Case Study Treatment Plan: The Assessment Process

For this assignment, complete the Assessment Process sections of the treatment plan for your course project. This treatment plan is based on the case study you selected for your course project. You can review the case studies in the Case Study Treatment Plan media piece available in the resources.

The Assessment Process sections of the treatment plan that you will complete for this assignment consist of the following:

• Identifying information.
• Presenting problem.
• Previous treatments.
• Strengths, weaknesses, and social support systems.
• Assessment.
• Diagnosis.
• References.

The sections of the treatment plan you submit for this assignment should be 4–5 pages in length, with a minimum of two references from current articles in the professional literature in counseling. Be sure to cite your references in current APA format.

To assist you in completing this assignment, please use the Case Study Treatment Plan Template (available in the resources) to organize your work. Each section of the template includes a description of the type of information you must include. You should type your paper directly into this template, save it as a Word document with your name, and then submit it to the assignment area.

For additional information, see the course project description.

Submit your paper to Turnitin before you post it to the assignment area so you can catch any areas that are showing up as possible plagiarism.

Note: Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click on the linked resources for helpful writing information.

 

THE CASE STUDY

Oscar is a 19-year-old Hispanic male who is the oldest of 5 children. His family has been farming the same land for 4 generations. Currently they grow vegetables for the regional grocery chain’s produce departments. They live in a rural area of the county. Three generations live in two separate houses on their land. They are fiercely independent and have little to do with people in town, although the family itself is extremely close knit.

Oscar is currently a freshman at the same college his father attended, majoring in agriculture. When he came home for spring break, his parents noticed significant changes in his appearance. He had lost weight, looked haggard, wasn’t sleeping and seemed irritable and argumentative. He told his parents that he did not want to return to college after the break. He went on to say that his roommate had placed cameras in the room so he could record everything Oscar did while the roommate was absent. His grades were poor and he expressed that he believed his instructors were prejudiced against him. This poor performance was in stark contrast to his performance in high school, where he was in the top 10% of his class. Within days of coming home he had stopped showering and began wearing multiple layers of clothes (3 pairs of jeans and 4 t-shirts). He became essentially non-communicative, responding to questions with one-word answers and not initiating conversation. Oscar seemed unhappy or irritable whenever he encountered a member of his family and began spending all his time in his room. He even refused to talk with his youngest brother, with whom he had always been close. He did not take meals with his family, a long-standing tradition in his family, and left his room only in the middle of the night. He could then be heard opening drawers in the kitchen, going into his siblings’ rooms and leaving the house for long periods of time.

The family (parents and grandparents) became very disturbed and consulted their priest. The priest recommended that the parents take Oscar to see a fellow parishioner who is also a counselor. This counselor was also disturbed with Oscar’s presentation and recommended hospitalization. The family was very reluctant, but eventually agreed. By the time they got to the hospital, Oscar was essentially non-communicative, only nodding or shaking his head in response to direct questions.

The parents provided history that indicated Oscar had been a good student in high school and had participated in the school’s FFA club. He has always wanted to carry on the family tradition of farming. He did not have many friends, but the family attributed that to their living in the country.

The psychiatrist diagnosed Oscar with major depressive disorder, single episode, severe with psychotic features and prescribed anti-depressants. He was released three weeks later, with some improvement. One week later he was readmitted, with the same presentation he had at the previous admission. This time, though, his father reported that he had found a cache of knives in the barn, some from the house, some from the grandparent’s house and some from the barn itself. When he asked Oscar about them, Oscar responded that he needed them to protect himself from attacks. When his father asked from whom, Oscar responded that he had seen one of his college professors in the field of broccoli. That same day, Oscar’s mother found notes stuffed between Oscar’s mattress and box springs in Oscar’s handwriting. The content of them was Oscar arguing with someone about killing his younger siblings. One side did not want to do it and begged to not have to; the other side ordered the killings, saying that was the only way to keep them safe. In light of these two events, both parents were afraid for Oscar to remain at the house. Oscar swore that he would never hurt any of his family and said that was why he had been keeping away from them. His parents could not be sure that no harm would come and were unable to watch Oscar day and night. Therefore, they readmitted him to the hospital.

