The genogram representation of a family is more advanced than a family tree. Claus Mikkelsen, grandfather to Cindy, is the only first-generation member still alive. Cindy’s maternal grandparents Desmond and Mary are deceased, and they divorced before death. From the genogram, Jenifer, Cindy’s mother is suffering from depression, possibly caused by the miscarriage she suffered recently. Cindy and her father, James, are conflicted by Jenifer’s condition impacting their daily lives. It is important to note that Jenifer lost her sister Harriet, while James was the only child to Mr. and Mrs. Mikkelsen. James and Jenifer are engaged but still cohabiting and are currently in intimate conflict. A genogram will represent all these family traits to aid the entire family therapy process.
Genograms
Genograms are crucial in systematic family system therapy used to conduct the assessment. According to Alexander et al. (2022), a genogram represents multiple family generations arranged like a family tree. However, unlike family trees which only depict familial relationships between members, genograms include relative factors like deaths, diseases, sociodemographics, disease and illness, relational dynamics, traumatic life events, and other human relational elements (Alexander et al., 2022). Genograms can generate rich information about the family as research, educational, or professional tool. The tool can tress a traumatizing experience across family generations. In the case of Mikkelsen’s family, a genogram is crucial for depicting all relational and co-occurring human factors that make them a social unit.
James and Jenifer’s Family Genogram
The referral
A referral is fundamentally a recommendation to a competent facility or personnel when needing a certain service. Today, many referral avenues exist for families seeking mental health services to explore. The family can talk to immediate family members to point them to a licensed psychologist. In this case, Claus is the one who referred his son James to a psychologist who helped him overcome the trauma he suffered during his active combat years in Vietnam. Also, many state psychological agencies set up referral services to link clients with professional mental health caregivers (APA, 2023). the referral agencies are also a choice for James to explore when seeking a professional psychologist to help his family cope with a problem.
Deconstructing the problems
In a family conflict or challenge involving one or more members, deconstructing the problem is crucial in establishing the origin or the root cause of the problem. Jenifer recently encountered a miscarriage, which forms the genesis of her recent behavior change. She seems withdrawn from her husband and daughter, claiming how special their loss could have been if he had been brought into the world alive. Specifically, Jenifer has refused to take care of their daughter, leaving James with most of the parental responsibilities. They recently shared that the father has to perform all the chores, including preparing Cindy for school and responsibilities. Deconstructing the problem in the process of formulation in systematic practice involve coming up with a hypothesis and explanation to explain the root cause of the problem (Tickle et al., 2015). In this case, suffering a miscarriage by Jenifer explains the sudden change in the behavior causing discomfort in the family. The emerging dysfunctional relations all stem from the trauma Jenifer experienced when she prematurely lost her child. Thus, the psychologist will use the root cause to develop a potential systematic hypothesis to kickstart the formulation process.
James is worried about the mental status of his wife, given that he was affected by the loss. When deconstructing the problem, the focus is given to how the situation affects different family members, how relationships are affected, the most affected member, the history of it, and exceptions that could be made (Tickle et al., 2015). By definition, deconstructing the problem situates the vital role of the psychologist in analyzing and guiding relations, focusing on the problem. James provided all the information case information so far, necessitating the need for getting Jenifer involved in the process. The important point is that Claus, a war veteran, referred his son to us, making him an important component of this process, given that he is one of the family members.
Contextual factors
The contextual factor primarily entails the descriptive elements of the problem as linked to various family factors. Specifically, the section entails the family structure and genograms, the history of the problem, family resources, culture, environmental factors, and the role that other non-family actors play in this case (Dallos & Draper, 2015). Mikkelsen’s family is not socially deprived, given the number of family friends within and out of their residential area. On numerous occasions, James has been helped by Jenifer’s female friends to do some domestic duties to show their support. James’ father has been supportive and is familiar with trauma can negatively affect individuals in a family context.
For non-family actors, Jenifer was taken to the hospital immediately after she realized something was different. However, the healthcare providers did not attend to her because the high number of accident causalities caused a crisis admitted on that day. Given their income status, the family has enough resources, as both parents are formally employed. Also, they have a security company that has been in operation for half a decade, further explaining how resourceful they are when accessing quality care services. James has been summoned by the school superintendent, citing how psychologically affected the daughter has been in recent times. Given the recent change in Jenifer’s condition, the social work agency will put with the family’s situation. The school had forwarded the case to child protective services explaining why agencies were involved in this case.
