Discovering Family Creatively: The Self-Created Genogram

Colleen M. Connolly, PhD

ABSTRACT. Creativity is a powerful force within the family therapy field, central not only to the therapeutic process but also to counselor education. Time-honored tools, such as the genogram along with its many adaptations, remain useful in learning about family. However, as our rapidly changing culture continually redefines and stretches the concept of family, we must learn new methods to discover who family is from the expert living within that family, i.e., the client or counselor-trainee. This article introduces and describes a creative, self-initiated model, the self-created genogram, developed to amplify discovery of each persons own unique perspective and experience of family. Case examples will be provided to illustrate the models use in both training and clinical settings. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress. com> Website: <http://www.HaworthPress.com> 2005 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Family, genogram, creativity

Colleen M. Connolly, PhD, is Associate Professor, Professional Counseling Program (Marriage and Family emphasis), Texas State University-San Marcos. Address correspondence to: Colleen M. Connolly, Department of EAPS, Texas State University-San Marcos, 601 University Drive, San Marcos, TX 78666 (E-mail: cconnolly@txstate.edu). This article is dedicated to Janet Lynne Maples (January 1, 1947-January 21, 2005), the core of a loving network of created family. Journal of Creativity in Mental Health, Vol. 1(1) 2005 Available online at http://www.haworthpress.com/web/JCMH 2005 by The Haworth Press, Inc. All rights reserved. doi:10.1300/J456v01n01_07

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Our rapidly changing culture redefines and stretches societys concept of family. While the definition of family can differ from person to person (Gelles, 1995; Milewski-Hertlein, 2001; Trost, 1990) as well as from culture to culture, a single definition of family has been rendered obsolete by current realities. Family scholars recognize that there is no unified definition of family within the field (Milewski-Hertlein, 2001; Trost, 1990). Clinicians and educators are attentive to the need for continued awareness, understanding, and sensitivity to how differently we might view family from the clients with whom we communicate (Trost, 1990). As a result, they often continue to struggle alongside clients. Never-ending questions abound, such as, What is my definition of family? and How do we approach the discussion of family and honor the diversity inherent in our society? At the same time, the creative arts continue to expand within the counseling profession. Creativity in counseling has ancient historical roots (Gladding, 1998), and its importance to the mental health field has continued to grow (Frey, 1975; Carson & Becker, 2003). Moreover, creativity as art and as science (Deacon & Volker, 2000; Gladding, 1994) is central to both therapy and the training of future counselors (Carson & Becker, 2004). As Gladding (1994) underscores, The practice of most family counselors demonstrates that the art and science of helping are complementary, not competing, forces (p. 3). Gladding calls for art and science to be maximized and dovetailed in theory and in practice (p. 10) to better ensure their viability. Carson and Becker (2003) point out how often both novice and veteran therapists either overlook or underestimate the important role of creativity in the therapeutic process, especially when working with couples and families. Although it is but one of several factors employed in successful clinical work, it garners increased importance because of the pressure toward briefer, short-term therapies. In general, therapists have lost the luxury of taking their time, being cautious, or remaining non-innovative. Instead, clinicians should be able to more fervently and effectively facilitate creative thought and action in their clients, using themselves and their skills as creative agents of change (Carson & Becker, 2003, p. 5). Family therapy and theories on creativity have many concepts in common. By using the two concurrently, counselors have access to a whole new area of study and intervention (Deacon & Volker, 2000, p. 14). Many times, when technical skills are lacking, turning to inventiveness and creativity unleashes an array of possibilities (Frey, 1975).

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However, as Frey posits, frequently we are taught to apply ideas of the experts rather than claiming the right to create ideas ourselves. In this article I present a model, the self-created genogram, which I developed in an introductory marriage and family course of a professional counseling program and later expanded for clinical use. I developed this model in response to the widening definition of family and the identification of creativity as an important means of bridging cultures (Henderson & Gladding, 1998). This modified genogram provides an opportunity to discover family, invite creative expression, and mutually explore areas of importance to others, whether used in family therapy training, continuing education programs, or in clinical work. This models development emerged because of several factors. I recognized my own struggle attending to the voices of the disenfranchised, and I sought to find a more inclusive way to initially assess family. My scholarly and clinical interest in lesbian and gay couples and families reinforced the need for a model of this type that amplifies hearing from the insiders perspective as to who family might be rather than learning by posing directives and directions. It also evolved because of my belief in the power of creativity in counseling and its important multicultural application (Henderson & Gladding, 1998). In developing and using the self-created genogram, several objectives were identified. First, it supplies a vehicle to discover the concept of family, with the initiator marking the beginning and ending points of family in context and guiding its direction. It is driven by discovery that is intentionally expansive and emerging from the expert living within that contextual family. The second objective focuses on an atmosphere consistent with the trend toward a strength-based, resource-oriented, collaborative-focused therapeutic process (Walsh, 1993, 2003). Dunn and Levitt (2000) note some benefits for purposefully moving from diagnostics to mutual collaboration in the construction of the genogram. The authors contend that a mutually collaborative genogram process can permanently anchor the therapeutic alliance and enhance the power of the genogram for the client. This collaboration respects the person initiating the genogram as having both expertise in her or his own life and capability of determining what information should be included in the genogram. Dunn and Levitt recommend modifications in training to ensure that the therapeutic power of collaborative genogram work in the field of family therapy is reclaimed and remains firmly established (p. 241). Third, this model invites creativity and can establish or stimulate an ongoing atmosphere of discovery and creativeness. A fourth objective

