Counseling Today, Member Insights

Enhancing the genogram to incorporate a narrative perspective

By Les Gura March 11, 2021

The first time I watched my internship supervisor use a genogram, I became enamored. Here was a tool that instantly created dialogue between counselor and client as they reviewed family history, dynamics, health, socioeconomic data and more.

But a funny thing happened when I began incorporating the genogram into my own work as an intern. Although the genogram helped promote conversation, I found I couldn’t always use the information gathered to help connect the issues presented by clients.

So, as I’ve often done since beginning my second career as a clinical mental health counselor after 35-plus years as a journalist, writer and editor, I put on my critical thinking cap. Might there be a way to do more with a genogram — a way to put my narrative experience into it?

I began to think about how writers create a cohesive narrative in fiction or nonfiction.

In America’s Best Newspaper Writing, Christopher Scanlan and Roy Peter Clark of the Poynter Institute note that when writers write in chronological order, they invite readers to enter a story and stick with it.

Phoebe Zerwick, director of journalism at Wake Forest University and a columnist I worked with when I was metro editor for the Winston-Salem Journal, refers to chronologies not just as a way to organize stories, but as a way to understand stories. “Once you have the events laid out on a timeline, you can pinpoint the most meaningful ones for the purpose of telling a story,” Zerwick told me in an email conversation. “That story is a series of ‘scenes.’ The timeline helps identify the scenes to draw out. Other events might be summarized or ignored. But without an understanding of the underlying chronology, the meaning of the story falls apart.”

So, why wouldn’t helping clients develop chronologies — along with a genogram — create a more cohesive story for my clients? To be sure, chronologies are not something new to practitioners and social service agencies as a means of tracking incidents relevant to a presenting client. In genogram work, chronologies have typically been used as a side tool to flush out connection between family occurrences and a specific presenting problem.

When I started working full time in September 2019 for CareNet Counseling as a licensed clinical mental health counseling associate, I decided it was time to merge chronology and genogram. My goal was not just to seek connection with specific family relationships or occurrences, but to allow clients to themselves identify and discuss the reasons behind key moments in their life — the “dominant narrative” that brought them to counseling — that may or may not be connected to their family history.

Thus was born the “geno-chronology.”

How a geno-chronology works

One of the principal jobs of a therapist is to help create moments of insight for clients. Toward that end, when I work from a narrative perspective, one of the first things I do is encourage clients to identify a “three-word dominant narrative” that brought them to counseling (see my previous article “Counseling from an editor’s perspective”).

I typically ask clients to do this as a homework assignment at the end of an initial assessment session. At our next meeting, we discuss the client’s identified three-word narrative to learn more details about current feelings and how things got to this point. When clients recognize and understand their dominant narrative, they often send signals — by their excitement or impatience — that help me decide to begin the geno-chronology.

As with the three-word dominant narrative, building the geno-chronology usually starts with a homework assignment. The purpose is to continue to engage the client in the process of therapy between sessions. Already in my career, I’ve observed that clients typically are more eager to get into work if they’ve done a homework assignment.

The assignment for the geno-chronology asks clients to identify “key moments” in their life — as few as two or three, or as many as 20 or more. What qualifies as a key moment? I typically use my own life as an example: I tell clients about the devastation I felt when my father died unexpectedly when I was 22, the joy of being the person to deliver my daughter (also unexpected) 10 years later, and the transformation I began after being fired at age 51 and recognizing that my life’s work as a journalist was over. In other words, key moments can represent triumph, failure, fear or any other emotion. If the moment is something that lingers in a client’s mind, it’s probably for a reason that’s worth discussing in therapy, regardless of whether it becomes part of the chronology.

Sometimes, based on the sessions that take place before the geno-chronology work begins, I might ask clients to pay particular attention to moments related to a specific issue — depression in their life or times when they felt overwhelmed, or devastating or traumatic incidents, for instance. For most clients, however, it’s a broader canvas from which they choose.

A fictional case study

Let’s use a fictional case study to illustrate how a geno-chronology provides therapeutic value.

