THE FAMILY

Dunn, Levitt / THE

JOURNAL:
GENOGRAM
COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2000

The Genogram: From Diagnostics

to Mutual Collaboration
Adriana Balaguer Dunn
Mary Michael Levitt
Seton Hall University

In this article, the authors present the need for the integration of mu- of the need to establish consistency and reliability in the con-
tual client-therapist collaboration into the process of genogram con- struction of genograms provide evidence of the problem
struction and demonstrate through case examples from their own (Coupland, Serovich, & Glenn, 1995; McGoldrick & Gerson,
practice how such integration enhances the therapeutic power of the 1985; McGoldrick, Gerson, & Shellenberger, 1999).
genogram. The authors also suggest possible changes in the training McGoldrick and colleagues (McGoldrick & Gerson, 1985;
of marriage and family therapists in order for such integration to be-
McGoldrick et al., 1999) have indicated the need for further
come more easily incorporated, especially by beginning-level thera-
research on the effectiveness of genogram work and the need
pists. The collaborative genogram is consistent with postmodern
principles and recaptures Bowen’s idea of mutual discovery in to establish reliability in genogram construction. Coupland et
therapy. al. (1995) argue, however, that establishing the reliability of
the genogram is not necessarily possible or even relevant
because the genogram “is a heuristic tool with which mar-
riage and family therapists can record family information and
T he field of marriage and family therapy appears to be
rediscovering the genogram and its possible uses in the
treatment of individuals, couples, and families as well as in
processes for the purposes of hypothesizing and planning
interventions” (p. 252). We believe the wave of specialization
and standardization in both practice and training of profes-
the training of professionals from a variety of fields. A review sionals in the field has actually worked to dilute the heuristic
of the literature indicates an increasing specialization in the value and power of genogram use in treatment.
use of genograms. Some authors propose uses with specific Although the cause of this shift toward specialization and
populations such as older clients (Erlanger, 1990), premarital standardization in the practice of and training in genogram
couples (Wood & Stroup, 1990), and families in exile (Wood- work is difficult to determine, some possible contributing fac-
cock, 1995). Others have focused on adapting the genogram tors are (a) the increased emphasis on accountability and
for use with specific issues or presenting problems. Some objective documentation of treatment interventions spurred
examples include tracking of intergenerational transmission by managed care may be moving practitioners away from
of incest and aggression (Bennett, 1992; Doumas, Margolin, more process focused orientations, (b) the focus on standard-
& John, 1994), addressing marital difficulties (Crosby, 1990; ization may be a response to the training needs of begin-
Sherman, 1993), enhancing academic success and facilitating ning-level therapists who show a greater tendency to concep-
career decisions (Moon, Coleman, McCollum, Nelson, & tualize cases and treatment interventions in concrete and
Jenson-Scott, 1993; Rita & Adejanju, 1993), and improving mechanistic ways (D. Friedman & Kaslow, 1986; Skovhold
mother-daughter relationships (Howe, 1990). Finally, the & Ronnestad, 1992; Stoltenberg & Delworth, 1987), and (c)
genogram has been adapted to fit certain theoretical orienta- the inherent difficulty of delineating, quantifying, and pass-
tions and approaches. These include the development of the ing on to others the key elements that constitute therapeutic
solution-oriented genogram (Kuehl, 1995), the cultural process may have led many in the field to focus on more quan-
genogram (Hardy & Laszloffy, 1992, 1995), and the use of the tifiable aspects of genogram work.
genogram in group therapy (Schamess, 1990; Vinson, 1995). Despite those factors that are contraindicative of a process
Although these efforts to revitalize the use of the orientation (e.g., managed care), a mutually collaborative and
genogram and increase its relevance have been useful both process-oriented approach to genogram construction should
theoretically and practically, such practices have inadver- be maintained and supported because it is actually more in
tently obscured the basic significance of genogram creation line with Bowen’s original ideas of therapy as being a process
in marriage and family therapy. Ongoing clinical discussions of mutual discovery (Kerr & Bowen, 1988). As stated in

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© 2000 Sage Publications, Inc.