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involves offering a process inclusive of all people within ones world that are significant rather than implicitly framing family as blood-bound or legal-bound relationships. This model intentionally sets aside preconceptions of what family should be and temporarily suspends traditional methods of learning about family. By stepping away from posing the questions, and by inviting the expression of family in a creative, experiential fashion, counselors can open the door to exciting discoveries and areas for future exploration. In this article I briefly outline the historical roots of the genogram and provide an assortment of adaptations and implications for training and therapeutic use. Although many tools for exploring families exist, I limit the focus to the genogram and provide some examples of its previous adaptations that are most pertinent to the self-created genogram. I then highlight why creativity is important to our profession to set the framework for how the self-created genogram fits into the energy around creativity. Next, I describe my approach for discovering family in context and provide themes that emerged from student-trainees surrounding definitions of family, graphic depictions of the family, postreflection comments from students on the process, and synthesis of the visual product. Finally, I present a clinical intervention using a case example, an expansion of the creative representations that emerged, and a theoretical and contextual conceptualization, along with a discussion of the overall process. THE TRADITIONAL GENOGRAM The genogram has long been considered an integral component of a comprehensive, clinical assessment for many family counselors and educators (McGoldrick, Gerson, & Shellenberger, 1999). The genealogical charts that social scientists and families used to trace kinship and compile family history provided the inspiration for its use in family therapy (Hartman & Laird, 1983). For decades, family-oriented therapists have considered the genogram to be the classic tool for gathering and utilizing family data (Hartman & Laird, 1983). It provides a roadmap of the family system (Guerin & Pendagast, 1976). Gerson (1995) refers to the genogram as the supreme integrative tool for understanding families, the royal road to both the family system and the inner world of the individuals in that family (p. viii). While the field most often associates the genogram with Murray Bowens work, clinicians of varying theoretical orienta-

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tions use it as well (DeMaria, Weeks, & Hof, 1999; McGoldrick & Gerson, 1985). The more fundamental format of the genogram assesses families in three steps (Friedman, Rohrbaugh, & Krakauer, 1988; McGoldrick & Gerson, 1985). First, the genogram charts the basic family structures, such as the biological and legal relationships across the generations. Second, it records information about individual family members including demographic data, personality characteristics, emotional or behavioral issues, and medical problems. A third focus of the genogram includes delineating family relationships, viewing such processes as conflict and closeness between and among family members and the intergenerational patterns in the family. Clinicians find the genogram appealing. Genograms are tangible, graphic, and function in mapping the family structure (McGoldrick et al., 1999; McGoldrick & Gerson, 1985). They also act as a therapeutic intervention, which can serve to free the therapeutic process from impasses (Papadopoulos & Bor, 1997). In the earlier years, the genogram graphically depicted the biological and legal relationship of different family members from one generation to the next, spanning at least three generations (McGoldrick & Gerson, 1985). Only later, as the understanding of family expanded, did the family therapy field begin to include extended family and non-blood kinship (McGoldrick et al., 1999). In focusing the genogram on biological relatives, the counselor assumes the risk of mapping an inaccurate family system (Milewski-Hertlein, 2001, p. 27). Concentrating on content, a natural inclination for most mental health practitioners often deemphasizes and obscures process (Beck, 1987). Clinicians often succumb and become prisoners of content (Beck, 1987, p. 343; also in Milewski-Hertlein, 2001, p. 28) when constructing a genogram. However, by attending to the process of the genogram construction, the overall therapeutic experience is enhanced as clients actively participate in the formulating phase of the clinical work (Beck, 1987). ADAPTATIONS TO THE GENOGRAM The genogram format has experienced many facelifts since being integrated into the family therapy field (Milewski-Hertlein, 2001), and a variety of adaptations have been developed that are particularly pertinent to the self-created genogram. The format shows flexibility in design and

