The first time I saw my internship manager use a genogram, I was in love. Here was a tool that immediately established a dialogue between counselor and client as they checked family history, dynamics, health, socioeconomic data and more.
But a funny thing happened when I started integrating the genogram into my own internship. Although the genogram helped promote conversation, I found that I couldn't always use the information gathered to connect the problems presented by customers.
As I have often done since beginning my second career as a clinical mental health advisor, after more than 35 years as a journalist, writer, and editor, I put my critical thinking cap on. Could there be a way to do more with a genogram – a way to bring my narrative experience to that genogram?
I started thinking about how writers create a cohesive narrative in fiction or non-fiction.
Christopher Scanlan and Roy Peter Clark of the Poynter Institute state in America's Best Newspaper Writing that when writers write in chronological order, they invite readers to enter a story and stick with it.
Phoebe Zerwick, journalist at Wake Forest University and columnist with whom I worked as the underground editor for the Winston-Salem Journal, describes chronologies not only as a way of organizing stories, but also of stories to understand . "Once you have the events arranged on a timeline, you can identify the most meaningful ones to tell a story," Zerwick told me in an email conversation. “This story consists of a series of scenes. The timeline helps identify the scenes to be drawn. Other events can be summarized or ignored. But without an understanding of the underlying chronology, the meaning of the story falls apart. "
Why shouldn't I help clients develop chronology along with a genogram to create a more cohesive story for my clients? Of course, chronologies are nothing new for practitioners and social services to keep track of incidents relevant to a presenting client. In genogram work, chronologies have typically been used as a tool to remove the link between family events and a particular presentation problem.
When I started working full-time for CareNet Counseling as a licensed clinical counselor in September 2019, I decided it was time to merge chronology and genogram. My goal was not just to relate to specific family relationships or events, but to enable clients to identify and discuss the reasons for key moments in their life – the "dominant narrative" that brought them to the consultation that it may or may not be related to their family history.
This is how the "Geno-Chronology" was born.
How a geno-chronology works
One of the main tasks of a therapist is to create moments of insight for clients. To this end, when working from a narrative perspective, one of the first things I do is encourage clients to identify a "dominant three-word narrative" that led them to consultation (see my previous article, "Consulting From." an editor's perspective ”).
I usually ask clients to do this as homework at the end of an initial assessment session. At our next meeting, we discuss the client-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 – through excitement or impatience – that will help me decide to begin geno-chronology.
As with the three-word dominant narrative, the structure of the geno-chronology usually begins with a homework assignment. The aim is to keep the client involved in the therapy process between sessions. In my career I have already noticed that customers are usually more willing to get down to work when they have done their homework.
The geno-chronology task asks clients to identify “key moments” in their life – just two or three, or up to 20 or more. What is a key moment? I usually 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 giving birth to my daughter 10 years later (also unexpectedly), and of the transformation I had started after being laid off at the age of 51 and realizing that my life's work as a journalist was over. In other words, key moments can represent triumph, failure, fear, or other emotions. If the moment is something that comes to mind to a client, it is likely for a reason worth discussing in therapy, whether or not it becomes part of the chronology.
Sometimes, based on the sessions that take place before starting the geno-chronology work, I may ask clients to pay special attention to moments related to a specific topic – depression in their life or times when they are overwhelmed or felt devastating or, for example, traumatic events. For most customers, however, it is a wider canvas that they choose from.
A fictional case study
Let us use a fictional case study to illustrate how genochronology offers therapeutic value.
Rob is a single white man, 34 years old, who initiated counseling when he was suffering from depression. Rob is a marketing manager who is marking his first leadership role since graduating from a state university. Despite a seemingly burgeoning career, Rob says he slept late and even called in sick twice for work in the past three weeks. He says he does not drink more than usual, he is not suicidal, and that he continues to be in good physical health even though he has eaten out more often; he says he was too lazy to cook.
From our earlier work, Rob's three-word short story was "Life bores me". I also know the basics of Rob's upbringing: he's the middle kid of three, with a high performing older sister who is a corporate attorney and mother of two, and a fun-loving younger sister who is a freelance writer and the family favorite. Rob's parents divorced when he was 16; his father is recovering from alcoholism. Both parents continue to work and neither has a current romantic relationship.
I'm going to use a large artist pad for geno-chronology just like we would use for a traditional genogram. I usually rotate the pad horizontally and draw a line across the floor with an arrow pointing forward. I have only one direction 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 start with the moment you notice the most and we'll go from continue there. "
The late journalist Don Murray wrote about this idea for chronologies in his book The Essential Don Murray. "Don't start at the beginning, but in a moment of intensity," he advised. Murray noted that readers understand the requirements of chronology and know that by the time the timeline expires they will have a higher understanding. Similarly, counselors can make more sense in determining the level of urgency if a story begins at a time the client chooses, rather than simply starting at the beginning.
Rob says he'd like to start with the first depressed moment he remembers – as a sophomore, when he'd be lying around in his dormitory and missing class. He said he was bored and spent hours playing video games and eating junk food, ignoring invitations from his roommates and brothers to go out. Rob stops at that point and I realize that the story needs to be fleshed out.
Scanlan and Clark find in their book that good editors help reporters clear time in a story and often put shallow explanations into action. Questions to ask reporters include: When did this happen? Tell me the story of how it came about. Do you know the history of this problem? As a counselor, I will take the same approach and gently elicit more detail from Rob using the usual narrative therapeutic practice of questioning.
I ask Rob if anything happened in his family at this point. "No," he replies. "In fact, it got a little better at that time, despite the divorce, because Dad finally got sober and when I saw him he was great."