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 Dunn, Levitt / THE GENOGRAM 237

Nichols and Schwartz (1998), “Bowenians insist that it is treatment because the genogram as a technique is being
important not to become preoccupied with specific tech- imposed on them rather than being used to facilitate the ther-
niques—not look for a magic bullet. If there were a magic bul- apy process in a way that is mutually determined to be benefi-
let in Bowenian therapy—one essential technique—it would cial. The loss of the clients’ voices in favor of using the
be the process question” (p. 160). Furthermore, the Bowenian genogram as a technique for the therapist’s benefit is, as we
model is characterized as one where therapists are discour- view it, a significant drawback.
aged from fixing family problems and instead focus on Recognition of the potential of the genogram as a facilita-
encouraging clients to engage in a lifelong process of self- tor of process in therapy is evident in the literature. For exam-
discovery. ple, Erlanger (1990) indicates that “as the mental health coun-
A collaborative, process-oriented approach is also more selor works with the client in completing a genogram, there
consistent with the shifting paradigm in family therapy are therapeutic benefits inherent in the process itself, includ-
toward postmodern principles that move away from the ing fostering an empathic relationship between the client and
mechanistic implications of the cybernetic model and toward counselor” (p. 324). Erlanger (1990) concludes that both the
more mutual exploratory efforts based in language and narra- process and the content of the genogram have unique benefits
tive (Pare, 1995). As expressed by various postmodern and that those benefits are in fact interactive. She goes on to
approaches, the definition of collaboration we propose discuss the usefulness of both the process and the content of
emphasizes (a) the importance of the client as having exper- the genogram. However, in her case examples, she reverts to
tise in his or her own life and solutions to problems; (b) mutu- focusing on the content and falls short in elucidating how the
ality in the search for solutions; (c) a disdain for the imposi- genogram construction becomes central to the process of
tion of theories, techniques, or opinions; and (d) an therapy, rather than just enhancing the therapy. Other authors
understanding of the power of social interaction in generating have also acknowledged the importance of involving the cli-
and maintaining meaning for people (Anderson & ent in a cooperative construction of the genogram as a means
Goolishian, 1992; S. Friedman, 1993; White & Epston, of increasing engagement in the process (Hartman, 1995; Rita
1990). Such principles remove the therapist from an expert & Adejanju, 1993; Sherman, 1993). Yet, details of how that
position and make the therapy an empowering process in process takes place remain vague and illustrations are limited.
which the therapist and client mutually work toward discov- Schamess (1990), in his use of genograms during group ses-
ering new options and solutions (Nichols & Schwartz, 1998). sions with children of divorce, probably comes closest in
describing the integral role of the genogram process in
THERAPEUTIC PROCESS AS therapy. He states that “the process of presenting and dis-
CREATIVE AND CLIENT CENTERED cussing individual genograms allows them [the children] to re-
experience the disruption of their family units” (p. 89). Such
Even though process is mentioned consistently in the liter- reexperiencing then enables the children to learn new ways to
ature on genograms, the word is used loosely and a clear defi- cope and construct new meaning regarding their family sys-
nition of process is not easily available in many publications. tems and thus new ways to view and respond to their family
The construction of the genogram usually occurs primarily relationships. Schamess’s description of genogram use in
for the purposes of information gathering, hypothesis genera- therapy as a constitutive act reflects the changing epistemol-
tion, or tracking of relationship changes as explicated by ogy in the field of family therapy. As stated by Pare (1995),
McGoldrick and Gerson (1985) and McGoldrick et al. “common to each of the emerging social constructivist
(1999). Nichols and Schwartz (1998), who in their summary approaches is the postmodern view that new stories, new
of Bowenian approaches emphasize the importance of pro- worlds, are ours for the creating, and that the act of creation
cess, state that “the function of the genogram is to organize leads to the demise of what has gone before” (p. 15).
data during the evaluation phase and to track relationship pro- Pare (1995) further recommends, in keeping with the
cesses and key triangles over the course of therapy” (p. 171). postmodern spirit of openness to multiple perspectives, that
Thus, the genogram becomes primarily an assessment or an therapists avoid adopting an exclusionary stance toward
evaluation tool for the therapist, diminishing the opportunity established approaches and concepts in family therapy.
for the client’s discovery process, an integral part of treat- Rather, he suggests that instead of abandoning the knowledge
ment. The training of marriage and family therapists tends to and perspectives of our history as a field, therapists should
further reinforce this therapist-centered focus by emphasiz- consider how existing approaches can be subsumed within
ing the need to obtain genogram information initially in treat- the postmodern framework so that “the notions of boundaries,
ment as a prerequisite for hypothesis formation and develop- positive connotation, intergenerational transmission, and a
ment of interventions. Although the value of the genogram as wide range of other concepts, which have demonstrated clini-
an assessment tool is not denied, if it is used exclusively in cal utility, could be retained” (p. 15).
that manner, it leads to important limitations in the treatment The genogram is one of those approaches that suits itself to
process. A result is that clients’ voices are obscured in the incorporation into the postmodern paradigm because by its