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implementation, and through the years therapists have been encouraged to discover and create new methods for its use (McGoldrick & Gerson, 1985; Milewski-Hertlein, 2001). Some examples of expansion of genogram context include adding to the original format a timeline dimension (Friedman et al., 1988) and color-coding to designate characteristics, traits, or issues (Lewis, 1989). Adaptations to the focus of the genogram also are plentiful. For instance, the multicultural genogram focuses on cultural factors such as ethnicity, race, immigration, social class, gender, and spirituality/religion (Thomas, 1998). The gendergram makes gender role assumptions overt, taking it from content to a consideration of gender as the wellspring of all behavior (White & Tyson-Rawson, 1995, p. 253). Tracking spirituality through the use of the spiritual genogram has gained much interest clinically (Frame, 2000; Hodge, 2001) and in counselor training and supervision (Frame, 2001). Additional expansions of the genogram include the sexual genogram (Hof & Berman, 1986) and the intimacy genogram (Sherman, 2000). Kaslow (1995) expanded the use of the genogram when teaching a family therapy course. She asked students to draw their family, using the typical genogram symbols. Kaslow then engaged students in a freeassociation about the results in a four-part process: (a) With whom did the student begin and why? (b) Whom did they omit or exclude? (c) Whom would they like to eliminate? and (d) Whom would they like to add to create a future fantasy family? (p. 26). The genogram also has been recommended for specific groups, such as engaged couples (Gilmour, 1995) and long-term and/or later-life couples for marital life review (Goldin & Mohr, 2000; Hartman, 1995). Furthermore, the genogram has been engaged for health issues, such as those that are cardiovascular-specific (Wimbush & Peters, 2000) or for people with family histories of terminal illness (Hockley, 2000), in an attempt to identify those at risk, sources of support, and risk reduction (Niederhauser & Arnold, 2004). Clinicians typically construct genograms face-to-face. Genograms also are self-administered outside of session, either prior to the initial visit or between sessions (Coupland & Serovich, 1999). TRAINING CONSIDERATIONS Teaching students the structure of the genogram and the concepts that emerge are critical. Students find the genogram helpful for visualiz-

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ing and understanding their family system (Bahr, 2001). Family therapy educators consider the genogram useful for increasing awareness of family therapy concepts and fostering a connection between systemic concepts and the students own family system (Halevy, 1998). Achieving the paradigm shift from an individual to a family-systems perspective (Dunn & Levitt, 2000; Thomas & Striegel, 1994) can take time, care, and concentrated efforts (Pistole, 1998). Dunn and Levitt (2000) point to several goals when employing the genogram for family-of-origin work with trainees. It tends to develop an internalized understanding of both structure and process from a systemic perspective. Integrating the genogram and family-of-origin work also helps develop an awareness of personal values and emotional reactivity, which can protect counselors-in-training from projecting their own unresolved issues onto clients and families. Employing a genogram with a trainee also raises her or his capacity to remain an individual, which can heighten clinical intentionality despite the highly emotional conditions that frequently occur in session. It is often difficult for students to step outside of their own worldview of family. As Gelles (1995) points out, most families function behind closed doors, and many counselor-trainees enter their graduate studies with a lack of knowledge about the diversity of family forms. An idealized image of family can create blind spots for recognizing and appreciating varying family configurations, which can impede the view of what family is and can be for others. Moreover, by holding a vision of the ideal family without critical analysis and expansion, a trainee can negatively impact the therapeutic process. This negative effect occurs when the trainee marginalizes those people of importance to the client. If therapist-trainees are to become proficient in constructing processoriented genograms, they must be offered ample opportunities to experience and practice them while in training (Dunn & Levitt, 2000). Dunn and Levitt recommend implementing the genogram early in the training process and suggest that the manner in which it is introduced to students is equally as important as when and how we present it to our clients. Challenges can occur in implementing a process-oriented genogram in family counseling training (Pistole, 1998). Although educators typically recognize the importance of self-awareness for counselor-trainees, they are often bound by the scholarly, knowledge-based study required by many graduate schools. Expanding student awareness in didactic courses often proves difficult. An additional challenge occurs when theories and methods of family therapy is the sole didactic course offered within a professional counseling program. That course then be-

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comes the major conduit for students to become alert and knowledgeable about how context and interpersonal relationships impact clients lives from a systemic framework. CREATIVITY IN COUNSELING Carson and Becker (2004) suggest that academia and creativity also are often at odds with one another (p. 3). The constraints and rigors associated with higher education can be counterproductive to counselor-trainees exploring and finding their creative voices (p. 4). The authors emphasize that learning about creativity starts as trainees begin the program rather than something to be acquired post-graduation. In other words, creativity should be considered foundational for effective counseling and counselor education, rather than being viewed as the icing on the cake (p. 4). Timm and Blow (1999) recommend including experiential training activities so that therapists and trainees can be touched at both the intellectual and emotional level. As Carson and Becker (2004) point out, creativity is a skill, something that one can learn, develop, and foster over time. People learn most and remember best by experiencing, especially as it relates to significant others. Experiences help people get closer to feelings more quickly and genuinely than conversing. An important distinction exists when using the genogram as a training tool rather than as a clinical intervention. When used as a training tool, the main objective is to help students visualize and understand their family system, and their own place within it, rather than to change it (Bahr, 2001, p. 243; Hardy & Laszloffy, 1995, p. 228). When engaging in self-of-the-therapist work, supervisors and educators still veer toward a pathology approach, according to Timm and Blow (1999). There remains a tendency to focus on deficits rather than what resources emerge from the students lived experience. The focus then becomes seeing potential problems, red flags (p. 332), and unresolved family issues that might interfere with the therapeutic process. While using this lens is important, a resource lens helps balance the process by focusing on strengths that the trainee brings to the case as a result of similar family-of-origin experiences. The resource focuses on processes that might make the student particularly well-suited to a case, thus maximizing how the student can use her or his family history to intervene effectively.