During this admission, Oscar was more forthcoming with his treatment team. Once they had this additional information, the team realized that Oscar’s initial diagnosis had been wrong. They began a re-assessment. Oscar acknowledged that the problems began about the time of the new semester. He was unable to complete his school work, as he was “consumed” with the need to follow instructions that were being given to him. These instructions actually began with a buzzing in his head, which quickly evolved into specific directions. When pressed, he acknowledged that he did not know who was giving him the directions, though he sometimes thought it might be Jesus. These instructions were for him to keep a log of every time he heard a door close on his hallway in the dorm. Oscar came to believe that doing this was the only way to keep his family safe from dark angels. Oscar tried to keep these voices quiet by smoking marijuana on a daily basis. While this helped in the short term, it also made it more difficult for him to complete any of his school work. By the time for spring break, the messages had begun to change. He was no longer able to keep his family safe by keeping a list; the voices told him he would have to kill them. Oscar knew that he did not want to kill his family. He could also not avoid going home for spring break. Therefore, he devised the plan to isolate himself.

Once the family recovered from their initial shock and as Oscar began to show some improvement with his new, anti-psychotic, medication, his parents and grandparents wanted to take him home to the farm. They believed that life on the farm, being outside and with hard, physical labor would cure Oscar. Finally, Oscar agreed to tell them what has been happening with him. At that point, the family agreed to residential treatment for Oscar. When asked if anyone else in the family has ever had symptoms like this, the grandfather acknowledged that he had a brother (Oscar’s uncle) who had religious visions. This brother left the family and became a monk. Later the family heard that he had died under mysterious circumstances. One of the other monks at the monastery told Oscar’s grandfather that his brother had died from engaging in a prolonged fast. The family is very lucky on two counts: 1) they have their medical insurance through the farmer’s co-op and it includes coverage for residential treatment for up to a year, and 2) this hospital has a residential treatment unit for late adolescents and young adults. You are working as a counselor at the Residential Treatment facility where Oscar has been placed. He will be here for a minimum of 6 months and as long as one year. Professional staff at this facility includes 3 counselors, an addictions counselor, a social worker (currently on maternity leave), a psychologist, and 2 nurses on every shift. Oscar’s psychiatrist is also on staff and will continue to follow his care.

The social worker usually coordinates clients’ treatment plans; however she is currently away on maternity leave so you will be the lead therapist who is coordinating Oscar’s treatment during the next 45 days. Once she returns, you will collaborate with her for developing Oscar’s post-residential treatment and resources for him and his family.

THE TEMPLATE FOR THE ASSIGNMENT IS ATTACHED

COUN6331 Case Study Treatment Plan

COUN6331 CASE STUDY TREATMENT PLAN

 

 

Instructions: Please type directly into this template as you develop your Treatment Plan. Your submitted assignments in Unit 5 and Unit 9 must be completed within this template in order for you to receive credit for your paper.

 

Unit 5 Assignment: Complete the first six sections of the template, plus your reference list, for the Unit 5 assignment. After you have completed the final draft of these sections, save the template as a Word document with your name (for example, Smith Unit 5 assignment) and submit it to the courseroom assignment area by the deadline for the Unit 5 assignment.

 

Unit 9 Assignment: Complete the last five sections of the template, plus your reference list, for the Unit 9 assignment. Although your instructor will only be reviewing the last five sections to score your paper for Unit 9, please retain the information you have already written in the first sections within the template so your instructor can refer back to this when reading your Unit 9 assignment. When the full template is completed, save it as a Word document with your name (for example, Smith Unit 9 assignment) and submit it to the courseroom assignment area by the deadline for the Unit 9 assignment.

 

 

 

 

Case Study Treatment Plan

Your Name

COUN6331

Mental Health Counseling Clinical Internship 1

 

Case Study Treatment Plan

 

Unit 5 assignment sections: The Assessment Process (4–5 pages plus references)

 

 

Section 1: Identifying Information

Describe the client in your own words. Include demographic data and relevant context (living situation, employment, current functioning, et cetera). Your description should be concise.

 

Section 2: Presenting Problem

Describe the key concerns that have brought the client to counseling at this time. Include a brief description of any relevant history (for example., previous incidents of concern, length of time issues have been going on, prior trauma, or other critical events related to the presenting problems).

 

Section 3: Previous Treatments

Summarize the client’s previous experience in therapy. Include hospitalizations as well as any community resources or other medical/mental health services the client has used. Include the degree to which previous treatments were successful; has the client had any experiences with previous treatments that may have a negative impact on the current counseling process?

