I was interested in expanding a theme that quickly emerged from my data regarding how genograms can facilitate therapeutic change in a number of ways. All therapists talked about the value of re-framing the client’s view of themselves by seeing their presenting issue, events and family relationships in a different context. This allows a shift in perspective which can be healing in itself, so “when the facts change, I change my views” (Therapist E). This can update the client’s internal working model (Bowlby, 1979) and re-write their life script (Berne, 1961) as they “can see it as a narrative rather than a given truth” (Therapist I). For example, Therapist H’s client was able to challenge the view of herself as ‘the wrong baby’ and develop a new core belief. Therapist E also confirms that “what can be surfaced through insight, through the internal working model is about the re-writing of that model, the re- offering of one's life”.
90 This change in view can precipitate the discussion of certain issues within families, encourage clients to experiment with alternative ways of communicating and facilitate family re-connections; for example, a client re-establishing contact with a family member in order to find out about gaps in their genogram. As Therapist B clarifies:
“sometimes they say, I really need to find out about this, I'm going to phone my gran, or whatever, urr, contacts and re-connections can happen as a result of questions that we've looked at from a genogram.”
Therapeutic work using a genogram can build strength, self-agency and empowerment in the client. Therapist A remarks that:
“I'm asking them how they spell this name and who's this and how old they are and they're pointing over, there is real collaboration you know, I am no longer the person in charge, they're telling me and I think they probably feel quite empowered by that.” More specifically, Therapist E said he identifies people in the genogram who have acted as an anchor or secure base (Bowlby, 1979) for the client and then reinforces what they have internalised from them. Therapist E states:
“doing a family tree, I might say things, so if he were here, and he was trying to help you, once we've identified the person who they see as being an important person, a secure base, if they were here and they were helping you to address that, how do you think they might do it then?”
It can also be helpful for the client to notice stories of survival and resilience in their family, so they can start to recognise that strength in themselves. Therapist E goes on to say:
“so there's something about identifying stories of survival, once we've identified that, we can then begin to say well, how can mine be more like that?”
91 Exploring a different way of looking at things can be empowering and increase the client’s sense of self. If clients can see “how past history is being re-played in the current relationship, it's really helpful, if people can see that they feel much more empowered” (Therapist B).
For example, Therapist’s I’s previously mentioned client remembered a forgotten part of herself when she delved into her childhood experience of her father leaving, thus allowing her to gain a sense of herself as a subject rather than an object. In her own words, she recalls:
“having done that, the, she's done a bit more remembering about being a child and remembering that part of herself....thinking about who she is....um, more of a sense of being a subject rather than an object”.
Therapist I also believes that focussing on the meaning of the genogram to the client can itself be therapeutic as they experience a relationship where they are assertive and in control. She says:
“I think that in itself is therapeutic, you know, somebody can feel that they're coming to a relationship which is about them, in which they have choice, in which people offer them things they don't necessarily have at their disposal but they are free to reject them if they wish”.
Indeed, gaining insight and awareness crucially offers the client choice. Therapist H said that genograms provide clients with a sense of their own history, thus giving them roots from which to make informed decisions. In her own words, she says:
“I think a genogram gives people a sense of their own history within a context of family and socially and internationally you know whatever, and spiritually, it gives them all of that and then they can think actually these are the bits, this is my direction though, so it gives them a sense of agency...it gives them roots doesn't it?”
92 Therapist I uses genograms as a tool for acknowledging who is influencing the client’s situation, so it is then possible to ask the client who they would like to move away from or who they would like to feel closer to, so they can build new relationships and opportunities. She believes a genogram offers a:
“way of actually acknowledging that all those people are there influencing the situation and it can be a tool for having some choice, well actually let's look at them, which ones are the ones which you'd like to move a bit off or to move further off the, towards the edge of the map or whatever it is you're doing”.
This choice presents options for different ways of behaving and responding in the future. So the client’s questioning of their knowledge base can facilitate behaviour change: “what you do is unpacking some of the stuff and changing their behaviour” (Therapist G). For example, Therapist H said that a genogram provided the platform for her client to choose a different life for her children compared with the instability of army life that she had experienced as a child. She confirms: “that's part of what she saw [in the genogram] and decided she wanted something very different for her life and her family”.
In addition, after she noticed the pattern of relating within his family, Therapist D’s previously mentioned client had more information which allowed her to help her husband understand and modify his treatment of their eldest child as “she felt this was something that she really needed to do something about, to help him change his responses” (Therapist D).
Therefore, Therapist D believes it is about personal change within the client as much as starting to shift family relationships and communication patterns. She remarks:
“you know they can get the responsibility of breaking, breaking the pattern much clearly and it being not just about themselves but about the generation to come, which I think is really important”.
93 My participants also felt that genograms foster emotional understanding as well as cognitive insight. The naming and re-framing of experiences allows the release of associated emotions, helping the client let go of their fears, grieve for their scripts or express anger about their unacknowledged role. For example, Therapist C says that one of her clients:
“was able just to then think about um, actually that fear of dying and fear of funerals was something that she'd carried with her but actually she'd outgrown now um, through I think just, through, in a couple of sessions just working on that pattern over time um, through using a genogram”.
This can sometimes involve different threads in a complex and subtle process of healing. In recognising the influence of family myths, traditions or transgenerational trauma, the client may experience some relief in understanding that "this isn't just about me, this isn't about me carrying this" (Therapist H), whilst also facing the task of learning new relational patterns or self-regulatory mechanisms. This allows them to develop a different emotional relationship to themselves. For example, acknowledging the influence of her father’s exodus when she was eight enabled Therapist I’s client to relate to her current bereavement differently as she was not “so filled up with emotions from the past”. So it is “not taking away the negative” (Therapist G), but enabling the client to express, explore and live with often conflicted feelings.
I recognise in writing this that such therapeutic change is possible without genograms, however I wanted to illustrate how my data suggests that genograms can specifically assist this process. As a main theme of interest for me, I shall return to this in my Discussion.