A Picture Is Worth a Thousand Words

by Natalie D. Pope, Ph.D., LCSW, and Jacquelyn Lee, Ph.D., LCSW

(Editor's Note: To read this article with all illustrations, please download the Spring 2015 issue from the "digital issues" page of the magazine section of the site. Also, please note that versions of software vary. Depending on which version of Word you are using, instructions may vary slightly from those provided.)

    Genograms are a practical tool in social work practice, both in terms of assessment and intervention. Historically, the genogram is most commonly thought of in relation to practice with children, adolescents, and families to explore the quality of relationships and behavioral patterns across generations. In child welfare practice, for example, the genogram is useful to incorporate changes over time, which is particularly helpful in charting shifts in custodial care for instances such as adoption or foster placements (Altshuler, 1999). However, genograms can also be helpful when working with adults and serve as a tool to examine issues of interest beyond family dynamics.

    This article will discuss the use of genograms in social work and describe how to create a genogram using Microsoft Word. It is noteworthy that the genogram can be useful for an individual client or a client system (i.e., a family). Throughout this article, “client” will be used, but it could be interchangeable with client system when appropriate.

The Genogram and Social Work Practice

    The genogram may be defined as a visual tool for exploring a client’s social relationships across time. Typically, these are familial relationships. In general, the genogram is useful in gathering information, understanding relationship dynamics and behavioral patterns, promoting the client’s self-understanding, conducting assessments, and guiding the practitioner to interventions.

    The use of the genogram in social work practice is supported by the profession’s knowledge base as well as its values and ethical standards. A central benefit is that this instrument introduces a client to the principles of systems theory, which are fundamental to social work practice (McGoldrick, Gerson, & Petry, 2008). Such a framework can help practitioners determine the sources of presenting issue(s) and the foci of interventions.

    Additionally, social work emphasizes the “not knowing” stance, acknowledging the client’s socially constructed understanding of his or her world and fit within that world. The genogram offers insight into that very understanding. For example, the genogram offers the opportunity to define and explore the family by acknowledging the client as the “expert.” This practice accounts for the evolving conceptualization of the family continually influenced by shifting cultural norms (Connolly, 2005). Similarly, the genogram invites the client to share personal identification in terms of race, gender, ethnicity, and cultural affiliation, which aligns with the discipline’s emphasis on understanding the various aspects of identity.

    Genograms used with families may also be helpful in overcoming resistance “as they begin to see the connections between their concerns and historical family patterns” (McGoldrick, Gerson, & Petry, 2008, p. 228). Identifying these connections can be useful when clients are stuck in a narrow view of the problem, blaming a particular family member for the issues of concern in the family.

    Seeing family behavior and relationships graphically can also help to reframe and normalize clients’ perspectives on their concerns. As the genogram is helpful in understanding patterns and connections, it has been noted as “the supreme integrative tool” (Gerson, 1995, p. viii). The genogram can be useful in charting the basic family structure, recording individualized information (e.g., biological or legal details) to better understand relationship dynamics, and delineating family relationships (Connolly, 2005). Further, the experience of constructing a genogram with clients can be therapeutic in and of itself (Papadopoulos & Bor, 1997). Given these factors and the overall flexibility of its use, the genogram is well-suited for generalist and clinical social work practice.

    Although most genograms graphically represent multiple family generations and the quality of family relationships, genograms can be designed to capture other information, as well. For example, spiritual genograms provide a way to map significant events, affiliations, and family conflicts related to religion (Frame, 2000; Hodge, 2001). Spirituality and religious beliefs are often a source of strength and identity for individuals and families, so displaying this significant aspect of life can be useful for clients.

    Weiss and colleagues (2010) have proposed a military genogram for use in assessment and intervention with clients who have service members in their families. This type of genogram takes into account strengths, as well as environmental, occupational, psychological, and family stressors that are unique to military life and culture.

    Other genograms might be used to attend to cultural aspects of the client situation, such as “depicting significant cultural patterns, beliefs, values, traditions, and family strengths in African American families” (Chavis, 2004, p. 30).

Creating the Genogram

    It is beneficial to know how to create a genogram using Microsoft Word. Most social workers have access to this computer program and are relatively comfortable using it. A genogram made in Word can easily be inserted into the narratives of assessments, which are often typed in Word format.

    The directions that follow will guide you in creating a genogram using Microsoft Word. Consider starting with a blank document from which you can copy and paste your genogram after it is completed.

    To begin constructing your genogram:

1. Insert the genogram title: Click the Insert tab > Text box > Select Horizontal text box > Here we typed, “Smith Family Genogram”

2. Format the “frame” of the diagram: Here we have formatted the “frame” of the genogram so that you can see it. When you insert the text box, it will appear within a larger square inside which you will create your genogram. To adjust the size of the frame, Left Click on it, then hold down the left side of the mouse as you move the cursor toward the middle of the figure (to make smaller) or outward (to make larger). After you have completed your genogram, you can easily Copy and Paste the frame (with genogram inside) into other documents, or you can create your genogram between existing text.

3. Insert a shape: Click the Insert tab > Shape > Square > Move your mouse to the place on the page where you want the figure. Then Left Click.

(Note: See McGoldrick et al., 2008 as a reference for commonly used genogram symbols.)

