Family Systems : Genograms

and Ecomaps
Dr. Mergan Naidoo
Principal Family Physician
Genogram: Definition
A diagram outlining the history of the behaviour patterns
(as of divorce, abortion, or suicide) of a family's
members over several generations in order to recognize
and understand past influences on current behaviour
patterns ; also : a similar diagram detailing the medical
history of the members of a family as a means of
assessing a family member's risk of developing disease
Genograms
Make it easier for the clinician to keep in mind
family members, patterns and events that have a
recurring significance in a familys ongoing care.
Should indicate conditions in a family that have a
period basis. Problems of less well defined nature
that have a high incidence in the family hence
predisposing future family members to the
likelihood of illness.
Family History
Background and family influences are essential to
the continuing and comprehensive care of the
individual and family.
Info concerning family background is a potential
source of valuable diagnostic info
Family Physicians (FP) usu accumulates a
complete hx over a period of time, gradually
adding items to the picture during a series of
patient visits.
In this way patients ask other family members for
the addition and clarification.
Family History and the patient
Family gatherings are an ideal time to catch
up on family news and information.
A family medical history or medical family
tree is a record of illnesses among family
members.
Medical family tree can be very detailed and
include health issues each family member
faced.
How is a family medical history used?
Diagnosing a medical condition
Determining whether you may benefit from
preventive measures to lower your risk of a
specific disease.
Deciding what medical tests to run.
Identifying other members of your family
who are at risk of developing certain
diseases.
Calculating your risk of certain diseases.
Calculating your risk of passing certain
conditions to your children
What can't your family medical
history tell you?
Can't predict your future. Whether you'll actually
end up with an inherited condition depends on your
health habits, such as diet and exercise. Knowing
now that you're at risk of certain diseases can
motivate you to change any unhealthy behaviours.
Doesn't apply to people who are adopted.
Provides limited insight into small families. If you
have few brothers, sisters and cousins, it will be
more difficult to identify health patterns in your
family.
Someday it may be possible to use genetic testing
to predict all of the diseases for which you're at risk.
Until that time, your family's medical history may
provide the best look into your possible future.
Questions family members
should ask of their relatives.
Can you provide significant dates, such as birth dates and
approximate dates when diseases were diagnosed?
What major diseases has the family experienced?
Examples are heart disease, stroke, cancer, depression,
diabetes, Alzheimer's disease, obesity, blindness and
deafness. At what age were these diseases or conditions
diagnosed? Was treatment successful?
Have family members had a tendency toward other
conditions, such as allergies, asthma, migraines or frequent
colds?
Has infertility, miscarriages, stillbirths or infant deaths taken
place in the family? If so, what was the cause?
Questions family members
should ask of their relatives
Are you aware of birth defects, learning
disabilities or mental retardation in the family
health history?
What is the family's dominant racial and
ethnic background? Some diseases are
more common among members of certain
races and ethnicities.
Can you think of any other information that
may be relevant to the family medical
history?
Family History
You might find that some relatives prefer to keep some health
information private. Relatives may not want to talk about an
uncle's alcoholism, a niece's treatment for mental illness, a
nephew's dyslexia or a grandmother's Alzheimer's disease.
Solving this problem calls for tact and compassion.
Explain your purpose. Emphasize that your purpose is to
create a record that will help you determine whether you and
your relatives have a family history of certain diseases or
health conditions. Offer to make the medical history available
to other family members so that they can share the information
with their doctors.
Family History
Provide several ways to answer questions. Some people
may be more willing to share health information in a face-to-
face meeting. Others may prefer answering your questions by
mail or e-mail.
Word questions carefully. Don't start with personal
questions. Begin your interview by asking questions about the
whole family and then let your relative volunteer his or her
personal health information.
Be a good listener. As your relatives talk about their health
problems, let them speak without interruption. Listen without
judgment or comment.
Respect privacy. As you collect information about your
relatives, respect their right to confidentiality. Some people
may not want to share any health information with you. Or they
may not want this information revealed to anyone other than
you and your doctor.
Design of a genogram
Purpose:
Realistic overview of the familys background and
potential health problems.
Components:
Info at a glance
Techniques and symbols.
Dont clutter information
Use 3 or more generations
All members must be represented names of all
family members
Age and year of birth of all family members.
Age, deaths incl age at or date of death and cause
Significant dxs or problems of family members
Components contd
Dates of marriage and divorces.
Major family events, occupations, losses, family
migrations and roles in the family.
Information about alignments and
communication patterns
Listing of first born of each family to the left,
with siblings listed sequentially to the right.
A key depicting all symbols used.
Symbols selected for simplicity and maximum
visibility.
Symbols used in designing a
genogram
Male
Female
Death
Index Patient or Proband
Two normal males
Three normal females
Four births,sex
unknown/unspecified
2
3
4
Spontaneous abortion
Induced Abortion
Pregnancy
Dizygotic twins
Monozygotic twins(girls)
Adopted male
Year of birth
Name
55
David
A
Date of birth
Date of marriage
Date of divorce
Date of Death
b 26/02/1965
m 14/11/1992
d 12/16/1998
D 16/05/2002
98
Year of death
Year of birth and death
Cause of death
Marriage and year
Divorce and year
30-48
ca
75
2002
Separation and year
Conflicting relationship
Distant relationship
Close relationship
Overly close relationship
Marital Discord and girlfriend
======
2001
Divorce-mother has custody of two
girls.
