Both in family medicine and in systemic family psychotherapy and in other areas of health, it is necessary to know the type of family relationships and dynamics of the patient (s) attending the consultation.
These relationships need to be contextualized and understood by knowing who the family members of the patient or the person being studied are, and therefore it is very important to know what their family tree is.
Familograms are tools widely used by professionals caring for families, an instrument that allows you to see how families are doing by glancing at it. We learn more about what they are and what symbols they are made of.
What is a familiogram?
The familiogram, also called the genogram, is an instrument widely used in family medicine, family therapy and any field of intervention in which the family environment of a patient or an individual must be studied. This tool is ideal for the family physician because its simple visualization provides information about all the members and relationships that exist in your patient’s home environment.
Familiograms can be defined as graphic representations of the evolution of a family over time, taking into account a minimum of three generations. These charts are family trees that provide information not only on family members visiting the clinic or under study, but also provide us with data on family members who cannot attend the medical consultation but also which are important for the dynamics of the family nucleus. to intervene.
Among the data recorded in this type of tree are the more general demographic aspects such as age, sex, family type and pathological history, among others. Outraged, they are also used to know the life cycle that the family goes through, the events of the lived life, the family dynamics and the emotional relationships, data which are generally represented in the same file so that, with a simple examination, the characteristics of the family can be understood.
How to make a familiogram
Doing a familiogram is really easy, and you don’t need to do family medicine or systemic family psychotherapy to be able to do one. However, it should be noted that its use is particularly interesting in the field of health, because it makes it possible to detect possible hidden emotional problems or important psychosocial conditions, because if they are reflected in an article as the dynamics between several individuals occur, it is possible to find dysfunctional relational patterns.
The main data collected are:
- Family members
- Biological and legal relationships
- Subsystems within the family
- Cohabitation unit
- Demographic information
- Diseases and problems
- Stressful life events
- Family resources
- Family relations
We can distinguish two components within familiograms. On the one hand, we have the most structural part, which refers to the members who make up the family, their names, ages, sex and type of relationship (couple, children …). On the other hand, we have the functional part which highlights the type of interpersonal dynamic, the style of interaction between family members and any problems they may have had.
Symbols of familiograms
In order to be able to properly make a familiogram, you need to know the appropriate symbols to use.
1. Sex, gender and main subject
We start the familiogram representing the members of the family. Baron members are represented by squares, while women are represented by a circle.
The person we are working with, our patient or main subject of study, is identified by a double line or, failing that, by an arrow which highlights them in relation to the others.
To indicate that a tree member has died, an X is drawn inside its symbol and, if desired, the date of birth and death can be shown to the left and right of the top of the tree, respectively. the figure. . The current age of living people and the age at which deceased members died is indicated by placing it in the corresponding symbol.
It is possible to indicate if a member is gay, bisexual or transgender. This should only be indicated if it is considered important to take it into account during the intervention. If this information is not, it may be unnecessary.
Gay men and women are shown by placing an inverted triangle inside them, while bisexual people are shown by drawing that same triangle but using a dotted line.
Transgender people are indicated by expanding their gender and internally the gender assigned to them at birth. If it’s a transgender woman (male to female), draw a circle with a square inside, and if it’s a transgender male, draw a square with a circle inside ( from woman to man).
Couples relationships are depicted using two vertical lines extending beyond couple members and connecting horizontally, placing the man on the left and women on the right in the case of heterosexual couples.
Marriages are represented by a solid line, separated couples are represented by placing a diagonal line on the solid line, divorces are indicated by a double diagonal line, and relationships before marriage are represented by a dotted line.
We can indicate the year of their marriage by putting the letter M followed by the date of the union. Where there is little likelihood of century confusion, the year of marriage is indicated using only the last two digits of the year. In the event of separation or divorce, you can also choose to indicate the date of the events.
To represent multiple marriages, the following type of diagram should be used, representing marriages in order from left to right when only one of the spouses has remarried. In the event that the two remarry, the more recent union will be centrally located.
If there are children, they will be represented by joining them with a vertical line to the line indicating the relationship. Children are always placed from largest to smallest, from left to right.
In the case where there are twins, these will be represented by putting the line which starts from that of the pair relation in the form of a diagonal, having the same origin. In case one of the children is adopted, the vertical line will be drawn in dotted lines.
You can spin more finely and indicate if the twins are bivitelline or univitelline.
Current pregnancies and abortions, spontaneous and induced, are also represented in the familiogram. In the case of pregnancies a triangle is used, in the case of unwanted abortions a black circle is drawn and in the case of planned abortions it is indicated by an X.
In the case of death at birth, this is indicated by a square or circle depending on the sex of the baby and by an X inside.
To indicate that several people live in the same household, these family or household members will be grouped together by drawing a dotted line around them. The reason the dotted lines are used to indicate households is because they are open systems.
5. Types of interpersonal relationships
The most subjective part of the familiogram is its functional part, as family relationships are the most inferential aspect of this type of graph, besides the same family members can offer different points of view and contradict each other with each other. others. The functional familiogram is about trying to demarcate relationships between family members, and this is done from information obtained from reports of family members and direct observation.
To represent a close relation, we will use two horizontal lines and, if it is very close, three. In the event that it is very close but at the same time in conflict, these same three lines and a fourth in a zigzag shape are used to represent the ups and downs of the relationship. If the relationship is only conflicting, only the zigzag-shaped line is used.
If the relation is distant, a dotted line will be used, but with long dashes so as not to confuse it with cohabitation relations. In case the relationship has been broken, if it is not a couple relationship, this will be indicated by breaking the line placing two vertical lines separated by a certain space.
Close, close, conflictual close, broken relationship, conflictual relationship and distant relationship
Finally, certain symbols indicate the type of relationship that the person has with agents outside the core of family coexistence. They can be indicated using a pentagon, which indicates that there is a relationship with an institution, or a triangle, indicating a relationship with a professional.
Reference points in the development of the familiogram:
Now that we know what symbols we should use to create a family tree and how to represent the relationships between its members, we should consider the following benchmarks.
- Minimum three generations and indicate each generation with a Roman numeral on the left side.
- The family of paternal origin is placed at the top left, and the kindergarten at the top right.
- In the center is the family of the main subject (s) of study.
- The proper names of family members are placed under their symbol.
- Occupations, pathological history, and other relevant aspects of interest may be indicated on the left side of each family member symbol.
- The last name is placed in the upper central part of the familiogram.
- It will specify the meaning of each symbol if necessary.
- The date of preparation of the familiogram will be indicated in the lower right margin.
- The full name of the person who made the family tree will be written.
- Jolly W. De J, Rosen MG. The genogram. The Journal of Family Practice, 10: p. 250 – 255.