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238 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2000

nature the process involves the telling of stories. The critical expertise and avoiding the imposition of techniques or
change that needs to occur in the construction of genograms is approaches is central to working collaboratively and is con-
that the story of the therapist no longer be given primacy, but sidered a crucial step in setting the tone for the therapeutic
that it involve a generative process that emphasizes respect alliance.
for the client’s perspective and the encouraging of multiple The boy’s difficulties at home and at school improved
views and possible outcomes. It is such a mutual and creative immediately in response to the initial behavioral interven-
use of genograms that needs to be elucidated further and that tions, therapy sessions, and teacher-parent-therapist consul-
we attempt to illustrate in the cases that follow. tations. With the immediate crisis under control, Mrs. J felt
The case presentations that follow are drawn from our own that therapy had been successful and anticipated termination
work with couples and families. They will highlight and of appointments. Had she decided not to continue with ther-
explicate the heuristic elements of the process that are essen- apy at that point, her decision would have been respected.
tial in both genogram construction and use in treatment. The However, during the course of these early interventions, Mrs.
cases will also demonstrate how to construct a mutually J also expressed a curiosity regarding possible underlying
developed, process-oriented genogram. The illustrations will explanations for her son’s difficulties. Thus, the invitation to
show how such an approach enhances the power and effec- explore intergenerational patterns occurred as a result of the
tiveness of genogram work with families by eliminating the client’s curiosity. The decision of whether to continue and of
dichotomy between assessment and intervention and high- how the genogram might be useful stayed within the client’s
lighting the client’s role in the process. The work is based on decision-making realm.
postmodern principles that emphasize that collaborative
efforts toward understanding family relationships and relat- Process as a Therapeutic Tool
ing them to presenting problems is the process of therapy, not
Evidence suggests that a therapist’s influence lies in pro-
a prelude to planning intervention (Andersen, 1993). This
viding the conditions under which the client can engage in
approach brings to light underlying issues, reactions, and
change, specifically emphasizing a process of mutual collab-
affects that occur during genogram construction, but might
oration between therapist and client (Duncan & Moynihan,
not normally be given voice by the client. These issues can
1994). The therapeutic alliance established in the initial ses-
then become significant and necessary ingredients in the col-
sions, based on the therapist’s respect for the client’s compe-
laborative efforts to create meaningful change. Implications
tence and ability to explore issues as well as on the family’s
for the training of marriage and family therapists in this pro-
experience of the therapist as responsive to their immediate
cess-oriented use of genograms will be discussed following
needs, provided the foundation for the integration of the
the case examples.
genogram process into the therapy sessions.
CASE 1: CO-CREATING NEW POSSIBILITIES The Invitation to Explore
FOR A MOTHER AND HER CHILDREN
Successful collaboration in introducing the genogram to
Mrs. J, 45-year-old, twice divorced, White single mother, the client requires that the therapist listen for the client’s
presented with concerns regarding her 12-year-old son’s request for the information the genogram will provide. In this
aggressive behavior and academic negligence. The family, case, Mrs. J simply asked, “I wonder where this came from?”
who lives with the maternal grandparents, also includes a Mrs. J’s request to understand her child’s behavior initiated
9-year-old daughter. the first step in the collaboration process: the invitation to
explore.
Building the Therapeutic Alliance
Following Mrs. J’s request for information, the second
Because Mrs. J requested therapy for her son’s aggressive step took place: the introduction to the genogram. This step
behavior and impending academic failure, the process of continued the collaborative process in that Mrs. J was not told
empowerment and collaboration began in the first session the genogram had to be done, but informed as to what the
when the issues Mrs. J needed to address were honored. Sec- genogram is and how she could potentially benefit from the
ondary to the boy’s academic deterioration were problems process. In this case, the therapist expressed to Mrs. J that the
with aggression at school with peers and teachers, as well as genogram was a way in which she might discover the answer
his hostility toward his mother and sibling. Interventions to her question. Mrs. J was informed that the genogram data
were immediately designed with the family to address the could empower her by providing information that would
boy’s academic difficulties. The therapist responded to the enable her to learn about her family’s multigenerational
family’s immediate concerns rather than focusing on gather- transmission process. The genogram information would give
ing genogram information because, despite the potential use- her the control to make important choices so as not to repeat
fulness to the therapist, the family did not view such informa- destructive interactional patterns that might have been estab-
tion as meaningful at the time. Respecting the client’s lished in her family.