4. Adjust shape color and outline: Our version of Microsoft Word created a colored shape in the default color of blue. We edited this by clicking the Format tab > Shape Styles > selecting the first option, which is a shape outlined in black with white inside.

5. Make a shape smaller or larger: Left Click on the square or circle, then hold down the left side of the mouse as you move the cursor toward the middle of the figure (to make smaller) or outward (to make larger). Remove your finger from the mouse when you are satisfied with the size of the symbol. HINT: If you hold the shift key down while adjusting the size of the circle or square, it will remain symmetrical.

6. Add text inside shape: Right Click (when you right click on box, the + needs to show up) > Add text > Here we typed “John S., 26”

7. Add a caption: Click on box > Right click > Insert caption > Here we typed “Primary Client”

8. Add a relationship line: Click on Insert > Shape > Line > Right click on line > Format shape > Here we selected the dotted line (line style, dash type) in black (line color, black). To shorten and lengthen lines, move the mouse to the line until a + appears. Left click on the small circle at either end of the line to adjust to the desired length.

9. Add a family member: Here we added a female partner to this 26-year-old male client: Insert > Shape > Circle > Click on the circle and move the mouse to connect the circle to the dotted line.

10. Provide subjective detail to a relationship line: Click on Insert > Text box (here we selected the “simple text box”) > we typed “m.2003, s.2006” to indicate married in 2003 and separated in 2006. (You may need to adjust the size of the text. To do this, highlight the text with your mouse > right click > adjust font size to 10 or 9)

11. Edit the text box so just writing is visible: right click on text box > Format shape > Line color > Selected white as line color since our shapes are black

    The figure below shows a primary client who is male, age 26, who separated from his wife, age 28, in 2006. The client has an older brother (age 29), and his father died in 2008.  

    Here are a few final suggestions for constructing your genogram:

• For large and complex families, consider using a landscape page set up (File > Page Setup > Landscape). This will help if you anticipate that the genogram will be wide. You can insert a Page Break, if needed, so the page with the genogram is on landscape and the rest of the document is written on a portrait page.
• The example we’ve provided here is in black and white, but color used judiciously in a genogram can be helpful. For instance, multiple generations can be represented easily by formatting (Right Click > Format Auto Shape > Fill Color). Each generation can be designated a particular color (e.g., 3rd generation, blue; 2nd generation, red)
• Consider including individuals significant to the client who may not be blood related. These people might include friends and other social supports.
• Include a key with your genogram to explain the meanings of symbols (e.g., circles, squares, triangles), lines (solid, dashed, thick), and other images you have used.
• Remember there is no “one way” to construct a genogram and that a variety of information can be presented visually, as long as it’s relevant to the client. Some examples include health behaviors and disease risk (Casado-Kehoe & Kehoe, 2006-2007) and trauma and resilience across generations (Goodman, 2013).

References

Altshuler, S. J. (1999). Constructing genograms with children in care: Implications for casework practice. Child Welfare League of America, LXXVIII (6), 777-790.

Casado-Kehoe, M., & Kehoe, M. (2006/2007). Using genograms creatively to promote healthy lifestyles. Journal of Creativity in Mental Health, 2 (4), 19-29.

Chavis, A. M. (2004). Genograms and African American families: Employing family strengths of spirituality, religion, and extended family network. Michigan Family Review, 9 (1), 30-36.

Connolly, C. (2005). Discovering “family” creatively: The self-created genogram. Journal of Creativity in Mental Health, 1 (1), 81-105.

Frame, M.W. (2000). The spiritual genogram in family therapy. Journal of Marital and Family Therapy, 26 (2), 211-216.

Gerson, R. (1995). Foreword. In F. Kaslow’s Projective genogramming. Sarasota, FL: Professional Resource Press.

Goodman, R.D. (2013). Transgenerational trauma and resilience genogram. Counseling Psychology Quarterly, 26 (3/4), 386-405.

Hodge, D.R. (2001). Spiritual genograms: A generational approach to assessing spirituality. Families in Society: The Journal of Contemporary Human Services, 82 (1), 35-48.

McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention (3rd ed.). New York: W.W. Norton & Company.  

Papadopoulos, L., & Bor, R. (1997). The genogram in counseling practice: A review (part 1). Counseling Psychology Quarterly, 10 (1), 17-28).

Weiss, E.L., Coll, J.E., Gerbauer, J., Smiley, K., & Carillo, E. (2010). The military genogram: A solution-focused approach for resiliency building in service members and their families. The Family Journal: Counseling and Therapy for Families and Couples, 18 (4), 395-406. doi: 10.1177/1066480710378479

Natalie D. Pope, Ph.D., LCSW, is an Assistant Professor in the College of Social Work at the University of Kentucky. Dr. Pope’s practice experiences include mental health counseling and assessment for young children and parents, child protective services case management, and facilitation of a support group for elder spousal caregivers.

 Jacquelyn Lee, Ph.D., LCSW, is an Assistant Professor at the University of North Carolina Wilmington. Broadly, her research focuses on the following areas: workforce issues, innovation in social work education, and social work practice with children and families. Themes across these areas include trauma, health and well-being, and professional socialization  Current projects address secondary traumatic stress and professional self-care among social workers, integration of mindfulness in the social work curriculum, and self-care among custodial grandparent caregivers.