Using Creative Genograms in Family Social Work to Integrate Subjective and Objective Knowledge About the Family: A Participatory Study

Abstract

Genograms are widely used in family therapy as a way of visually mapping out systems and recurring family patterns. Creative genograms enable families to phenomenologically self-define recurring themes and issues, thus combining both historical, but also, experiential data on the same page. This participatory research gathers the self-defined, phenomenological experience of family social workers who experienced creative genograms firstly on themselves and then administered it with their clients: Examples are analyzed within the text. The findings point to the usefulness of including creative genograms in family social work contexts to intensify information, engagement, and stimulation and to re-perceive calcified problems through new visual terms. Challenges were the unfamiliarity of art language and fear of being “diagnosed” through art. Ways to overcome these challenges and to utilize the benefits were discussed. A theoretical understanding of social versus psychological art is outlined. The specific tool of the creative genogram enabled us not only to provide a clear directive tool for family social workers but also to demonstrate the ways that social art corresponds to and can enhance the aims of family social workers in more detail.

Keywords

genogram couple and family therapy art therapy

Genograms are widely used in family therapy as a way of visually mapping out systems so as to understand recurring patterns, themes, and issues over generations using universal symbols. Genograms show who died, who divorced, who moved away, how many children were born, and more. They are usually utilized diagnostically or as a method to highlight patterns within the family structure, such as patterns of individuation, distance, or closeness and patterns of marriage and divorce. This information can be utilized in family therapy to understand history of traumas, deaths, and transitions and can provide a map of family patterns and themes. These patterns are often national, cultural, class, and gender specific, but also, belong to the personal “culture” and specific family history (Magnuson & Shaw, 2003; McGoldrick & Gerson, 1985; Patterson et al., 2009; Piercy et al., 1996).

Genograms can also provide data on family structures of groups of populations and can highlight different types of information such as community affiliations, relationship characteristics, employment, or health histories. Examples of such innovations are its use to map out specific experiences, such as traumatic events (Jordan, 2006; Kuehl, 1995), to enable the contextualized examination of a specific element such as ethical decision making within the family (Peluso, 2003) or to map out cultural differences within the family (Hardy & Laszloffy, 1995).

Genograms echo the theoretical outlook of family therapy that assumes that personal problems are connected to the learned and repeated systems of family interaction within which they occur. When extended, they also capture cultural and ecological elements of the families’ experience. This is particularly relevant to family social workers who often work with different minority cultures and utilize shared reality empowerment groups (Dominelli, 2005; Huss et al., 2012). While genograms can be extended outward toward cultural community and population experiences, they can also be extended “inward” to capture the phenomenological experience of members of a family, thus combining both historical, but also, experiential data on the same page.

Creative genograms can replace standardized signals with more personally selected symbols and compositional elements chosen by the creator to depict his experience of his family through the generations or to capture central themes that he is concerned with, for example, that the women are like butterflies, flighty and active, and the men are like fish, silent and more static. The use of colors, sizes, shapes, textures, and symbols enables one to include additional self-defined symbols to those of marriage, death, and divorce that contain how the drawer experiences different themes in her family (Huss & Cwikel, 2008). The genogram can maintain its traditional shape or the family member can utilize a general symbol for the family as an organizing metaphor (e.g., a political stand) or can relate to the background of the genogram (e.g., to put a wondering family in a boat or on a black cloud of depression). Creative genograms can also take the generations a step forward to project how one wants to see the family in the future. This information is in addition to and based upon the historical facts of the genogram but continues to the drawer’s phenomenological experience of themes in his family over generations. From the above, we see that different members of the family, while sticking to the historical data about their family (such as who married, divorced, died, and how many children then had) will draw the central themes of the same family differently, expressing their personal experience of the system. Creative genograms can highlight specific themes or focus on all themes in the family. Creative genograms can be used, like genograms, within individual therapy to help connect personal themes to family issues or within families to help to communicate experience of the family to others in the family. Within shared reality, cultural, gendered, or class groups, they can highlight repeated gendered and sociocultural patterns that go beyond the individual family, such as the experience of violence to women in the family (Huss, 2015a; Huss & Cwikel, 2008).