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 Dunn, Levitt / THE GENOGRAM 239

Critical to this second step is that Mrs. J be the one to in the genogram allowed Mrs. J to shift from viewing herself
decide whether to proceed, wait, or choose another means of as deficient to understanding her struggles within the context
answering her question. Mrs. J expressed interest in the of family patterns. It was a critical factor that Mrs. J came to
genogram and chose to engage in the process. the conclusion herself that she was not the one to blame rather
than being told so by the therapist.
Construction of the Genogram
Mrs. J had been raised in a family environment where she
The genogram was constructed in full view on a large had never been allowed or encouraged to make her own deci-
poster board, and each entry made was explained as to its sig- sions. The collaborative process of therapy provided her with
nificance (e.g., specific dates denoting possible anniversary the experience of being able to have control and make her own
reactions) so that Mrs. J was fully informed and could partici- decisions. The use of genogram construction also provided
pate actively in the process. Each symbol was explained so the opportunity for her to review her family script and create a
that she would continuously understand the visual content. new story that opened up new possibilities for herself and her
Mrs. J determined what information was relevant to include in children. Together, the collaborative process and the review
the genogram, where the therapist should begin, and what of the genogram content had a synergistic effect in empower-
meaning was given to the patterns that began to emerge. Mrs. ing Mrs. J to respond differently to her present situation.
J was encouraged by the therapist to tell relevant stories or Because Mrs. J determined the content of the genogram and
recall events about the family members as they emerged from made sense of its meaning, she was able to fully own the con-
her consciousness and describe in detail anything she thought clusions she reached and the changes that ensued. For exam-
would be helpful to the construction process. Mrs. J chose ple, as Mrs. J described having always been told what to do by
which family members she needed to address first. A list of her family members, she realized that her feelings of ineffi-
data that would be helpful to know about each family member cacy and indecisiveness were understandable and ultimately
was provided so she could prepare the material for all the indi- contributed to the lack of control over her son’s behavior.
viduals in her family (e.g., dates, deaths, education, employ- Because she expressed a desire to change that pattern, Mrs. J
ment, ethnicity, medical, experience of trauma, addictions, and the therapist decided to look for instances in her
marriages, divorce, arrests, mental illness, pregnancies, and genogram where she had in fact been decisive and effective.
religion). However, she remained in control of the process. Mrs. J has always been successful in the work realm and had
As the genogram began to reveal the family legacy and supported her family following her divorces. She had also
Mrs. J had visual access to the genogram chart, she began to been decisive in ending her marriages when they had become
construct her own family story and generate her own conclu- harmful to herself and her family. Mrs. J also reached the con-
sions. Mrs. J was encouraged to let the therapist know if at any clusion that she should take the credit for initiating therapy
time she needed to stop and discuss the material. The and getting her son’s behavior under control.
genogram would be put aside temporarily until there was As Mrs. J began to take greater control, the intergenera-
mutual agreement to continue. Many times, the genogram tional impact of her changing position began to be evident.
construction raised intense emotional catharsis or nudged his- Her son began to reveal his own internal distress more
torical memories. Again, Mrs. J, in collaboration with the directly. The creation of a new family story during the
therapist, decided what she needed to do with the material as genogram construction allowed Mrs. J to understand her
it arose. son’s behavior without the intense shame and blame she orig-
The process of inviting Mrs. J to take charge of her own inally experienced, which had prevented her from confront-
genogram construction enabled her to begin revealing very ing and helping her son. Mrs. J responded actively to her son’s
complex and difficult information concerning the alleged distress by placing him in an inpatient unit for 2 weeks for a
sexual abuse of her children by her second ex-husband. The psychiatric evaluation of suicidal ideation. She sought out
genogram process itself contributed to her feeling empow- protective community agencies to address the alleged pater-
ered by encouraging her to draw her own conclusions about nal sexual abuse and petitioned the court for supervised visi-
what she needed to do for her children. Mrs. J entered therapy tation with the ex-husband.
expecting the therapist to control the interaction and provide The genogram process was particularly helpful when the
direction and solutions. She initially would become angry and court refused Mrs. J’s request for supervised visitation.
frustrated with the therapist for not assuming that responsibil- Because she was already engaged in the exploration process,
ity. For example, several times during the initial therapy, Mrs. she was able to address questions regarding her own legacy of
J would ask, “What should I do about this?” The therapist victimization and explore other avenues for protecting the
would respectfully respond, “It depends on what meaning this children. The genogram process, in this case, enabled a vul-
has for you and how you would use that.” As the therapist nerable parent who questioned her own ability to protect her
continually reaffirmed Mrs. J as an expert on her own life and son to tackle the arduous task of empowering herself to stop
a co-creator of her own solutions, Mrs. J experienced the shift the family legacy of abuse. During the genogram construc-
of power within herself. In addition, the information provided tion, Mrs. J had identified a pattern of submission in the face