Beliefs and explanations
When faced with a problem, family members give a different meaning based on underlying belief systems. According to Dallos and Draper (2015), beliefs and explanations entail the meanings and understanding different family members give the problem, where there could be similarities or differences in their values, beliefs, and expectations. Also, different family members’ understanding of the impact of the problem on the community, religion, or any social group is crucial to understanding the cultural impact of the problem on the individual and the whole family (Dallos & Draper, 2015). In terms of belief concerning their lost child, Jenifer appears to believe that James is not concerned by what happened. On the other hand, James suggests that his wife is over-attached to the tragedy since it happened over five months ago. In this instance, the difference in belief regarding the mourning period of their child is influenced by the emotional attachment a mother has for their child compared to the father.
Outside the family, Jenifer is religious, while James does not subscribe to any faith system. The wife will likely associate family tragedies like the miscarriage she suffered with the unseen dark forces. It explains why she has been spending much time in church compared to any other place. On the other hand, James treats the problem as a medical condition, a belief that creates disagreement with her wife. Given the existing belief differences in processing the problem, Cindy’s school believes in an existing relational dysfunctional explaining her lack of concentration in class. All the beliefs from Jenifer, James, and the school explain the problem differently.
Problem-maintaining patterns and feedback loops
Family structure and how different units relate with each other during a crisis is vital in understanding problem-maintaining patterns and feedback loops. Tickle et al. (2015) identify family structure in terms of emotional communication and the exploration of the existing boundaries and other subsystems within it. Family hierarchy is also within this concept. As the father, James has displayed repetitive behavior in taking care of the family, even knowing well that he needs the help of his wife. On the other hand, Jenifer has emerged emotionally withdrawn from the family despite having Cindy and her husband caring for her. A pattern of resentment is evident in Jenifer’s expression of emotions. She seems to blame herself for the loss, a feeling that has been challenging for James to process for the past five months.
A pattern of Jenifer’s withdrawal from her family’s well-being uniquely explains this concept. An aspect of problem-maintaining patterns and feedback loops is evident in repeating forms of emotions, behaviors, or attitudes which escalate into an identifiable trend (Dallos & Draper, 2015). A trend in the wife’s non-involvement in the daughter’s welfare worries the family. For the past five months, Jenifer had not tucked their daughter to bed, shared an ice cream with her, or go shopping with her, the bonding routines that strengthened the mother-daughter emotional attachment before the tragedy happened. The escalating pattern of a distancing mother-daughter bond is fueled by the bereavement emotions that Jenifer suffered when she lost her pregnancy through miscarriage. The lack of the mother’s love previously enjoyed by Cindy negatively impacts Cindy’s emotional well-being explaining the difficulties encountered at school, as reported by the teacher. James also displays repeated frustration because he has to care for everyone and misses her previous emotional connection with her family, especially his wife.
Emotions and attachments
The concepts of emotions and attachments encompass the family’s emotional well-being, focusing on shared emotions and interdependencies between family members in all generations. Expression of emotions can be used to establish interpersonal relationships shared by family members (Dallos & Draper, 2015). When Jenifer expresses their resentment towards her husband after losing their child indicates anger towards him for not being concerned enough. Also, it may be interpreted as some degree of blame by the wife towards the husband for not doing enough to save the pregnancy. However, the husband is not to blame because he took her to the hospital immediately, he learned of the problem, but the hospital delays and other unforeseen circumstances may have contributed to the problem. Without the loss, no indicators of an existing emotional dysfunction within James’ family exist. Things only escalated after the miscarriage incident.
Cindy has been more emotionally drawn to her father than her mother. When James is in the house, her daughter engages in clingy behaviors with him, and most of the time, she will cuddle him until she falls asleep. The behavior shows how emotionally attached the daughter has become to the father since the mother lost the pregnancy. There is a possibility that Jenifer lost the emotional connection she had with her daughter before she encountered the problem. Jenifer seems traumatized, making her emotionally insecure with her family, including her daughter. However, Cindy still shares a strong emotional bond and attachment with her grandfather and father. Expression of emotions is encouraged in this family, whether positive or negative, a social trend that could help solve the problem.