Within family meetings, the use of symbols and images in a genogram can help to share silenced experiences in a nonthreatening way through indirect symbols and metaphors. Within shared reality group meetings, the multiple versions of the same historical reality can enable people to understand other family members’ experiences (Huss & Samson, 2018; Meekums, 2000; Pruginin et al., 2016). Family art therapy is different from this use of genograms in that it emerges from central art therapy theories such as utilization of family drawings as diagnostic tools and art use in families as spaces within which to explore projective unconscious or subjective experience of the individual or family (Greenspoon Linsech, 1993; Jordan, 2006; Kerr et al., 2008; Kwiatkowska, 1978; Riley & Malchiodi, 1994). The use of a creative genogram is based in systemic theories that are closer to family social work in that it combines both ecological and historical data on the family with subjective experience of the family on a single page.

Indeed, the use of arts is intensifying in social work due to an increase in visual social media. We see a rise in arts in social work that is based on systemic and social theories in social work arts-based research, use of visual culture, visual anthropology, community art, photovoice, art therapy, outsider art, arts in conflict negotiation, and arts for social change. It is important to explain that social uses of art do not focus on unconscious elements in the art or on aesthetic quality of the art, as in fine art that aims to create aesthetic innovation within its own bracketed world. The aim of social art in social work practice is to embody and enrich verbal expression, leaving the interpretation of the art to the creator, while aiming to understand how the individual experiences and is constructed by his social reality and is a way to excavate silenced narratives and to embody communication with others. This is also different from psychological dynamic uses of art as in art therapy that aims to reach an unconscious layer of the socially decontextualized inner self. Social “art” can include symbols, colors, photographs, TV shows, advertisements, photographs, and others. Visual methods commonly used by social workers include projective cards, visualization, drama, music, and art exhibitions of various populations such as cancer survivors, psychiatric patients, and prison inmates. Art is included in individual social work encounters in hospitals, clinics, community centers, prisons, schools, and various frameworks for children (Huss, 2012). When the arts are used in such manner, there is an alignment between its use and social work values such as those of the importance of social relations, context, and culture (Chamberlayne & Smith, 2009; Foster, 2007; Freire & Macedo, 1987; Huss & Boss, 2018; Huss & Sela-Amit, 2019). Freire and Macedo (1987) state that the arts enable personal interpretation and the engagement of the imagination in relation to social reality (p. 86).

However, often social workers experience resistance to art because they feel untrained, or they may associate it with the projective dynamic methods of art diagnosis. They may also feel that they have too many “real” problems to deal with. We see that arts help move social work “away from the dominance of western style talk.” To return to the example in this article, then, when working with genograms, family social workers often work with minority populations who have different family hierarchies and cultures and who may not be able to express themselves well in the hegemonic language or who may resist talking about personal and family issues (Freire & Macedo, 1987; Manicom & Boronska, 2003).

Within family social work in general, the arts connect to family therapy through being a spatial metonymic rather than abstract medium and, thus, can help to map out, evaluate, or understand the perceived power relations, relationships, and physical and emotional spaces between people in a physical and concrete way. The arts can be a way to intensify communication with self and with others. On a deep, neurological level, the arts as an action method help to intensify the reflective process through creating perceptual processing based on the tension between form and content, that is, in thinking how to depict a situation, the situation is further clarified (Huss, 2015b; Sidling et al., 2014). The arts simultaneously utilize emotions, cognitions, and the body in an embodied aesthetic experience that helps to arouse autobiographical, cultural memory while also challenging homeostatic stands through showing new perceptions of familiar things. The arts create metabolic arousal that mobilizes the organism. Indeed, the arts, from a neurobiological perspective, are a way to group together stimuli into a coherent gestalt or unit and, thus, to organize what one wants to communicate to others (Bojner Horowitz et al., 2017; Conway & Pleydell-Pearce, 2000; Sarid & Huss, 2011). On a community level, this process helps to select and update images and sensations that are momentarily most relevant to the individual, and these images become the base of narratives, rituals, symbols, sports, and other forms of symbolic interaction. Thus, arts and symbolic interactions are the spaces where the core values and integrated, learned patterns of behavior, ideas, and products characteristic of an individual and of a society are defined and communicated to others.

