All in the Family: The Genie in the Genogram

As some of the past posts have shown (take the post on triangles, for example), utilizing the genogram within the family systems approach often has significant explanatory powers for why a person finds him or herself stuck within current relational patterns.

But it can do more than that, too, I believe, if we use it to predict who might be prone to illness or maladjustment, based on family history–and that power can be exceedingly useful.

Take a look, for example, in McGoldrick and Gerson’s book, Genograms in Family Assessment, and there you can find the [much more legible] original of playwright Eugene O’Neill’s family genogram, below, from http://www.systemagazin.de/buecher/neuvorstellungen/2005/02/genogram_maker_millennium.php. I ask you to bear with me regarding size, and to look for boxes/circles that are half-full [or half-empty, as might be more appropriate in this case]. Go ahead.

There is clearly a repeated pattern of alcoholism and drug abuse throughout the O’Neill family. Although I don’t believe you can use a genogram to predict the number of spouses someone will have or whether they will or won’t drink, you can use it to predict susceptibility. It is worthy of note that Eugene himself was an alcoholic and married three times–and his eldest son, Eugene, Jr., also struggled with drinking, and also–I couldn’t make it up–married three times. [Eugene’s other two children had to fight ther demons of drink, as well.]

Could we step back in time, perhaps to when Kathleen, Eugene’s first wife, was expecting Eugene, Jr., we would see that her son would be born to an alcoholic father, and into a family with two alcoholic uncles, a paternal grandmother who was a morphine addict, and a paternal great-grandfather who was an alcoholic. If I were working with such a family, I would want to make interventions as early as possible to help Eugene, Jr. deal with his stresses in a way that didn’t involve alcohol.

Thus genograms in family systems work are not prophetic, of course–just highly predictive.

WJ Watson et al depict a sample genogram in their article “Genograms: Seeing Your Patient Through Another Window” published in Patient Care Canada in 2005 that clearly indicates strong repeating family patterns both of diabetes and depression. Connect below:

Check out a genogram with potential predictive value

Let’s add to the above genogram several of the known predictors of depression* that the genogram allows us to account for, such as:

  • Having biological relatives with depression
  • Being a woman
  • Having family members who have committed suicide
  • Taking certain high blood pressure medications, sleeping pills or certain other medications.

*(see the Mayo Clinic’s list of Risk Factors for Major Depression for a complete listing)

Using family susceptibility combined with risk factors makes it clear that Jane Doe is highly susceptible to depression–and any therapist worth her salt should work long and hard to teach Jane coping mechanisms in an effort to avoid an illness that her genogram shows to be only too likely to want to plague Jane.

Genograms have the power to suggest what might likely be–but don’t ever forget, if you see yourself looking circumscribed on the page, that we as free beings can always intervene to take control of our own destiny, despite every shape, line and squiggle–but it takes work on our parts–and perhaps the assistance of a good family systems therapist.


I help adults and adolescents through the particular struggles of our time: tension between couples, parenting frustration, blending new families, separation and divorce, (un)employment, cancer, and loss. When relationships come to an impasse, I use mediation techniques to try to ensure that each party will have his/her needs heard and accounted for in a dignified way. In addition to talking, listening, and reframing, I utilizes the tools of metaphor, active teaching, role-playing, visualization, and hypnotherapy.for families and businesses, as well as in cases of divorce.

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