Synthesis
In formulation, synthesis marks a crucial stage of piecing together information gathered about the family. Synthesis is the selective and intuitive task of weaving together much information to derive meaning (Dallos & Draper, 2015). Therapists must remain objective to help the family find solutions to the problem. It is not about testing the correct hypothesis but staying curious and active to efficiently deconstruct the problem (Dallos & Draper, 2015). In that case, Mikkelsen’s family therapist should not decide positively or negatively construct its image. Using the information, the therapist should string together the information to establish its negative and positive attributes before and after the problem. Synthesizing information is not easy, especially when the therapist has existing values and beliefs that could make them biased. The goal is identifying beliefs and assumptions that could make us biased crucial for shaping our formulation. For instance, evidence should establish if James did not emotionally support his wife after the miscarriage escalating her condition, or Jenifer did not allow her husband to support her.
A crucial factor concerning formulation is that the process is a two-way traffic. As much as the focus is on the family’s cultural beliefs, norms, and practices, they are also weary of our attitude and beliefs and are likely to shout us out when they identify a conflict of interest. In that case, collaboration through reflective team discussions is integral to finding mutual understanding between the family and therapists (Dallos & Draper, 2015). Through collaboration, the professional team and the family will likely map out conflicting ideas, beliefs, and practices and foster understanding. Without understanding, the conflicting ideas will lay the ground for disagreements between the family and the therapists making it difficult to synthesize information.
From the case, problematic family patterns that need to change include the following:
- Ignoring Jenifer’s feeling of bereavement after she suffered a miscarriage. The family has never contacted a specialist since Jenifer lost their child. They have never discussed the problem, creating conflict between James and his wife.
- Also, another pattern that needs to be addressed is the inability of the mother to provide the needed emotional and resource support to the daughter. James has been alone when caring for their daughter for the past five months. Cindy has emotionally distanced herself from the mother, and if the situation is not rectified, their relationship may be permanently damaged.
- An experience of reality shift, where the daughter can only turn to the father when needing a parent, needs to be addressed. When Cindy asks her mother for help, she always seems withdrawn, which has left the daughter conflicted about their relationship. Cindy is growing up in a dysfunctional family setting where parental responsibilities or practices are not aligned with the expectations of a normally functioning family.
- Also, this family has a problem with expressing or processing emotions. Jenifer prefers to withdraw from the family and suffer silently after losing their child. On the other hand, James does not know how to express his emotion and help Jenifer process her feelings.
Conclusion
Family conflicts can be catastrophic if not resolved and normalcy restored. Using a genogram, a psychologist can trace the root cause of a family conflict and demonstrate how the problem impacts each member. In the case of James’ family, when his wife suffered a miscarriage, physical and emotional gaps developed between the parents, negatively impacting the child. When the grandparent referred James to a psychologist, it showed all members’ willingness to help eliminate the dysfunctional elements of the family affecting members. The whole process of deconstructing this problem involved the assessment of individual factors like emotional attachment and expression and group factors like culture and religion. With the guidance of a genogram, the therapist can mend the existing gaps within the family.
References
Alexander, J, H., Callaghan, J, E., & Fellin, L, C. (2022). Genograms in research: Participants’ reflections of the genogram process. Qualitative Research in Psychology, 19(1), 91-111, https://doi.org/10.1080/14780887.2018.1545066
APA. (2023, March 21). How to find help through seeing a psychologist. American Psychological Association, https://www.apa.org/topics/psychotherapy/psychologist-therapy
Dallos, R., & Draper, R. (2015). An Introduction to Family Therapy: Systematic Theory and Practice. (4th Ed.). Open University Press.
Tickle, A., Rennoldson, M., Schroder, T., Cooper, A., & Naidoo, R. (2015). 8. Systematic family therapy. In: Formulation in Action: Applying psychological theory to clinical practice (p. 123-141). Warsaw, https://doi.org/10.1515/9783110471014-010
write