On the level of communication with others in the family and community and with the social worker, symbols and metaphors form a much broader hermeneutic base that might contain multiple and conflicting meanings in comparison to words that tend to be more linear. Thus, new understandings can be coproduced. By shifting communication patterns, then the first step toward change in the system is initiated. Additionally, shifting from verbal to visual languages enables shifts from abstract, often calcified concepts and arguments in the family, to visual languages such as symbol, color, and shape that help to gain new perspectives. As stated, the shift to visual elements enables “visual” solutions to be seen, such as moving closer or further, merging or separating shapes, enlarging or making smaller, and centralizing or decentralizing overall gestalts of systems (Bucci, 2007). Symbols and metaphors are broader concepts than words and, as such, provide more space to shift perspective (Huss, 2017; Liebmann, 1996). In terms of family systems, shifting to a new, unfamiliar language can help to “shake the system” that has set verbal constructs of the problem. Because symbols and metaphors are used, indirect methods of expressing difficult feelings are enabled. This is important in cultures that do not directly express conflicts (Bowler, 1997; Ford-Sori, 1995; Riley, 1997a).

Another use of arts in family therapy is as a way to create here and now interaction through joint family drawings, in which the family creates a joint image. This will also show who leads, who follows, and who is next to who, providing a live but concrete map of family interaction. This is important when working with families from different cultures. The family dance captured on the page can also be reorganized (maybe according to the demands of the dominant culture), for example, by separating coalitions or creating new leadership roles (such as giving women more power) in the art process (Abu-Said & Champagne, 2005; Chernesky, 1997; Cole, 1996). Families are often negotiating complicated transitions and may be less verbal or used to expressing themselves in the dominant verbal language if they are from minorities.

This definition of social art enables family social workers to introduce an additional language to enrich family therapy but that emerges from the systemic and cultural theories of social work. Creative genograms and other directive uses of art to reach the above aims do not focus on art talent or complex art materials but can be undertaken with the help of felt tip pens, oil pastels, different paper sizes, scissors, glue, and/or magazines used for collage.

The above theoretical basis suggests that family social workers could find the creative genogram and similar arts-based tools helpful in their work. The aim of this article is to explore this premise by teaching family social workers the creative genogram tool and determining its usefulness with them. We undertook a participatory research methodology in order to see how family therapists and family social workers themselves experienced and used creative genograms. Our aim was to explore in the field its usefulness for family social workers after learning it and using it within their interventions. From this, we hoped to learn how to fine-tune social, arts-based methods for family social workers.

Method

Research Strategy

The research focuses on the self-defined, phenomenological experience of the family therapists and social workers working with families who experienced this tool on themselves and with their clients. They are considered a group of experts in family therapy and, thus, helpful in understanding the contribution of this tool within the family therapy context (Tuhiwai Smith, 1999). This article utilizes a participatory phenomenological methodology that included two stages:

First, family therapists undertook a workshop in creating their own creative genograms and summarized the experience and potential usefulness of this tool.

Second, they used the creative genogram with suitable clients over a 6-month period and received group supervision and shared impressions of ways to enhance creative genogram use and the overall effectiveness of it. The two workshops undertaken by the family therapists and social workers were recorded. Their own comments, as well as observational themes (such as rise in animation or daring as well as characteristics of their creative genograms), were observed and noted by the two authors (Huss & Cwikel, 2008).

Field of Research

The participants in the group included 20 family social workers and family therapists working in a family therapy center in Be’er Sheva, Israel.

Data Sources

These included two taped workshops with the therapists and social workers and 20 creative genograms of the therapist. This also included summarizing focus groups and semistructured questionnaires about the creative genogram after experiencing it themselves, and again, after utilizing it with clients.

Analytical Strategy

The questionnaires, taped sessions, and genograms were all analyzed thematically focusing on the research question of how the participants experienced the creative genogram as a tool in their practice (Denzin & Lincoln, 2000; Mason, 2002).