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240 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2000

of authority figures in her family, particularly her father. Not the home until the genogram was completed. Here, the geno-
wanting to continue that pattern, the opportunity arose for her gram process provided a powerful intervention designed by
to experiment with new behavior. In collaboration with the the client with the therapist to build healthy boundaries into
therapist, she enlisted the support of her immediate family to her relationships.
construct an emergency plan for her son should he feel endan-
Construction of the Genogram
gered while visiting with his father. Her experience during the
genogram construction not only allowed her to construct The genogram construction took place over the next 4
alternative ways of viewing her self and her family (which weeks, which was considered an adequate amount of time to
opened up new possibilities for relating) but also enabled her evaluate Mr. C’s commitment to recovery and therapy. The
to experience the empowering effects of being in control and process helped Mrs. C verbalize secrets that had generated
making her own decisions. difficult feelings of shame and guilt holding her hostage to
victimization. In addition, Mrs. C began to understand family
CASE 2: USING THE GENOGRAM TO rules, myths, and roles and learned that she was the family
ADDRESS ISSUES OF DOMESTIC VIOLENCE peacemaker. She reported that the collaborative genogram
process had made her stronger because of the rich under-
Mrs. C, a 35-year-old woman of Irish descent, requested standing she gained about her family. She repeatedly stated
an appointment to discuss an incident of domestic violence that the freedom she felt to control the genogram construction
where a restraining order was needed to remove her husband process spilled over and reemerged in feelings of assertive-
from the home. Mr. C, also 35 years of age, had a history of ness within her marital relationship. The construction gener-
alcohol abuse. This episode constituted Mrs. C’s first request ated a discussion of relationship boundaries, which lay the
for help. She had been reluctant to request help in the past groundwork for the beginning of scheduling therapeutic
because of issues of shame and family privacy. The family meetings with Mr. C, who was sober and attending daily
included two children, aged 7 and 4 years. It was her concern Alcoholics Anonymous (AA) meetings as well as seeing a
for the welfare of the children that had led her to seek private therapist.
treatment. Mrs. C referred to her genogram information many times
Building the Therapeutic Alliance in the initial sessions with Mr. C She remained firm in her
expectation that Mr. C, who was campaigning very hard to
Mrs. C needed several sessions to work through the imme- return to the home, must attend daily AA meetings, remain
diate crisis. The primary therapeutic goal was to ensure fam- sober, stay in therapy with his private therapist, and respect
ily safety, develop community resources, and restore her her and the children’s needs. Mrs. C maintained the assault
self-confidence. Mrs. C made it clear that she did not want to charges and the restraining order except for therapy sessions.
reunite with her husband until she was sure her family would Eventually, Mrs. C, who was attending Al Anon, reunited
be safe. As in the last case, the therapist responded to the with Mr. C, and they continued couples therapy. At that point,
expressed needs of the family, leaving the gathering of more Mr. C also requested to construct his own genogram based on
general information for a time that was mutually indicated. In how useful that experience had apparently been for his wife. It
this case, waiting for the client’s indication of a desire to was mutually agreed that focusing on Mr. C’s intergenera-
explore family history was crucial given that imposing the tional history would be a beneficial use of the therapy at this
genogram early on would have likely violated the client’s time. Consequently, the next several sessions were dedicated
sense of privacy and heightened her feelings of shame, thus to the process of constructing his genogram.
damaging the therapeutic alliance. It became evident in the construction of the genogram that
Mr. C’s family was quite secretive. In taking control of the
The Invitation to Explore
genogram construction, Mr. C began changing the family
The invitation to explore emerged when Mrs. C made a ref- dynamic by freely revealing information about himself and
erence to several family members who abused alcohol and his family. Mr. C also initiated several conversations with his
questioned her own drinking pattern. Acknowledging the own active alcoholic parents to obtain the information. In the
family’s repetitive alcoholic behavior opened the door to process of exploration, Mr. C discovered that his aunt had
explaining the genogram process and how Mrs. C and her been killed by her mate. Mr. C also realized how his own
children might benefit from its construction. Mrs. C’s need experience of child sexual abuse was directly connected to his
for safety provided the motivation to risk revealing herself. current behavior. Mr. C’s genogram revealed that he was born
The mutually agreed on goal of the genogram construction on the same day his maternal grandfather died. He spoke at
became to discover what had impeded her from seeking help great length of the impact this had on his life. Because the cli-
earlier and to assist her in resisting Mr. C’s pressuring to ent was a cofacilitator of the process, the information became
return to the home prematurely. At this point, a verbal con- nonthreatening and provoked a lower level of anxiety and vul-
tract was made, on Mrs. C’s initiative, not to allow Mr. C into nerability when exploring difficult information, thus opening