Married couple, each with multiple
spouses (divorced)
85
90 98
92 86
Obesity
Alcoholism
Allergy
Asthma
Depression
Heart disease
Asthma and Allergies
Stroke
xxx
*Receptor site is the patient himself*
Genetic Makeup
Society
Neighbours
Friends
Family of origin
Spouse
Children
Myths
Doctors tend to err by considering
themselves as either omnipotent or
impotent.
Cure everyone, save marriage
Ineffective against socio- political
problems, smoking, Aids
Doctor as the drug
The role of the doctor as the drug is that he/she
should act as a catalyst facilitating the inherent
growth potentials which exist within each patient
and family and helping them to find healthy
solutions to their problems.
The patient centred approach has the advantage
amongst other things, that if correctly practiced
we often do not have to worry about treating
symptom complexes.
Family Physicians should
always think Family
A family is a social organization that has features
in common with other social systems. As system
is defined as a number of parts and processes
standing in mutual interaction with each other.
The family system changes over time as its
members grow older.
Thinking family also involves an awareness of
the challenges faced by the family in adapting to
these changes.
The family in the person
Anything that affects one member of the family
affects relationships within the family as the
whole.
Person in the family
(Represents the I-P relationships in the family grp)
vs
The family in the person
(Represents the individuals incorporated experience of his
or her family of origin on experience that profoundly
affects behavior)
Influence of family on health
and disease 6 main effects
1) Every indiv is a product of the interaction
between his or her genotype and the
environment.
2) Family is crucial in a childs
development. Parental deprivation-
suicide/ psych illness.
3) Infectious dxs spreads in families.
Influence of family on health
and disease 6 main effects ctd
4) Some families are more vulnerable to illness than
others RN
Incr childhood illness:
Parents tend to avoid conflict
Mother little involved in social networks outside of
home
Parents more prone to somatic complaints
Mother strongly inclined to accept the sick role
Discrepancy in parents knowledge of the
complaints of the spouse
5) Family factors affect morbidity and
mortality in adults incr in
widows/widowers first year
Incr(3x) angina in families with problems
6) Family isimpt in the recovery from
illness, family support is aimpt factor in
the outcomes of all kinds of illnessesp
chronic illness
Uses of the Genogram
Gathering and utilizing family data in FPrac
Indiv understood in the total family system
Allows FP to understand the impact of the system
on the patient
Counselling parent/child conflicts
marital pair
old family issues e.g family of origin
Aging- life review- central link between past and
future allows aging relatives to reconnect past
and future.
Uses continued
Child welfare agencies adoption
Hospital setting expanded health hx
- patterns of illness & health in the family
e.g IHD in paternal grandmother
- Patterns of illness and attitudes towards
illness+ ill people may appear.
Family Systems Theory
Family orientation requires that each family
member and their s/ be understood as part of a
whole.
Homeostasis needs to exist bet the various family
members for effective f(x)
To Rx a family it is essential to understand
family relationships.
Unresolved conflict & subsequent
communication blocks leads to far reaching
effects on every family member
Family Systems Theory
Apart from being tickets of admission
the minor illnesses seen in Fam Prac may
point to family dysf(x) as sources of
lowered resistance
Stressful life events may lend itself to the
development of illness
Family Systems Theory
Rx Both compliance and results of Rx
are influenced by family factors.
Prevention Threshold for angina 3X
- Relationship bet family dysf(x) and IHD
- Strokes in disruptive families
- Rel bet preterm labour and stress
Treatment
Appropriate crisis intervention
Ventilation of anxiety
Involvement of family members in
decision making
Expectations from the a FP should be clear. The
system orientation does not imply radical changes
in practice of family therapy by the FP. Skills
should be in Family Assessment
When a pt consults the FP is aware of the
family in the Patient
Family Assessment Schema assesses the family
as a whole
Ecomaps
Simple simulation developed as an assessment,
planning and intervention tool.
Maps the ecological system person, family in
life space.
Relationships of the family with the various
systems.
Mapping process highlights the nature of the
interfaces and the conflicts that need to be
mediated, bridges to be built and resources to be
sought and mobilized.
Drawing an ecomap
Draw household as per the genogram-circle.
Draw in the various systems that have an
influence on the family
Relationships are depicted as lines:
- solid thick black line= strong rel
- Dotted line= tenuous connection
- J agged marks across line= stressful or conflicting
rel.
Indicate the direction of flow of resources,
energy or interest by arrows.
Uses of the Ecomap
Visual impact- organizes relationships and
presents factual info
Gives holistic and integrative perception.
Helps make assessment of the family.
Promotes closer working rel bet counselor and
client.
Increased understanding and acceptance of ones
self - insight.
Clients sometimes use the eco map to give insight
to their families.
Important for planning and intervention.
Allows one to move to a task orientated
program.
Maps the past and present in space and
time - useful in life changing experiences.
Record keeping and measurement of
change.
Uses of the Ecomap
J ohn
52
Beth
50
Social
Welfare
Family
Counselling
for J oan
J ohn
disability grant
Work
Beth
Part
time
Health Care
J ohn CVA
10 years
St Augus
Hosp
Church
Extended
Family
Beths mother
demanding &
needs fin and
emotional
support
Recreation
Beth involved in
gardening Friends
J oan popular with
rough crowd
School
J ack UKZN
Peter Gr 11
J oan Gr 10
Extended
Family
Father in
CT little
contact
Recreation
J ack elite
athlete.
J ohn used
to be
J oan
16
Peter
17
J ack
22
Probation
Officer