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Using the genogram in a training setting provides a learning opportunity as well as an integration of the match between thoughts and feelings, content and process, and incorporation of personal and professional identities that can impact therapeutic style and clinical effectiveness (Hardy & Laszloffy, 1995). Furthermore, creativity invites intimacy when one has the courage and willingness to become intimately involved in the lives of others (Carson & Becker, 2004). Creativity involves applying traditional approaches in fresh and new ways (Carson & Becker, 2004; Carson, Becker, Vance, & Forth, 2003; Murray & Rotter, 2002). Carson et al. (2003) conducted a national online study to discover therapists perceptions of the role of creativity in counseling. Participants reported that creativity involves the willingness to improvise, take risks, and act with immediacy. Furthermore, being creative in therapy requires the ability to access the creative and intuitive parts of both self and client. Impediments to creativity included time restraints and personal limitations of the therapist, such as inhibitions, self-doubts, and the lack of confidence as a creative being. As Gladding (1995) points out, creativity in counseling offers opportunities to view life events from different and more positive perspectives, reduces stress, and enhances coping skills. Creativity in counseling can leave a trail of experience that a client can look back on, remember, and use in present or future difficult situations (p. 5). There is no one way to be creative in counseling (p. 8); the self-created genogram provides one way to creatively discover family. DISCOVERING FAMILY IN CONTEXT I originally developed the self-created genogram while teaching a marriage and family introductory course. I later expanded it when providing continuing education to clinicians and counselor educators at professional conferences. I also have employed it in my clinical and supervision work. Following the process over several years in classroom settings allowed me the greatest opportunity to understand, adapt, and solidify this modified genogram into a useful tool for the self-creation and self-initiation of the family in context. This access to extended exploration with students in family therapy courses also allowed opportunities to gather data and identify consistent themes. I first will provide a four-part process that can be used when training counselors and family therapists and then describe how the

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self-created genogram can be used in a clinical setting by providing a case example and therapeutic engagement of the process. The four-part process involves: (a) asking the student to write a personal definition of family, (b) inviting the student to represent your family in whatever way you would like, (c) classroom discussion, and (d) subsequent written reflection of the process. Students are advised to participate and share only if they feel safe in doing so, and to decline response to any question with which they do not feel comfortable. I reiterate these points several times throughout the process, as needed. Emerging Themes of the Self-Created Genogram I discovered a consistency in themes among the students definitions of family, graphic depictions in the self-created genogram, and reflection papers. I will highlight representative samples of each area before providing a clinical example. Definitions of Family I initially request that students write their definition of family. This helps orient me to the students cognitive understanding of family and the breadth of their concept of family. It also creates a grounding point for classroom discussion. Some students supplied traditional definitions, such as: Family is a multi-layered system, held together by blood and a sense of permanency and trust and support. All members know of their membership and, either passively or actively, maintain it. Other students automatically included blood and non-blood relationships. Some students shared a more expanded definition of family. For example, one students first thought when approaching the definition was, My family includes the people I feel attached to because of blood and/or a feeling of permanency. However, upon further reflection, her definition of family expanded. Family to me means support and a willingness to remain as part of a group with a shared history and a future purpose. A group whose members lives are intertwined in some way, bonded together, for better or worse, in a variety of degrees, but permanently.

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Five definitional themes of family emerged: family as (a) formative, (b) mutually responsive, (c) continuous, (d) dedicated, and (e) safe. A student example of the first theme of family as formative is as follows: The origin from which we learn nearly everything in life, how to go about life and form who we are. It is the place where we learn how to trust, love, and carry out relationships. Family makes us who we are (generally and/or through experiences). Being mutually responsive was a second theme. Mutuality is defined not only as a reciprocal exchange of intimacy (Moss & Schwebel, 1993), but as an openness to influence, emotional availability, and a constantly changing pattern of responding to and affecting the others state (Jordan, 1991, p. 82). For example, one student captured many others sentiments: Family is two or more people who are connected through love, respect, patience, and kindness. They depend on each other and offer support during times of laughter and tears [accepting each other regardless of] similarities and differences. Third, not only was mutual care and respect for one another important to many. Family being continuous appeared important. Family includes the people or significant other in your life that you come home to every day, share your life with. Family does not desert you, but will be there in good times and in bad, and you/they will always be there, no matter what. A fourth theme, family as people who are dedicated to each other, surfaced. When someone is family, they make the well-being of the others in the group their highest priority in times of need or crisis and receive the same type of nurturance from the group in their time of need. Finally, the theme of feeling safe was important to some: A support network of people you can rely on, trust and love through any circumstance or crisis. Family is your safe place. You should always be told the truthbut loved. Graphic Depictions The self-created genogram offered a beginning point for understanding family in context as each unique student punctuated those persons, places, or things that came to the forefront dynamically at that particular juncture. Several themes were reflected in the students depictions of families. Family was represented as (a) growth-oriented/foundational, (b) circular, (c) interrelational, (d) symbolic, (e) dynamic, and (f) repre-