Validity and Reliability

The use of experts, in this case, family therapists, as research participants helps to intensify the reliability of the research. The use of dual workshops, with self and with clients, also helps to intensify validity and reliability. The triangulation of data, both phenomenological and observational, and the analyses of the workshop by two researchers, also help to intensify reliability (Gerson & Horowitz, 2002).

Ethical Considerations

This research was voluntary, and all participants signed consent forms to have an enrichment workshop in exchange for research data. The genograms were presented in terms of general themes with no reference to specific families of therapists or of clients. The focus of the research was on the usefulness of the research tool rather than on specific therapy dynamics. The therapists could decide to integrate the creative genogram into their therapy or not, according to the needs of their specific families. They were given half a year to attempt to use this technique. We obtained written consent from the therapists’ place of work for their participation in this study (Denzin & Lincoln, 2000; Mason, 2002).

Data Presentation

First, in order to illustrate the use of the creative genogram in the workshops, three examples that use the methodology in different ways will be outlined. The first example utilized example, a connection to the overall cultural contexts of the family (Figure 1).

Figure 1.

Connection to the overall cultural contexts of the family.

I thought of my family, my heart started beating faster as I drew this genogram, I thought of my seven children from my two marriages and I thought there is room for all of them, I started thinking what each placement meant, but most important, is that there is room for them all in the family, so they are the dots. I don’t know what the purple lines are, I need to think about it more, I am curious. I know the brown at the bottom is my mother, who is the earth at the base of our family that we all lean on. I noticed I did not include my father. He died a few years ago, but he was not there anyway—also before. I drew the arrows as a type of symbol of our focus on the future of our wish to grow upwards as a family.

The above example shows how it raised multiple themes (my mother as the base, missing experience of father, and concern with finding place for all of the children) and also helped to organize them spatially. We see that the genogram was an embodied involvement that engaged him (heart beating stronger) and, so, was a good trigger for exploring the family. We see that it created a reflective dialogue (still trying to understand the purple lines). We see that the symbols are engaged with images of the future (the upward arrows).

I was scared to draw people, so I drew a fish (found creative solution to difficulty in moving to visual language). It’s me, my husband, and our two children. Each one is a separate color, but we are entwined together. I think about this a lot—are we together? Are we entwined too much? The children are getting older, and it’s hard to find the right distance. I’m glad it came out a fish; it makes me smile. It reminds me we are a family together even if we have different colors. I added the yellow dog that is our dog. I missed my dog.

In this example, we see how the creative genogram captures a specific theme of concern to the drawer at this stage in her life (Figure 2). She focused on one theme. We see that it enabled a reflective space to explore compositionally, the distance and closeness of the family system. The fish symbol enabled a new way of understanding the family, and maybe, imaging how it can move into a new stage of the future. The fish symbol became an organized metaphor. It would be interesting to hear how others in the family experience this fish symbol and, also, how other generations in the family resolved this theme. We see that the drawer overcame her challenge of discomfort with drawing through turning to a fish symbol, which actually enabled her to think more intensely about the family.

Figure 2.

Specific theme of concern.

In the next example, the drawer explains (Figure 3):

Figure 3.

Focus on the cultural elements.

I put the symbol of Israel in the center of our family because my father was very nationalistic, and this was a central organizing theme of the family, serving one’s country. My family is drawn as a tree; we are the new growth of this country. There is a strong circle of our country around the family, and this is also the world. We also need to protect the world. Maybe it’s a little too closed; we tend to be overly protective parents. My father was hurt in the war, so on the left are the judgments in the bible, and on the right, are elements of mercy. There is a woman between the trees in mourning and a daughter who is trying to be more present for the parents.

In this example, we see a focus on the cultural elements that form the family such as national connection as an organizing metaphor. We see the theme of protecting the children, the country, and the world, as a central issue that is moved between the ecological circles. The same theme thus occurs in multiple ecological circles rather than in multiple generations. This theme starts to become visible to the drawer through his narrative, and he questions if they are overprotective. Thus, the art brings an unconscious theme to light but in an indirect way that does not have to be picked up by the creator.

Overall themes concerning usefulness and challenges of creative genograms for family therapists. As stated, the aim of the data presentation is to explore the usefulness of creative genograms according to the experience of family therapists and social workers. The following were the advantages of the creative genograms as perceived by the therapists:

A reflective tool that helped stay with contents.