Rob is a single white man, 34 years old, who initiated counseling when he was experiencing depression. Rob is a marketing manager, which is his first leadership role since graduating from a state university. Despite what appears to be a burgeoning career, Rob says he has been sleeping late and even called in sick to work twice in the past three weeks. He says he is not drinking any more than usual, he is not suicidal and he continues to maintain good physical health, although he has been eating out more frequently; he says he has been too lazy to cook.

From our earlier work, Rob’s three-word narrative was “life bores me.” I also know the basics of Rob’s upbringing: He is the middle child of three, with a high-achieving older sister who is a corporate attorney and mother of two, and a fun-loving younger sister who is a freelance writer and the darling of the family. Rob’s parents divorced when he was 16; his father is recovering from alcoholism. Both of his parents continue to work, and neither has a current romantic relationship.

I’m going to use a large artist’s pad for the geno-chronology, just like we would use for a traditional genogram. I usually turn the pad horizontally and draw a line across the bottom with an arrow pointing forward. I have only one instruction for Rob when I ask him to share his key moments: “Don’t necessarily go chronologically, even if that’s how you thought of them. Just begin with the moment that most stands out in your mind, and we’ll go from there.”

The late journalist Don Murray wrote about this idea for chronologies in his book The Essential Don Murray. “Do not start at the beginning, but at a moment of intensity,” he advised. Murray noted that readers understand the demands of chronology and know that when the timeline ends, they will have reached a heightened level of understanding. Similarly, counselors can make more sense by ascertaining the level of urgency when a story begins at a moment the client chooses rather than simply starting at the beginning.

Rob indicates that he’d like to begin with the first depressive moment he recalls — being a college sophomore, when he would lie around in his dorm room and miss class. He says he was bored and wound up spending hours playing video games and noshing on junk food, ignoring invites from his roommates and fraternity brothers to go out. Rob stops at that point, and I recognize the story needs to be fleshed out.

Scanlan and Clark note in their book that good editors help reporters unfreeze time in a story, often turning flat explanation into action. Questions for reporters include: When did that happen? Tell me the story of how that came to be. Do you know the history of this problem? As a counselor, I’m going to take that same approach, gently coaxing more detail from Rob by using the common narrative therapeutic practice of questioning.

I ask Rob if anything happened in his family at that point. “No,” he responds. “In fact, despite the divorce, things were getting a little better at that time because Dad finally sobered up, and when I saw him, he was great.”

Yet Rob’s grades were plummeting. “So, how did you get out of this funk?” I ask him.

His eyes light up. “Well, a professor in my major pulled me aside, basically, and told me he knew I was better than this and that if I accomplished even half of what he believed I could, I’d have a great career ahead of me.”

Rob says he went back to his room, tossed out some unopened bags of chips and hit the books for that day. He also began accepting invites to parties. It was the end of his depressive period, which had lasted a month. “To tell the truth, I’d almost forgotten about that period until you gave me this assignment,” he says. “But it was the first time I can remember being in that kind of funk.”

That is a lot of information to process, and I file it away knowing there is more to Rob’s story. But first, there are other key moments to consider.

Rob goes on to report two other “funks” between that incident and what he’s experiencing now. One of those depressive periods lasted six weeks. It began when his older sister got married; he couldn’t get a date, and that made him look at his life, where he had few friends and wasn’t socializing. The second depressive period lasted about three months and had occurred only a year and a half ago. That incident centered on breaking up with a girlfriend of four months after another wedding; she told him the event made her realize she had no interest in a long-term relationship with him.

I go back to the beginning, a question I often use at the start of my initial counseling assessment: “Why are you sitting in that chair, right here, right now?”

“Well,” Rob says, “I suppose this latest episode began when I saw my baby sister had an article published on HuffPost. I felt really proud of her. And yet that night, I got hammered.”

Once again, I know there is more to investigate. So, in the sessions that follow, Rob and I build a traditional genogram above the chronology. I begin to see a pattern, although I keep it to myself. It feels to me that Rob’s key moments of depression are closely tied to a perception of inadequacy, especially fed by the achievements of his siblings and a lack of connection with his parents, or both.