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sented by place. Most students represented family entirely through drawing with names or descriptors added. Some students drew family in picture-form without any words. A growth-oriented or foundational representation was depicted, such as with the visual image of a tree. For one student, the center trunk of the tree was self and partner. Below self and partner were brother and sister; above were mother and father. Branches represented family units, such as sibling with respective family or parents, or relationships, such as neighbors and pets. Another theme involved a circular representation of family. One student drew five concentric circles with names listed within each. Below this drawing was a narrative. My family consists of a set of circles you might say that impact/ create a village for me. . . The closer a person is to the center circle, the more impact they have on my immediate family. All the people play an important role and all help one another whenever needed. This process helped this student identify layers of the familys emotional closeness/distance, and recognize how geographical distance affected the relationships. Some students depicted and described highly interrelational processes of family. For example, the genogram adaptation helped one student expand her understanding of the uniqueness of relationships and the complex interconnectedness among the members. She began her drawing in the middle, with herself in a circle; she then drew additional circles around the initial circle. These circles represented people and animals, really close friends, and deceased grandparents. Next she drew a line from herself to each of the other circles. Then the student reflected and recognized the different relationships among the people represented by circles. She subsequently drew lines linking each of those relationships. Finally, she connected each of the outer circles to each other. She wrote at the bottom: They all have a relationship with me, but they each have a different relationship with one another. Each relationship is unique to the individuals. Others represented family in a symbolic fashion. Many students used an icon to represent either a whole faction, such as all siblings, or one person. For example, a student drew her family and her husbands family facing each other. She represented two deceased persons through the illustration of an ear and a pair of glasses. She drew a horse, which rep-

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resented a grandparent. Her drawing also contained icons next to people to represent either issues that surrounded these people (such as money signs) or what she remembered most (such as an icon of a book symbolizing a persons quest for knowledge). Another theme that emerged was family as dynamic. One student drew well-spaced puzzle pieces with adjectives within the pieces: nurturing, loving, respectful, and supportive. Other descriptors were interspersed in between the puzzle pieces: dependable/loyal, critical (constructively), and circular. At the top, on the right-hand side of the page, the student drew an easy chair with the word comfort written above. The student wrote at the bottom of the drawing: My depiction of a family is best described as a puzzle. All of the pieces fit together to show the elements in a family. But its important to see each as an individual piece not only as a whole. Family also was represented by place. One African-American female student drew a large table that spanned the entire piece of paper. This table represented a room within her home that contained a large table where family gathers. Those people coming to the table are considered family, whether related by blood or not. This table represents the place where intimate connection occurs. Reflections Students wrote reflection papers in the ensuing week. They generally conveyed that they enjoyed the experiential activity and found it a very enriching experience. It increased knowledge. As described by one student, the exercise helped further define my constructs of family and the world. Not only was I able to move more deeply within myself, I also found more freedom, which then helped broaden the concept of family into a more holistic framework. I felt personal development in progress. It also heightened awareness. For example, one student represented family by drawing hearts. Sibling and parents were each in separate hearts to show how the family has grown. She wrote: Then I put a home in the middle of the three hearts, which symbolizes my parents home, because I feel that I have truly come home whenever I go there. I am sure this will change eventually in my life, but for right now, I still feel that home is where my parents live, which is why I still associate family with my parents. It is neat

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to think that when I become married and one day when I say family I will be referring to [my fianc] and our children. Students also reflected on processes that supported family. One student drew a house, within which were stick figures with the relationship identifiers of husband, son, daughter, wife, cats. She wrote: Within the picture I showed smoke coming from the chimney [of the house], which indicates to me that the house is being lived in and is alive and important. . . There are also musical notes [drawn] inside and outside of the house, because music is a huge part of our family life. Another student, who used a music symbol to represent its importance in how his family functioned, also used a river to represent distance from important family members and a subway to represent travel to that family. For him these processes remained important to connection with family. Synthesis When viewing the total created product, it is important to attend to negative spaces, relationships and proportions, lights and shadows, edges, and the gestalt or total product, as with any visual arts medium (Gladding, 1998). One student drew a more traditional genogram, placing self and spouse in the middle. As the student continued to add more and more members on the spouses side, the drawing became more and more crowded. This was in contrast to the sparse image on her side of the family (parents and one sibling). Her drawing unveiled a key process occurring within the relationship, that of feeling crowded out by her partners family, which was confirmed during the discussion. Another students drawing contained a great deal of negative space. The top one-third of the paper had the name of the student and her boyfriend, underneath it, and circled were two dogs and a cat with their names. All words were encased. At the bottom-right quarter of the page was a box with the name of her brother, with an interspersed/dotted line drawn to him. At the very bottom-left corner was an unconnected box with Mom and sister written together within that box. One might recognize a connection with brother and discon-