A way to search for new words or conceptualizations.

Using creative genograms as a way of imagining the future.

Concretization and embodiment of characters from the past.

Symbols as an organizing metaphor for family experiences.

Symbols as a way of including cultural themes within the family.

Activation of involvement through embodied investment in the artwork.

Indirect communicative tool as a space to create active involvement.

Creates not only a more immediate, intense, and emotional but also reflective connection for the client to the content, as compared to words, because the senses are involved such as color, texture, and so on.

Raised multiple themes and meanings were helpful—a good trigger for excavating themes in the family.

The overall effect of the addition of the creative art process to the genograms created an intense and rapid presentation of problems and solutions.

Intensifies voice and self-definition of issues of clients.

Could be used over the therapy and different themes worked on and adjusted.

Enabled differentiation within the family, that is, the phenomenological element of deciding on themes enabled different members of the family to see how others in the family experience the same family in a different way.

The challenges of using creative genograms as defined by the family social workers

Discomfort with the unfamiliar medium of art.

Fear of failure or not drawing well enough.

Fear of being “diagnosed” or having unconscious contents exposed.

The relatively unfamiliar language of art gives a chance to redefine elements before returning to new words, rather than telling the same calcified stories again and again. The need to experience the art is important information in training family social workers to use art.

Discussion

This study utilized participatory research methods to see how family therapists experience and evaluate the effectiveness of creative genograms as a tool for family therapy. The findings point to distinct advantages that they found in using a creative genogram in therapy together with challenges. The advantages of using creative genograms with clients divided into the following themes:

First, the family social workers and therapists experienced the process of drawing the creative genogram as helping clients to self-define and sort through central themes of concern to them in the family. The use of the broad language of form, such as line color and shape, and of symbols enabled to concretize and embody these themes. Thus, the client could “excavate” and organize his own experience of the family before sharing it with the social worker, making their conversation richer. This finding follows the above described theoretical prism of social arts that describes the process of excavating and organizing a silenced or unexplored narrative through the tension between form and content (Huss, 2015a, 2017; Silver, 2001; Sinding et al., 2004).

Another theme is that the symbols used became a type of organizing metaphor for family experiences that can emerge from the past but also be shifted and changed in terms of a vision of the family in the future. This follows the literature on the use of perceptual elements to help shift perceptions in the future.

An additional theme was that the process of drawing the creative genogram made the client active, creative, and in charge of his family genogram. The experience of drawing intensified and activated involvement and became a quicker and more intense way to raise issues. This fits the theories of action therapies and the embodied aesthetic experiences that mobilize the whole self through creative expression and engagement in the world in the here and now. This shift to spatial and phenomenological contents provided control for the drawer and, also, a fresh terminology perspective or definition of the issues (Foster, 2007; Greenspoon Linsech, 2013; Huss & Samson, 2018; Huss & Sela-Amit, 2019; Manicom & Boronska, 2003; Riley, 1997b).

The fourth theme was the ability to use art to show a few simultaneous themes and enlarging ecological circles in which the family is contained at once. This is described in the above literature as the spatial element of art that enables to create a single gestalt of a complex system or things side by side, as compared to the more linear and abstract expression of language. Creative genogram enabled the inclusion of additional ecological circles such as cultural beliefs and historical events that had become themes within the family dynamics. This is very relevant for social work orientations that aim to see person in social context. It is also relevant for shared reality group work. This ability to situate person within layers of context can be seen as a methodology to embody the critical stand in social work as described by various researchers (Foster, 2007; Freire & Macedo, 1987; Huss et al., 2015). This concept of using art to situate the family within a cultural and historical context is less developed in both family art therapy and social work literature. This connection is particularly relevant for family social workers who aim to understand the family within the ecological circles of their social reality (Huss, 2015a; Malka et al., 2017).