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 Dunn, Levitt / THE GENOGRAM 241

up new possibilities for change. Mr. C explained that the to cooperate with genogram construction. As McGoldrick et
genogram process had enlightened him and underlined his al. (1999) indicate,
motivation to stay sober. The process itself had also enabled
one can not simply set out to gather all of the genogram infor-
him to begin changing the pattern of secrecy, which helped to
mation in the initial session and ignore the family’s agenda
support the drinking and abuse in his family of origin, and he for the appointment. Such a single-minded approach would
began constructing a new legacy for his own family. surely alienate the family from treatment. Gathering informa-
tion for the genogram should be part of a more general and
IMPLICATIONS FOR THE TRAINING gradual approach of joining with the family and seeking clues
OF FAMILY THERAPISTS as to the current problem. (p. 151)

Likewise, training programs should emphasize to their

The following modifications in the training of marriage
students that the resistance of clients to engage in genogram
and family therapists are suggested to ensure that the thera-
work needs to be respected. The key is to affirm their deci-
peutic power of collaborative genogram work in the field of
sion, maintaining the therapeutic alliance and promise of col-
family therapy is reclaimed and remains firmly established.
laboration. Such an affirmation supports the client’s place as
Because mutually collaborative processes of therapy imply
an expert on their own life and treatment and creates space for
that none of the parties involved exclusively determine where
the client’s voice in the therapy process (Anderson, 1993).
the process will take them, training programs need to provide
The therapist can then wait again for the invitation to explore,
a context for their students where, as therapists, they no lon-
which is likely to come at a future point in therapy. A discus-
ger need to function as the director of the client’s experience
sion of the reluctance, when treated as consideration of an
but can feel free to enter into experience with the client. Cre-
alternative perspective, may actually leave the client feeling
ating such a training context involves providing interactive, more open to the experience.
process-based experiences for students in addition to ensur-
ing that the students can accurately map intergenerational Why: Providing a Rationale for Genogram Work
diagrams. The following suggestions for training are derived
The manner in which genograms are first introduced to
directly from the case examples presented previously. They
trainees is as crucial as the manner in which therapists first
involve the when, why, what, and how of genogram work.
introduce the genogram to their clients. Generally, the initial
When: Timing of the Introduction of the Genogram introduction to genograms in marriage and family therapy
training focuses on the mechanics of genogram construction
An example of the tendency for beginning therapists to and subsequently on the generation of hypotheses from the
overemphasize technique is the focus placed by many train- completed genogram and its use in treatment. This progres-
ees on the need to complete the construction of the genogram sion makes sense in terms of having trainees learn the logis-
within the first sessions of therapy to be able to proceed with tics of the technique before focusing on its application. How-
treatment. As seen in the case examples, if the therapist ever, because of the isomorphism that exists between training
focuses on the process of therapy and follows the client/fam- and practice (Liddle & Saba, 1985), this approach often
ily’s lead, the genogram, rather than being imposed on the results in a reductionistic and task-oriented use of the
family by the therapist, emerges from the therapeutic work as genogram with clients, particularly by beginning therapists.
a logical next step in the process. This may occur in the first Trainees focus on the construction of the genogram, making
couple of sessions, or it may not be appropriate until later on sure that specific information (e.g., names, dates, critical
in treatment once crisis issues are resolved. The family needs events) is obtained. They hesitate to engage in treatment until
the opportunity to have their concerns heard and is likely to sufficient information is obtained so that hypotheses can be
begin asking for a way to understand their situation or actions. generated and a treatment plan can be developed. What gets
As a result of the therapist’s flexibility in introducing the lost in the process is a consideration of whether intergener-
genogram based on the family’s lead, the process of collabo- ational work is most appropriate for that case at that point in
ration permanently anchors the therapeutic alliance and time and whether such work seems relevant to that particular
enhances the power of the genogram for the client. The geno- client. As evidenced in the case examples, inclusion of the cli-
gram has typically been a method for the therapist to get infor- ent in the process is critical to the outcome.
mation to use for the client, not with the client. However, The training of marital and family therapists in the use of
when encouraged to take the lead, the family is more likely to genograms must, therefore, continually emphasize the fol-
become invested in the genogram construction and use the lowing points: (a) The family needs to be given a full explana-
information generated for therapeutic change. Therapists tion of why the therapist feels genogram construction may be
should, therefore, be trained to listen for requests by the fam- relevant at this point in the therapy, and how it might be help-
ily that would indicate the appropriateness of introducing ful in resolving the issues that are of concern to the client; and
genogram work rather than focusing on how to get the family (b) the family needs to be given a say as to whether they see

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242 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2000