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nection and/or issues with Mom and sister. However, the large amount of negative space could suggest a lack of support. The visual image actually punctuated a loving relationship, which mirrored the students life cycle stage of early adulthood. This period is often marked by a focus on intense relationships and building a career (McGoldrick & Carter, 2005). Clinical Intervention The previous descriptions reveal how high-functioning graduate students uniquely self-identified their families, framing them in contextual and dynamic manners. The students provided many examples of the self-created genograms use in a training setting. The following vignette illustrates how the self-expressed genogram can be used as an intervention tool in a clinical setting. Vignette Amy arrived for her first appointment with Cynthia, looking preoccupied. Susan, her partner of eight years, just had informed Amy that she would not be going home with her for a holiday weekend. During the intake call, the counselor learned that Amy and Susan had been together for eight years, liked many of the same things, and rarely fought. However, Amy said that she felt a sense of stuckness with the relationship: the love was there, the mutual interests, the friendship, and even the sexual intimacy was present although erratic over the last few months. Amy had been to therapy twice before, but each time it stemmed from a crisis. John, her first therapist, helped her recognize and understand her discontent in a traditional marriage. Although John seemed okay as she began a same-sex relationship, Amy later realized that he was unsure of what to do when it came to her process of coming out. That first relationship did not last. Neither did the second or third. Amys next therapist, Marcia, supported her through those beginnings and endings and was helpful in Amys process of lesbian identity formation and integration. Marcia understood to the point that at times Amy felt some difficult processes seemed to be set aside by the therapist. At times, Marcia, who had always known she was lesbian, took solutions and processes for granted while Amy struggled with identity management in her contextual world.

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Upon entering this therapeutic relationship with Cynthia, Amy felt a mixture of anticipation and trepidation. Susan was her life partner and the only female relationship of which her family had known. Amy was afraid of losing what she had with Susan. She asked herself if Cynthia, a heterosexual woman but clearly a strong ally, could help her process. Cynthia was well-known in the lesbian community and many of Amys friends spoke highly of Cynthia as a therapist. The first appointment had the typical getting-to-know-you feel. However, Cynthia asked Amy to do something different: Amy, I think it would be very helpful to our process if I could better see your family. Would you be willing to take this piece of paper and represent family in whatever way you would like? It seemed a bit odd at first. Amy was used to responding to therapeutic questions. Although a little hesitant at first, she quickly became engaged in the process. She began at the center writing partner/self. Around that Amy drew a triangle and at the left top point she wrote her family. On the right top point she wrote my family and at the bottom point, she wrote our family. Amy paused for a few seconds and then sketched various things in the upper-left-hand side. These included hills, music notes, fireworks, and a Christmas tree. Two stick figures were placed underneath. She broke her concentration for a moment. Im no artist, you can see. Yet after a nervous giggle, Amy returned to the drawing. At the lower-left was a rectangle with the word bible inside. Four stick figures underneath were drawn. These looked like one man, one woman, and two children. A few seconds went by and Amy drew a box with three question marks placed inside. She sighed and she gently shook her head. Amy then went to the upper-right corner and drew a music note that looked like a roughly-drawn basketball scene, and two stick figures joined together with a line. At this point she wrote basketball, and dancing, and then drew a little smiley face. Over the top of these figures was what looked like a rainbow. She glanced at her watch. At the lower-right side of the paper she wrote Mom/Dad, eight names, and two roughly drawn four-legged creatures. This time she paused longer, scanned the drawing, and then drew a line in the bottom center, wrote two names, and two sad faces. Amy then turned the paper for the therapist to see.