 

Section 4: Strengths, Weaknesses, and Support Systems

· Describe the client’s areas of strength and resilience.

· Describe the client’s limitations, challenges, or areas in which the client lacks knowledge, awareness, or specific skills.

· List the support systems the client currently has access to, such as family, friends, community groups, et cetera, and the extent to which the client is currently able to utilize these supports.

· Describe the impact of a co-occurring substance use disorder on the client’s medical and psychological disorder.

· Identify the key factors that may impact this client’s successful progress in therapy, how and why these factors may have an impact on treatment success, and how you will take these factors into account as you develop your treatment plan.

 

 

 

Section 5: Assessment

Describe the process you will use to complete a clinical assessment of this client. If you intend to use specific instruments (such as self-report instruments, structured interviews, or psychological tests), state what they are and why you have selected them. Discuss any concerns you will need to address regarding the relevance and biases of assessment tools with multicultural populations. Also discuss the methods you will use to arrive at an accurate DSM diagnosis for this client.

 

Section 6: Diagnosis

Present a DSM-5 diagnosis for the client. Provide a description of your rationale for making this diagnosis (for example, what information did you consider?). Discuss other possible diagnoses that you ruled out (or will need to rule out once you have additional information).

 

References for Unit 5 Assignment

Support your decisions and ideas for the Unit 5 assignment with a minimum of two references to articles from current professional journals in the field of counseling. Use correct APA format.

 

 

 

 

 

 

 

 

 

 

Unit 9 assignment sections: Treatment Goals (4–6 pages plus references)

 

 

Section 1: Treatment Plan Literature Review

Review the current research and best practices presented in the professional literature that relate to types of clients and presenting issues that are similar to the case you have selected. What does the literature have to say about the most effective types of counseling approaches used with clients who share similar social-cultural backgrounds, history, current situations, and/or presenting problems? Be sure to address the impact of diversity when selecting approaches and interventions. Summarize your review of the literature so it provides clear support for your choice of counseling approach, goals, and interventions that you will be presenting in the sections below. Keep direct quotes to a minimum; you should paraphrase the information you’ve reviewed in your own words. Remember to use correct APA format for all citations.

 

Section 2: Goals and Interventions

List four goals that you will work on with this client during the first 3 months of counseling. Present these goals in concrete and specific terms. For each goal, list two specific interventions that you will use during counseling sessions to assist the client in making progress towards the goal. What will let you know if these interventions are effective (for example, what changes would you expect to see in the client during sessions; what changes between sessions might the client report; will you utilize any self-report measures or other assessment instruments to help measure change)? Be sure your interventions reflect the effective practices that you described in your treatment plan literature review; address how your approaches will also take the client’s sociocultural background into account and their appropriateness for addressing addiction and co-occurring disorders.

 

Section 3: Communication With Other Professionals

Who will you consult with as you develop your client’s treatment plan and begin to work with him or her in therapy (for this segment, assume that you have a written consent from the client to do so)? This might include other medical/mental health professionals currently working with the client, as well as previous therapists; it could also include experts in the field with whom you may want to consult about the client’s presenting issues. How will this information inform your work with the client?

 

Section 4: Medications

Discuss in the section any medications your client is currently taking. What impact do these medications have on the client (for example, side-effects, improvement in symptoms, interactions with other drugs, et cetera)? What information do you want to provide to the client about these medications and how might you need to continue addressing the issue of medication in your work with this client over time? Do you think psychopharmacological medications are advisable for this client? Would you consider referring this client to appropriate medical professionals for evaluation for psychopharmacological medications?

 

Section 5: Legal, Ethical, and Other Considerations

How will the ACA Ethical Standards apply to your work with this client? Describe any potential legal or ethical issues that may arise and how you will address them. Refer to the specific state laws or regulations or ethical standards in your discussion. Also list any other red flag issues that you have identified and the ways in which you address these issues with the client.

 

References for Unit 9 Assignment

Support your decisions and ideas for the Unit 9 assignment with a minimum of four references from current professional journals in the field of counseling. Use correct APA format.