the genogram work as relevant or potentially helpful at that requires that the therapist feel free to stay in the moment and
point in treatment and whether they are willing to participate not be responsible for determining the direction of the therapy
in such work. Consequently, regardless of whether the deci- and its outcome (S. Friedman, 1993). Rather, the therapist
sion is made to proceed with genogram work or not, the dis- needs to provide the conditions under which the family can
cussion itself has already contributed to the therapeutic pro- engage in therapy and bring about change.
cess and to the empowering of the client.
How: Process-Oriented Work
What: Facilitating Family Requires Process-Oriented Training
Involvement in Genogram Work
For therapists in training to become proficient in pro-
If the family is to be truly involved in the genogram pro- cess-oriented genogram construction, they must be provided
cess, they need the opportunity to view and experience the with opportunities to experience and practice such work in
genogram as it is being generated and the invitation to their training programs. Training programs can use a variety
become actively involved in directing its construction. The of approaches to facilitate such training. For example, the ini-
genogram should be available throughout the course of ther- tial introduction to genogram work should be an experiential
apy so that information can be added or modified as needed. one. Trainees could become involved in their own genogram
The family also needs to play an integral role in determining work. An initial group genogram construction could familiar-
how the information generated can be most helpful to them at ize trainees with the mechanics. Role plays could then be used
different points in the therapy. in conjunction with reflective feedback to illustrate the power
Because the process is generative and often unpredictable, of genogram information in treatment. The training focus
the details of the genogram are likely to be interrupted by the needs to combine the learning of skills and an understanding
family/client’s need to resolve difficult feelings awakened by of the purpose of the process with the trainee’s personal expe-
the connections made during the session. For example, Mr. C rience of that process. Also, integration of genogram material
began to realize the impact that the previous sexual abuse had at different points in the therapeutic process should be empha-
on his present drinking behavior. At such a point, it is impor- sized and illustrated. How can the genogram be used to decide
tant for the therapist to make a process comment that will on initial steps in therapy? How can genogram material facili-
allow a collaborative decision on how to proceed (e.g., “It tate impasses that arise in therapy? Does the genogram have a
seems you are exploring new areas that are sensitive and pain- role in the assessment of progress in therapy and in deciding
ful. We can put the genogram aside for whatever time you when termination might be appropriate? Can the genogram
need to work this through. Just let me know how you want to be used to highlight the perspectives of different family mem-
proceed”). Turning the process over to the client is imperative bers? Trainees need to be invited in courses and in supervi-
for the client to continue emotional integration. This process sory contexts to explore the multiple ways in which
comment will make room for the completion of the emotional genograms can help them learn about and help families. Thus,
work that is the goal of the therapy. they will be able to invite their clients to do the same. Finally,
If the genogram work is suspended, the dilemma then the creativity of therapists in training should be supported and
becomes how to continue the genogram from that delicate encouraged by training programs so therapists become capa-