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Creative Representation This self-initiated genogram formed a foundation for Amys contextual world that stemmed from the emotional as well as the intellectual. It provided a base that was referred to and reflected upon often during the course of therapy. Amy and her partner were drawn first and were contained within the triangle, a standard symbol for the lesbian and gay community. (This symbol, once used as a Nazi marker for homosexual, was claimed and celebrated within the community as a symbol of power.) Amy described the balancing act of her family (Susans) and my family (Amys), and the realization that our family provided the pivot point. The hills, fireworks, music, and Christmas tree represented Amys idealized family of the past. Relocation and deaths of key family figures shifted the ideal to the real. Two figures represented an aunt and a cousin, the only blood family members with whom Amy remained close. A substantial amount of work revolved around the loss and grief she symbolized in the lower left corner. The bible represented religion to Amy and the loss of family members whose religious ties were such that they were unable to respect the love and dedication that Amy and Susan shared. The four stick figures were symbolic of the Dad-Mom- and twochildren families and how she and Susan struggled with finding a place within that framework. Amy related that some family members were so caught up in their world of traditional family that she and Susan felt like an appendage rather than an integral part of the whole. The box with question marks stood for the unknown, relationships with family members that felt strained. Amy was unsure of whether the strain was a result of naturally growing apart, family distancing because of her relationship with Susan, or mutual awkwardness over a culturally-laden issue. The upper-right corner had symbols of the lesbian community: family that grew as a result of events such as womens basketball games, womens music events, and dancing. This community carried forward Amys memories of family that shed had as a youth. What began as a shared event developed into relationships, connections, and interconnections that have lasted for many years. The rainbow over the figures had a double meaning. Rainbow is a prevalent symbol in the lesbian and gay community representing freedom and power. This rainbow also symbolized an event that produced a vivid experience. Amy and Susan had attended a womens concert that ended with both feeling joy for the

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couple in sharing the event, safety in being among the lesbian community, and an actual rainbow on the horizon. The lower-right corner contained Amy and Susans two pets, Amys parents, a sister and her daughters, and another sister and her husband. She also included Amys and Susans previous partners who are considered family. Another named person was a lesbian woman who had become Susans surrogate Mother. This person provided a sense of history of the lesbian community, an example of longevity in relationship, and expanded the circle of extended family for Susan and Amy. The center line with two names and two sad faces were pet companions who were now deceased. Their pets had been significant for this childless same-sex couples relationship during their formative years. Amy referred to them as our babies and reflected on the profound loss in losing them. They were considered shared family members and were symbolic in the couples formation, history, and longevity. Conceptualization in Context The clinical vignette and creative representation illustrate how this modified genogram, initiated by the client, can be employed as a clinical intervention. Amys self-created genogram provides factors and processes that give voice to what is often ignored or obscured in clinical work when employing the traditional genogram. If the genogram had been used in a conventional manner, four key areas might have been overlooked. First, Amy described ongoing stressors. A stressor involves an event significant enough to perturb the status quo. Boss (1988) refers to no volitional stressors, or those originating from the outside, and ambiguous stressors. Amys family withdrawal, and at times devaluation of her same-sex affiliation provide an example of a no volitional stressor. Ambiguous stressors were seen in the strain she experienced with some family members since bringing Susan home. The experience is akin to living with a sleeping giant (p. 42); one is never sure when the heterosexism and discrimination prevalent in Amys life may come. A second area that emerged from this self-created genogram is heterosexism and discrimination. As we see in Amys first two therapeutic relatings, these issues are not always explored. Still, these processes play a large role in her contextual world, affecting Amy at the individual, relational, familial, and sociocultural levels. Regardless of the appearance of insulation or resources, all same-sex couples function in the context of these two interlocking forms of oppression and the re-

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sulting internalization of both (Brown, 1999). Amy described the prevalent, sometimes subtle marginalization experienced by lesbian women; this experience can be one that is often ignored (Brown, 1995). In a similar way, religious exclusion and/or ambiguity surrounding inclusion can create unrest at deep levels. Clinicians who wish to be effective in working with lesbian and gay issues in counseling must understand how debilitating and pervasive the stressors and isolation can be for all those concerned and respond according to the contextual dilemmas (Dahlheimer & Feigal, 1994, p. 71) that clients bring to counseling. Third, creating family can be a critical process for those living or having been raised outside the traditional nuclear family. Older notions of family surrounded the family of procreation, partner and children, and family of orientation, the person and parent (Gelles, 1995). The term family of choice has become popularized, especially within the lesbian and gay literature (Green & Mitchell, 2002; Slater, 1995), and this clinical vignette adds insight as to why this might be so. The term created family recognizes a viable and often preferable option for individuals and couples who have either lost family support or have found amplified kinship with those who are chosen rather than maintained through involuntary membership. Furthermore, Amys clinical example makes reference to the two previous partners of the couple. Continuing relationships with previous partners remain vital for many lesbian women, and integrating new partners into the base they have established becomes an important task (Weinstock, 2000). This continued inter-reliance of partners might be an interlocking piece of the lesbian culture. A fourth process spotlighted by Amys self-created genogram is the broader context of community as an essential focus for many within this population (Dahlheimer & Feigal, 1994). Dahlheimer and Feigal (1994) point out how the lesbian and gay community provides the alternative (replacement) and supplemental (adjunct) roles in fulfilling the core functions of family for gay and lesbian clients (p. 71). Community can provide protection and socialization; it can also increase self-esteem and a sense of identity and contribute to learning basic survival skills to maneuver in contemporary society. Rather than continually starting from scratch, group wisdom can be gained through community relationships (Slater, 1995). Future interventions with Amy involved a content-based genogram where the self-created genogram could be placed contextually within the larger family system. New details emerged, as well as processes sur-