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Family Genogram Project Instructions

Building Your Family Genogram

Part I (GenoPro Genogram Software)

A genogram (pronounced: jen-uh-gram) is “a pictorial representation of family relationships across several generations. It is a convenient organizing device to help you identify family patterns or develop hypotheses about family functioning” (GenoPro.com). The genogram resembles a family tree; however, it includes additional relationships among individuals. This instrument facilitates the practitioner and his client’s identification an understanding of patterns in family history. The genogram also does a better job than a pedigree chart in mapping out relationships and traits.

Even though there are a plethora of books and websites on the subject of genograms, it is worth noting that Monica McGoldrick and Randy Gerson are responsible for its initial development and popularity in clinical settings. The structure of a genogram is by and large determined by the imagination and creativity of its author. Some of the most common features on a genogram are information related to the number of families, children in a given family, and the birth order of the family members—including the number of births and deaths.

Index Person: In constructing the genogram, identify yourself as the “index person” and complete the genogram on your family.

Focus: The focus of this genogram will be on family strengths and resilience, family patterns, rules or ways of being, and the overall health of the family. Of course, you should also address any issues and concerns that may be discovered; however, do not make the genogram problem-focused, even though this is typically how it is used in counseling.

Construction: You will submit your genogram through the assignment manager via GenoPro, found by clicking the “assignments” button. This submission will come in as a GenoPro document. You will also need to attach your narrative on an MS Word document. Make sure to include the following items:

· Two preceding generations—that is, the genogram must include the index person, his/her parents, and his/her grandparents (three generations, in all). It would also be imperative that, in the event of the index person being involved in a marital or significant relationship, mention must be made of the significant other involved, including their immediate family such as their parents, siblings, and children. In the case where the index person is either a parent or a grand-parent, his/her children must be included in the genogram.

· Use the symbols as illustrated within the GenoPro software to indicate the nature of many of the relationships among family members. Be sure to indicate yourself as the index person by drawing a double circle or double square around yourself. Do not forget to include the current date on your genogram.

· Use the relationship lines to indicate significant relationships within the family system. Do not use the “normal” line provided by GenoPro. This only crowds the graphic and makes it difficult to read.

· Include a legend at the bottom right corner of the genogram document. The legend must only include items represented on the genogram.

· In order to make it easy to understand, ensure that there are notes on the genogram graphic regarding people, family events, etc., in their appropriate places (for example, on the side of a relevant person or generation). Even though this is not required for the successful completion of the assignment, it may be helpful to interview other family members about important areas of their family history. It would also be a good idea to include labels (a word or two will do) about each family member’s strengths—especially those that are either known by the index person or have a relevant connection to them.

· GenoPro gives you the freedom you need to manipulate your genogram to allow enhanced viewing on a computer system. You can shorten or lengthen lines, move entire family units around to maximize space, and more. Your objective is to work with the graph to create a genogram that is easy to view and can be understood at a glance.

Analysis: Once you have completed your genogram, you will need to interpret your family map. Analyze the genogram and who you are in the context of the family based on race/ethnicity, culture, class, gender, spiritual tradition, family life cycle, etc.

Part II (Microsoft Word document)

Written Narrative: After analyzing your genogram graphic following the guidelines above, state your interpretation of yourself in clear terms. Do this by writing a paper that describes the contributions that religion, gender, race, culture, etc., and your own unique family history have made to your personal identity. Do not forget to demonstrate your understanding of key concepts learned in this course. Apart from the quality of your written work, you will also be graded on your ability to widely, deeply, and accurately analyze and utilize theoretical concepts in describing your family’s interactional process.

Rest assured that this paper will be kept confidential. Be reminded that you are solely responsible for any information you choose to disclose in this project. Also note that you are under no obligation to reveal any information that you choose not to reveal.

The following outline must be used for your paper, using current APA format:

I. Briefly introduce your family. Discuss the sociopolitical, cultural, economic, spiritual, etc. issues in your family. Do not spend a lot of time describing demographic details that can be observed on the genogram.

· You can use first person in this narrative.

· You will not need an abstract; however, you will need a cover page. A reference page must be provided if you use citations.

II. Using the data gathered and the analyses you have made based upon your genogram and other resources, address the following questions:

A. What do you understand about yourself within the context of this multigenerational family?

B. How do the cultural, historical, and personal characteristic aspects of the information impact your understanding of the self?

C. If at all, what are the family lifecycle-related issues in the past or present that have influenced your family and/or interface with question D?

D. What intergenerational dynamics, patterns and/or themes that you have identified influence you (or others) in your current family? Jump to the last section of the present document, “Interpreting Genograms” and then draw a conclusion about your analysis.