point. If the family/client needs the rest of the session or sev- ble of devising multiple ways to use genogram material effec-
eral sessions to resolve the difficult feelings, a process com- tively with their clients. For example, children can be
ment is necessary to maintain the focus (e.g., “It is apparent involved in creating an emotional genogram, indicating who
that you needed the rest of our time to work on these feelings, is angry, sad, happy, or the most fun in the family based on
so would you find it helpful to pick up the genogram again their own experience. The possibilities are countless.
next time or sometime in the future?”). Incidentally, the thera- However, the emphasis needs to remain on keeping the
pist can recommend that because the client needed the session material relevant to the family and to their current needs. Oth-
to work on the issue, the client is free to take the genogram erwise, what could be a creative facilitative intervention runs
home and fill in some of the details and bring it back the fol- the risk of becoming an empty technique. The surest way of
lowing week. The client’s response may reveal how they are avoiding such a pitfall is to engage the family collaboratively
feeling about the process because they will comment on their in the work. Training programs also support trainees in this
decision. One family took the genogram home and had a fam- endeavor of keeping the process relevant to the client by
ily meeting where family members recreated the genogram engaging in collaborative and mutually determined processes
on a larger piece of paper using multiple colors to denote rela- in supervision, thus providing an isomorphic experience for
tionships and significant information. Another family the therapist (White, 1989/1990).
designed a computer genogram that they were able to read In conclusion, there is a need for research endeavors to
more easily. Such a collaborative approach to the genogram determine the relative contributions of a diagnostic versus

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 Dunn, Levitt / THE GENOGRAM 243

collaborative use of genograms to treatment effectiveness. It Hardy, K. V., & Laszloffy, T. A. (1995). The cultural genogram: Key to train-
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inherent expertise of the client that are now so strongly 10(1-2), 31-40.
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(Freedman & Combs, 1996; White & Epston, 1990; Bowen theory. New York: Norton.
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244 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2000

Adriana Balaguer Dunn, Ph.D., is an assistant professor in the Mary Michael Levitt, Ed.S., a licensed marriage and family thera-
Department of Professional Psychology and Family Therapy at pist, has been providing professional care for clients since 1984. She
Seton Hall University. She teaches in the master’s, post-master’s, has fulfilled a year-long teaching fellowship in human development
and doctoral programs in marriage and family therapy. Dr. Dunn is at Fairleigh Dickinson University, graduated as an educational spe-
currently the clinical director for the Ph.D. program. She is a clini- cialist in marriage and family therapy from Seton Hall University,
cal member of the American Association of Marriage and Family completed cross-cultural training in family therapy in Moscow, Rus-
Therapy and an American Association of Marriage and Family sia, and is currently the director of The Randolph Marriage and
Therapy-approved supervisor. Dr. Dunn is also a member of the Family Counseling Center in New Jersey. Ms. Levitt, also a school
American Psychological Association, Division 43 Family Psychol- counselor, is board certified in school crisis response, has been a
ogy and a licensed marriage and family therapist. hospice volunteer since 1989, and is a published author and poet.

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