I ask him whether, as a middle child, he’s ever felt lost. He acknowledges he has, saying his mother bonded closely with his sisters, but he felt he hadn’t been able to have that type of close relationship with his father because of the alcoholism. In fact, Rob admits he resents that his dad got sober only after Rob was in college and his parents’ marriage had collapsed.

The conversation has Rob intrigued. He can look at the geno-chronology and see his key moments, which include both the “what” of the incident in question and the “significance” of it as he described it to me and I jotted notes next to the entry. Rob eventually brings up his resentment of his sisters and what he believes is his own lack of achievement in his personal and professional life. He thinks about his father, who bounced from job to job during his drinking years, always earning but never establishing a career of which to be proud. Rob feels that his marketing career is like that — enough to pay the bills but nothing that cultivates a sense of pride. And he doesn’t even have a family of his own.

The key moments of Rob’s chronology in this case have direct ties to his genogram. Rob is ready to talk in more detail about his lack of self-esteem, which, it turns out, was his true dominant narrative all along, hiding behind what was, in effect, the bravado of “life bores me.” Rob considers this and eventually recasts his three-word dominant narrative to “Failure overwhelms me.”

The addition of the chronology to the traditional genogram provides a visual cue for Rob to see the connection of the identified key moments in his life to the family system in which he was raised. Although it takes some time, the process prepares Rob, with a more accurate, self-identified dominant narrative, to begin the work of moving away from that dominant narrative and toward a preferred alternative narrative that he will identify in sessions to come.

Chronology and connection

Each incident that a client considers a key moment should be given weight during therapy. I’ve had entire sessions built around one key moment, as clients delve into a trauma they suffered in childhood, the story of the death of one of their children or how they made a life-changing decision. When clients are prompted by proper questions, these moments become a way to help them bring context to the stories of their lives, both in the period in which the moments occurred and in the present day.

In her book The Genogram Journey, Monica McGoldrick notes that “even the worst and most painful family experiences — alcoholism, sexual abuse, suicide — are part of our accumulated identity.” She goes on to write that “only by understanding what led to those behaviors can we begin to understand the dark side of ourselves and learn to relate more fully to others.”

The strength of the geno-chronology is that in today’s more fragmented immediate families, “the dark side of ourselves” often presents when clients have long separated — physically, emotionally or both — from their nuclear family. Adding good and bad life incidents to a genogram forms a more complete picture for clients and thus creates more opportunities for insight.

My ultimate goal in using narrative interventions is to help my clients identify a “preferred narrative” that will replace their dominant narrative. We use the same three-word approach. Clients have latched on to the concept by this point in therapy because during the building of the geno-chronology, I have asked them to develop three-word narratives for different points in their life. Looking back at past narratives identifies character traits that have developed through their families and relationships and have come into play during their key moments — all of which are conveniently on display in the geno-chronology. In the fictional case study I have presented, Rob might eventually settle on a preferred narrative of “Rob craves more.”

When clients identify a preferred narrative, we have a rich foundation from which to understand how character traits become magnified, lost or strengthened. We can have conversations about the process of gaining better awareness and control of character traits, enabling clients to move away from the dominant narrative and toward the preferred narrative. Rob might learn to recognize that despite his perception of self-failure, he can identify successes in his life, such as his ascension at work to a managerial role. We can discuss the traits that helped him achieve that, and he can learn to use those traits in other areas of his life.

Ultimately, the geno-chronology is a story-building tool that adds a narrative element to the classic genogram.

One of the things I have enjoyed most about becoming a counselor after a lifetime of writing and editing is letting go of my own concept of story. As a writer, my job was not just listening, but also absorbing the information from interviews and research and then determining the story to be told. As a counselor, I have the privilege of listening, absorbing and then allowing the chips to fall, with minimal guidance from me. I have ideas, and I can share those ideas, but the client is the protagonist of their own story.

****

Les Gura is a licensed clinical mental health counselor associate and national certified counselor based in Winston-Salem, North Carolina. He works for CareNet Counseling, where he is part of a two-year residency program and also serves as director of communications. Contact him at lgura@wakehealth.edu.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Leave a Reply

Your email address will not be published. Required fields are marked *