But Rob's grades fell. "So how did you get out of this funk?" I ask him.
His eyes shine. "Well, a professor in my major basically pulled me aside and told me he knew I was better than that and that if I could only achieve half of what he was, I would have a great career ahead of me thought possible. "
Rob says he returned to his room, threw away some unopened bags of chips and hit the books for the day. He also accepted invitations to parties. It was the end of his depressive episode, which had lasted a month. "To tell the truth, I had almost forgotten that time by the time you gave me this assignment," he says. "But it was the first time I remember being into that kind of funk."
This is a lot of information that needs processing, and I'm putting it away because I know there is more to Rob's story. But first there are other key moments to consider.
Rob reports on two more "funk" between this incident and what he is about to experience. One of these periods of depression lasted six weeks. It started when his older sister got married; He couldn't get a date and that made him look back at his life in which he had few friends and didn't socialize. The second depressive phase lasted about three months and had only occurred a year and a half ago. This incident centered on the breakup with a friend four months after another wedding; she told him that the event made her realize that she was not interested in a long-term relationship with him.
I'll go back to the beginning, a question that I use a lot at the beginning of my initial counseling evaluation: "Why are you sitting right here, right now in this chair?"
"Well," says Rob, "I suppose this last episode started when I saw that my little sister had published an article on HuffPost. I was very proud of her. And yet I was hammered that night. "
I know once again that there is more to investigate. In the following sessions, Rob and I create a traditional genogram over chronology. I'm starting to see a pattern even though I keep it to myself. I feel that Rob's key moments of depression are closely related to perceptions of inadequacy, particularly due to his sibling's accomplishments and lack of connection with his parents, or both.
I ask him if he has ever felt lost as a middle child. He admits that his mother was closely related to his sisters, but he felt that due to alcoholism, he had not been able to have such a close relationship with his father. In fact, Rob admits he refuses that his father sobered until after Rob was in college and his parents' marriage collapsed.
The conversation fascinated Rob. He can look at the geno chronology and see his key moments, which include both the "what" of the incident in question and the "meaning" of the incident as he described it to me, and I made notes next to the entry. Rob eventually expresses his grudge against his sisters and what he believes is his own lack of achievement in his personal and professional life. He thinks of his father, who jumped from job to job during his drinking years, always making money, but never starting a career to be proud of. Rob believes his marketing career is like this – enough to pay the bills, but nothing that encourages a sense of pride. And he doesn't even have a family of his own.
The key moments in Rob's chronology in this case are directly related to his genogram. Rob is willing to go into greater detail about his lack of self-esteem, which it turned out to be his true dominant narrative all along, hiding behind what was actually the bravery of "Life Bores Me". Rob thinks about it and finally sums up his three-word dominant narrative, "Failure overwhelms me."
The addition of chronology to the traditional genogram provides Rob with a visual clue as to how the identified key moments in his life are connected to the family system in which he grew up. Although it will take some time, the process prepares Rob with a more specific, self-identified dominant narrative to move from this dominant narrative
to a preferred alternate narrative that he will identify in the upcoming sessions
Chronology and connection
Every incident that a client considers a key moment should be weighted during therapy. I've built entire sessions around a key moment as clients delve into a trauma they suffered in their childhood, the story of the death of one of their children, or how they made a life changing decision. When clients are prompted with correct questions, those moments become a way to help them bring context into the stories of their lives, both in the time the moments occurred and in the present.
In her book The Genogram Journey, Monica McGoldrick states that "even the worst and most painful family experiences – alcoholism, sexual abuse, suicide – are part of our accumulated identities". She continues: "Only when we understand what led to these behaviors can we begin to understand the dark side of ourselves and learn to relate more fully to others."
The strength of geno-chronology lies in the fact that in today's more fragmented immediate families the “dark side of us” often occurs when customers have separated from their core family for a long time – physically, emotionally or both. Adding good and bad life events to a genogram gives a more complete picture for customers and thus creates more insight.
My ultimate goal in using narrative interventions is to help my clients identify a "preferred narrative" to replace their dominant narrative. We use the same three-word approach. Clients stuck to the concept at this point in therapy because, while building the geno-chronology, I asked them to develop three-word narratives for different points in their life. A review of past narratives identifies character traits that have evolved through their families and relationships, and that came into play at their key moments – all of which is conveniently seen in geno chronology. In the fictional case study I have presented, Rob may eventually agree on a preferred narrative of “Rob longs for more”.
When customers identify a preferred narrative, we have a rich foundation on which to understand how character traits are increased, lost, or strengthened. We can have conversations about the process of better perceiving and controlling character traits so that clients can move away from the dominant narrative and towards the preferred narrative. Rob might learn to realize that despite his perceptions of self-failure, he can see accomplishments in his life, such as his rise to a leadership role at work. We can discuss the qualities that helped him, and he can learn to use those qualities in other areas of his life.
Ultimately, geno-chronology is a tool for creating stories that adds a narrative element to the classic genogram.
One of the things I have enjoyed most becoming a consultant after a lifetime of writing and editing is letting go of my own conception of the story. As a writer, it was my job not only to listen, but also to take in the information from interviews and research and then determine the story to be told. As a consultant, I have the privilege of listening, absorbing, and then dropping the chips with minimal guidance from me. I have ideas and I can share those ideas, but the customer is the protagonist of their own story.
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Les Gura is a Licensed Clinical Mental Health Consultant and Chartered Consultant 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 a communications director. Contact him at [email protected].
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