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rounding gender, power, intimacy, and oppression. The therapists understanding of the culture allowed an opportunity to communicate more effectively and make the best use of the metaphors generated in the process. The self-created genogram highlighted key points in Amys present world, noted past historical context, and provided insight into potential future issues and strengths. In sum, Amys drawing in context suggested her own self and her relationship as pivotal in Amys world. It quickly and accurately identified that extended biological family were not presently impacting Amy due to time and geographical distance. Individual, relational, and familial issues existed as a result of living in a sometimes hostile and/or dismissive culture, and religious and spiritual conflict resulted. Special events expand from typical socialization to reconnection with a social and intimate support system and family within the larger community. The model also captured strengths for Amy and her family: community, lesbian-mother figure, strong interreliance with previous partners, and the importance of pets, both as practical companions and as symbols of shared relationship. Key blood and legal-based relationships were identified, which provided a starting point for the therapeutic work and a marker for people who were later identified but missing within the self-created genogram. This modified approach to the genogram facilitated a strong joining between the therapist and Amy, lead to discovery of central processes in Amys life, and served as a guide for their therapeutic work. The method was time efficient; it spotlighted those issues pivotal to Amy and set the stage for creativity in counseling. Moreover, those people and processes that emerged in this self-created genogram remained central throughout the entire therapeutic process. CONCLUSION The self-created genogram assesses family-like relationships and contexts that might otherwise go unnoticed by traditional methods. Vitally important information might be lost or obscured without the therapist first finding out what is most contextually pertinent to the client. I chose to use a clinical example of a lesbian woman, which employs what Akamatsu, Basham, and Olson (1996) refer to as decentering, or pivoting the center (p. 24). Decentering is to begin from the perspective of the marginalized, foregoing loyalty to the socially sanctioned world view and, especially, to the dominant canon (p. 24).

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Although the genogram remains an important tool by which we can learn about family, the standard genogram does not address those areas of unresolved hurt that involve people with whom we are not genetically tied (Milewski-Hertlein, 2001, p. 28). In addition, it does not always address the multiple systems levels. The sociocultural, political, economic, and the community-associated levels of neighborhood, work, friends, religions, and organizations (Carter & McGoldrick, 2005) are all sources of potential hurt. Just as the family therapy field is changing in one direction, the expansion of the concept of family and the concurrent trend toward and linking of marriage and family presents a multi-systemic conundrum. I am not implying the self-created genogram should be used instead of the traditional genogram. On the contrary, in my experience employing both the self-created genogram and a traditional genogram is ideal. This self-initiated adaptation is particularly useful when it is initiated prior to gathering details for the more traditional genogram approach. Although many adaptations of the genogram exist, I found no selfinitiated, self-propelled, expressive modifications of the tool, such as the self-created genogram. This model has a multicultural appeal that can transcend culture and create relational touch points. Expanding creativity within the therapeutic arena becomes even more important as our culture becomes increasingly diverse (Murray & Rotter, 2002). The self-created genogram helps to formulate a conceptualization of family and applies theoretical and clinical constructs in counselor training. It creates a vehicle for counselor-trainees to better understand themselves, the profession, and clients world. This adaptation of the genogram increases insight for the students own experience of family and how it might impact the therapeutic process. Group discussion expands the language around family and normalizes diversity in form, inviting students who lack a multicultural perspective of family to begin the process of opening their viewpoints. Additionally, it provides a window to how students process information, view family, and approach others. The self-created genogram elicits an internal perspective that can be clinically broadened. This type of genogram adaptation is important not only in counselor training, but also in clinical settings. This creative genogram helps bring into being a sense of discovery and openness, facilitates an expanded concept of family, and supports an interdynamic exploration of family as process versus content. Through the ensuing discussion, experiences are shared and more is learned about the varied process of experience and expression.

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Formal academic and clinical training play an integral role in obtaining knowledge, attitudes, and skills for future professionals (Chung & Brack, 2005). Many biases and institutionalized isms exist (Adams, 2005). It is during this important developmental phase that trainees learn to become sensitive, affirming, and competent of sexual orientation issues as well as all multicultural concerns (Chung & Brack, 2005). Family therapy, creativity, and multiculturalism all play parts in the larger professional picture. The self-created genogram is but one attempt to implement a creative means to discover family and infuse a broader, multicultural approach in counseling. Yet, each step taken toward creating an affirmative, diversity-based training and clinical environment can produce a ripple effect. The cumulative effect of a multitude of tiny waves engenders a subtle but systemic change that can have far-reaching impact in the profession. REFERENCES
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RECEIVED: 10/04/04 REVISED: 11/22/04 ACCEPTED: 12/18/04