E. What areas do you need to work on in order to become a better spouse, parent, counselor, and godly person?

Conclude this part of the assignment with personal reflections on the development of this project. Were there any issues that came to light? What did you learn?

This assignment is due by 11:59 p.m. (ET) on Sunday of Module/Week 6.

How to Build a Genogram

(Many of the symbols and definitions are adopted from GenoPro.com)

Although there is general agreement on the basic genogram structure and symbols, there are some variations from one author to another and some in the GenoPro software program on how to depict certain family situations, such as cutoffs, adoptions etc. (Bowen, 1980; Kramer, 1985; McGoldrick, Gerson, & Shellenberger, 1999). The following are the common to genogram construction. The male is represented by a square and the female by a circle. You may also use a diamond for a pet and the question mark for unknown gender.

Deaths are typically represented by putting an “X” through the symbol. (If you ever do a genogram with a client, ask the client how he/she would like to represent the death since putting an “X” through the symbol without their permission could be traumatizing.)

For one to be called a parent, they would have to have at least 1 of the 3 types of children: biological/natural, foster, or adopted. On the genogram, a triangle is the standard diagrammatic representation of a pregnancy, a miscarriage, or an abortion. While an abortion is represented with a horizontal line on top of the triangle, a diagonal cross in the same position indicates the death of a baby through a miscarriage. As for a still birth, it is displayed the same as its gender, though the gender symbol is two times smaller, while the diagonal cross remains the same size.

The reason is obvious as to why the children on a genogram are placed below the family line, starting from the oldest to the youngest, and from the left hand to right. Take note that these are vitally important rules to remember down the road, as the family system becomes labyrinthine. The GenoPro software, however, does allow variations in this area.

Birth, marriage, divorce, and death dates may be indicated by the initial and year (i.e., b. 89). The ages of the individuals are put in as numbers in the markers. Alcoholism (or other relevant issues) is frequently indicated by filling in the bottom part of the individual’s marker.

Genogram symbols for child links and special birth

The child links are joined together for multiple births, such as twins, triplets, etc. Identical twins (or triplets, etc.) are displayed with a horizontal line between the siblings. In the example below, the mother had two fraternal twin brothers, two identical twin sisters and triplets, one of which died at birth.

Child links are joined for multiple births such as twins and triplets

There are 4 general rules to keep in mind:

1. The female is always at the right of the family and the male is always at the left.

2. Where there is ambiguity, it is recommended to assume a male-female relationship instead of a same sex relationship.

3. It is assumed that a spouse must always be closer to his/her first partner than to subsequent partners (if any).

4. The youngest child is always at the right of the family and the oldest child is always at the left.

Family Relationships

The next genogram component is the family relationship to describe the union of 2 individuals, typically through marriage. Other family relationships are divorce, separation, cohabitation, engagement, etc. Each completed genogram needs a legend to describe the various symbols. This legend should include the emotional relationship and family relationship lines indicated on your genogram.

GenoPro uses this type of indicator for emotional and relationship lines. When there may be a discrepancy between this document and GenoPro, use GenoPro.

Legend of family relationships

Each type of family relationship is described in the table below:

	This family relationship represents a married couple. There is no special symbol to distinguish a civil marriage and/or a religious marriage.
	This is the generic symbol to describe a married couple no longer living together. A separation is displayed by a single oblique bar.
	The married couple is separated and started legal procedure for an eventual divorce. If you know a couple is separated but you are not sure about the legal procedure, it is recommended to use the separation in fact symbol.
	The married couple has divorced. No comments.
	The marriage was annulled. This is a rare case, but it must be included.
	One of the spouses died while married. Use this symbol only when the surviving spouse re-married. Otherwise, everyone in your ancestry will be widowed.
	The two individuals are in the process of getting married.
	Same as above except the individuals are living together before getting married.
	There is a legal paper trail about the cohabitation. The two individuals have written contract about the cohabitation status, involving benefits such as parental responsibility, common ownership, and inheritance.
	The two individuals no longer live together and are in the process of terminating their cohabitation contract.
	The cohabitation contract has been terminated.
	One of the partners is deceased. This situation is similar to widowed; the difference is the two individuals had a cohabitation contract rather than a marriage contract. Again, use this symbol if the surviving partner has had other partners, or every legal cohabitation will end by either a separation or a death.
	Although there is no legal definition of cohabitation, it generally means to live together as a couple without being married. Use this relationship to define the generic common law spouse. There is no such thing as illegal cohabitation.
	The generic symbol of two individuals no longer living together.
	The two individuals lived together until one of the partner died. Same as legal cohabitation and decease, but no cohabitation agreement had been written.
	A relationship where two individuals live together, but there is no affection towards another.