Overall, we see that the advantages of the creative genograms as defined by the family social workers and therapists were not only the more internal elements of reflectivity and subjectivity but also on the ability of arts to mobilize the service user into action, organization, excavation of content, and focus. Thus, the creative genogram is not only concurrent with insight-oriented therapy but also concurrent with systemic and empowerment aims. Family social work, more than individual or community social work, sits at the intersection of individual experience and of systemic experience, and so, this creates a tool that can bridge both of these perspectives or directions of family therapy (Sinding et al., 2014).

The following sets of themes concern the stage of verbalizing and explaining the creative genogram to the social worker. The central theme at this stage was that the exploration, for example, of a chosen color shape or symbol, served as a visual trigger to find the words to explain the service user’s experience to the social worker. Service users did not always know why they chose a particular color or shape, but through verbalizing their choice, they could reach additional layers of experience, or also, stay with things that were not yet clear because they became more concrete when put on paper. This follows the literature above on the ability of arts to excavate and find the words for experiences of the family that are silenced due to trauma or to cultural taboos (Segal-Engelchin et al., 2015). When working with couples, the sharing of the creative genogram enabled space to understand each other’s phenomenological and learned experience of roles within a family (Arrington, 2001). The arts enabled a space for new organizations and perceptions and a space to communicate this to the social worker. The creative genogram enabled the service user to be not only victim of his family history but also an active interpreter of it, and as such, an expert. This connects to empowerment theories.

Second, the ability to provide a multifaceted and broad system of themes in the family that connects to the background of the genogram, that is, the culture and history, was experienced as an advantage. The potential of the cultural and community use of creative genograms in shared reality groups such as mourning and loss groups, single mother groups, children of abuse, and more is an important direction that the findings of this article strengthen (Benson, 1987; Huss, 2016, 2017). It can also become a useful assessment tool based on coproduction of knowledge and ability to chart out future aims of the service users (Huss, 2017).

The challenges of using creative genograms as defined by the family social workers, in their own experience and with their service users, included discomfort with the unfamiliar medium of art. This included fear of failure or not drawing well enough and fear of being diagnosed or having unconscious contents exposed. These challenges were overcome with the family social workers by creating transparency as to the role of the art in the family intervention (Huss & Maor, 2015). The use of social art, rather than fine art or diagnostic art, helped to explain the rationale for including another form of expression in addition to words. This phenomenological and systemic art use, where the chief explainer of the art is the client and not the therapist and where the aim of the art is to approach the family with fresh eyes, is helpful. The relatively unfamiliar language of art gives a chance to redefine elements before returning to new words, rather than telling the same calcified stories again and again. The need to experience the art is important information in training family social workers to use art.

Most importantly though, the family social workers stated that experiencing the art enabled them to overcome their own resistance to art. This shifting to another language can be used as a metaphor for the aim of family therapy to “shift” the language of the family. Thus, moving out of the social workers’ comfort zone was parallel to the process they were trying to create with their service users.

A limitation of this article is that it has not provided a formal evaluation and thus evidence for the effectiveness of a creative genogram as a method. However, it does enable to understand it's mechanisms deeply, and its potentials and self defined contributions for familly social workers.

Overall, the contribution of this article is to illustrate, using the social workers’ lived experience, that the arts are a useful tool for them and to provide the ways in which art is helpful. These themes strengthened the connection between social arts use in family social work and the aims of social work. The ability of art to simultaneously mix “inside” or subjective reality with “outside” or objective reality is a very helpful tool for family therapists. The importance of perceptions of reality rather than the only objective understanding of reality is a central axis in contemporary CBT interventions. Art analyzed through a social rather than dynamic metatheory enables the creation of roles, spaces, and power relationships within a system visible and, as such, transforms them.

The aim of this article was not to provide a “recipe” of art within systems theory but to try to evaluate its usefulness from the perspective of family therapists and to theoretically connect between art use as in the creative genogram and family therapy. The specific tool of the creative genogram enabled us not only to provide a clear directive tool for family social workers but also to demonstrate, in more detail, the ways that social art corresponds to these aims of family social workers, rather than being an external agent. This concept is reflected in the literature on arts in social work (Chamberlayne & Smith, 2009; Foster, 2007; Huss, 2017; Huss & Boss, 2018; Huss & Sela-Amit, 2019), but is here, given a clear connection to practice and to the lived experience of social workers.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Ephrat Huss

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