‘unplanned mistake’ and that her ear- to know the family and their history, to ‘warm had previously heard. Jessica’s mother liest memory was of her parents arguing about the context’ and to prepare the way for the revealed she had an older child whom she who had wanted her least. Her father had died diffi cult conversations that were certain had placed up for adoption three years before when she was 17 years old and she had never to be had. Indeed, what actually occurred Jessica’s birth. Jessica’s mother continued shared a close relationship with her mother or and what I expected to occur were two very telling her story and explained that this child sisters. Kathy had stopped seeing her second diff erent events. At the time of meeting with was conceived when she was raped by a oldest sister, Sally and her husband aft er an ‘in- these families, I had an awareness of a family maternal cousin, resulting in her immediate cident’ between Kathy’s husband and Sally’s protectiveness around diffi cult stories, but I family rejecting her outright and abolishing husband. Both Suzanne and her sister asked had litt le awareness that in being complicit her from the family home. their mother to explain what had happened, The power of the genogram in joining in this intervention, both families With this new information surfacing that they had diff ering accounts of the story would leave feeling exposed and vulnerable Jessica became quiet and agitated and from multiple sources but still did not know and desiring never ‘to do THAT’ again. her younger sister quietly sat next to her what had happened from their mother’s story. 30 Context June 2010 Four generations of men/boys in the Adam family. Kathy refused to explain what had and how they function together as a unit. feeling anxious and worried. Being aware happened and queried what this story had to In my work, I fi nd that if I do not complete of this while in the room I tried helping the do with Suzanne’s illness. Th e conversation a thorough genogram within the fi rst three family move to a more sett le and manageable once again returned to the timeline of sessions of my work, the opportunity to place before lett ing them leave. But, it would events, where Suzanne remarked with a assess the family passes and the information be fair to say that in each case I was left certainty that her illness was the result of is harder to obtain in the later stages of the stunned by the power of the genogram. I her mother’s relationship with Michael. therapy. Th ere is an argument for delaying found myself in a position of disbelief, that Suzanne, Emily and Kathy spoke openly and the use of this therapeutic tool for later in the telling of a story would be so powerful as candidly about Michael and the confl ict that the work, surely the therapeutic relationship to make the family distrust the therapeutic had developed between Suzanne and her will have developed and trust and safety, process. I think it took me taking this mother as a result of the inevitable distance both essential to creating a secure base, may position of disbelief to allow me to consider this new relationship had created. beginning to take hold. But perhaps this what it was that actually happened. I realise Th e genogram was nearing completion delay may further entrench a family’s desire that for me, the genogram placed me in a and Kathy briefl y stated that her divorce to ‘hold on’ to stories that may infl uence position of power over the women in the from Suzanne and Emily’s father had been how an outsider might perceive them. room. Th e telling of the family history was messy and taken fi ve years. I summarised In both my case examples, the so powerful and I, having asked these stories the session, stating that the issues about genogram was provocative and made an to be told, became perceived as part of the men seemed important to this family when initial impression that family therapy oppressiveness of the stories. Kathy became visibly agitated and upset, was dangerous, not to be trusted, and expressed that she felt uncontained and uncontainable.