Genogram Case - Tom and Susan

Discussion Question

Discussion Response

The purpose of the genogram in the clinical setting is to assist both the clinician and the client in looking at certain family patterns that may be repeating themselves, or influencing the client, across generations. Relationship patterns, trauma, cultural values, and the behaviors that have developed provide a symbolic picture of the family and its patterns through the generations. These repeated patterns can include relationship factors, personality characteristics, specific illnesses, and mental health issues. By creating this history along with developing an understanding of the present generation, it is possible to reconstruct many important aspects of the way the family process may have operated across the generations and predict possible functioning in future generations.

In family therapy, genograms are used to study and record relationship patterns between family members and the individual characteristics that make up these patterns that occur. "A genogram will help family therapists to make an appropriate assessment of the relationship patterns and where intervention may be needed to help the family reduce the dysfunction and/or problematic situation that brought them into therapy" (McGoldrick, Carter, & Garcia-Preto, 2011).

In the case of Tom and Susan we are able to watch and review how Dr. Muchnik develops and interprets Tom and Susan's family genogram. This exercise is extremely enlightening in how a clinician utilizes the genogram process as well as the genogram itself to develop a rapport and begin to engage the couple, while eliciting some of their feelings, resentments, problems, and current issues with their marriage and their son. At the same we begin to see a picture of Tom and Susan's family, the repeating patterns of behavior through the generations, along with how these may be affecting them and their children in this generation, especially with their son.

Clinicians can track multigenerational patterns of resilience, strength, and success as well as failure (McGoldrick, Carter, & Garcia-Preto, 2011). The genogram can be integrated into several therapeutic paradigms. The genogram can be used to identify relationship patterns, issues and potential problems as well as viewing how a client typically handles a relationship issue and if one is about to occur. This genogram exercise can help the client to identify and avoid an issue that is about to arise. The therapist can also use the genogram to document various factors that contribute to a client's personality and background, which is valuable for the client's file (McGoldrick, Carter, & Garcia-Preto, 2011). By the therapist keeping the genogram in the client's file this can be used for future use and reference in future therapy sessions with the client.

In couples counseling, genograms can assist a couple in developing insights into the extraneous influences on the couple's relationship. Separate and distinct developmental issues of one member of the couple arising from family history are also assessed. Genograms are used in pre-marital counseling to identify possible conflicts, and resources. Couples also benefit from exploring areas of compatibility and possible conflict which a genogram can reveal.

In family therapy, genograms can be used not only to assess the family's current dynamics, but also to track progression as the family brings about needed change. Individual members can also explore personality development within the context of the family--with immediate feedback. Generational patterns such as addictions, abuse and personalities are also explored within a context of family development.

Substance abuse counselors use genograms as part of assessment and for tracking progress. A genogram can help the client identify current relationships which act as triggers or support active use. They can also be used to identify and create new relationships which can act as supports in maintaining abstinence and constructive social interactions.

School guidance counselors use genograms as part of a developmentally-focused career education. The goal is to assist the student in career selection and personal development through the integration of information obtained from the genogram. For example, relationships which support the student's personal, educational and career developmental goals can be developed or expanded upon.

In the debriefing session it was described that they were connected to Dr. Muchnick. "Tom" made a point that Dr. Muchnick informed and validated each person's feelings. This was key as in the first session of therapy needs to be relationship building for all in the room. It needs to have a safe feeling within the session. Dr. Muchnick used the genogram as a motivational tool that helped the couple see that they can make it through this. The genogram brought clarity on what they both had endured in their lives and yet have conquered. Dr. Muchnick used the genogram as also a tool for the couple to see what is starting to happen with their son in relation to "Tom's" past relationship with his father. What I liked how they used the genogram is to add any other information that they were getting such as statements, questions, and cycles that were prominent in the session.

The genogram can be used in various therapeutic ways. It can be used with relationship patterns, health issues, drug and alcohol problems, mental health issues, marriage problems, types of abuses, immigrations, and financial standings. The genogram is great to get a lot more of the demographic information but also to put in a visual tool. This will also help with other key parts that the clinician may want to remember for future sessions besides the presenting problem.

In the case of Susan and Tom, Dr. Muchnick uses the genogram interview as an engagement process that allows the couple to think more clearly into where they want to go from here, why they behave the way they do, as well as how the genogram can assist in understanding (clarity) concerning their hectic marriage. According to the text, (McGoldrick, 2008) states that if the family is under severe stress or there is serious marital conflict, the clinician will want to explore what factors and strengths have helped to keep the family together." Just by Dr. Muchnick's providing the genogram to explore other options than just what they had experienced in the past such as divorce, adultery, abandonment, isolation, and embarrassment. This also gets Tom and Susan engaged in talking about their feelings, their hurts,