The action of seeing someone or dating. Be aware the terms boyfriend and girlfriend are often used for cohabitation, but not exclusively.

	The two individuals are no longer dating. This could be called ex-boyfriend or ex-girlfriend. Be aware, the term ex-boyfriend and ex-girlfriend may also be used for cohabitation and separation, but not exclusively.
	This is the polite term for having a mistress or a one night stand. Select this relation if children are the product of such a relationship.
	One individual is abusing or has abused the other individual, including date-rape, drug-rape, and wife-rape. This type of relationship is mostly used in therapy or when a child was the product of such relationship.
	A relationship not specified in the list above or is unknown to the creator of the genogram. Use this symbol to highlight an unusual type of relationship.
	A blank value is used to describe an unspecified relationship when creating a new family. This is the symbol used to indicate that the user has not yet specified the type of relationship.

A family always has two parents. Use the appropriate family relationship symbol to describe the status of the family. For instance, a single parent family (single mother or single father) is still a family of two individuals, but one individual left. If a new partner or spouse is replacing one parent, create a new family to describe the relationship of the new couple.

Emotional Relationships

Although the family relationship may describe the emotional bond between the two parents, the emotional relationship component can be used to describe the emotional bond between any two individuals in the genealogy tree.

Legend of emotional relationships

Each type of emotional relationship is described in the table below. The legend symbols have been made bigger so you can see them better.

	Define a cutoff relationship where the two individuals have no contact at all; characterized by extreme disengagement and emotional intensity.
	Define an apathetic relationship where one or both of the individuals is indifferent to the other.
	Define a distant relationship between two individuals. Communication is very limited, usually because of lifestyle differences.
	Define a plain/normal relationship. This is not very useful, except to highlight a normal relationship among massively dysfunctional relationships. Therefore do not use this unless there is a situation as stated above. This emotional relationship may resemble the identical twins; however if you take a closer look, the line is colored in gray. When twins are present, the child links are connected together, producing an inverted V. If a plain/normal relationship has to be displayed, then create a non-linear line between the two twins.
	Define a close relationship (friendship) between two individuals. The two individuals are friends and share secrets.
	Define an intimate relationship, where communication is open, uncensored, and without secrets.
	Define a fused relationship between two individuals. Each submerges “self” in the other, and the partners become fused with little space for their own identities. There are great books about this topic.
	Define a hostile relationship between two individuals. The two individuals have conflicts and argue on major issues.
	Define a distant-hostile relationship between two individuals. The two individuals rarely see each other, but when they are together, they argue and are hostile towards another.
	Define a close-hostile relationship between two individuals. These people have frequent contact but argue and keep secrets from one another.
	Define a fused-hostile relationship between two individuals. These individuals are always together yet unable to live without arguing.
	Define a violent relationship between two individuals. The two individuals have conflicts which result in extreme actions such as physical force or excessive power.
	The two individuals rarely see each other, but when they are together, they argue and exhibit violent behavior.
	The two individuals have frequent contact, yet argue and exhibit violent behavior when together.
	A violent behavior to avoid a break in the relationship when intimacy/fusion is difficult or impossible to maintain. Fusion compromises the feelings, identities and self-direction of each, thus creating instability.
	One individual is abusing another individual. Use this relationship if you don’t know the exact type of abuse.
	One individual is physically abusing another individual. Any non-accidental injury to an individual, typically to a child or a woman. This includes hitting, kicking, slapping, shaking, burning, pinching, hair pulling, biting, choking, throwing, shoving, whipping, or paddling.
	One individual is emotionally abusing another individual. Any attitude or behavior which interferes with mental health or social development is emotional abuse. This includes yelling, screaming, name-calling, shaming, negative comparisons to others, telling them they are “bad, no good, worthless” or “a mistake”.
	One individual is sexually abusing another individual. Sexual abuse is any sexual act between an adult and child, or a forced sexual action between two adults. This includes fondling, penetration, intercourse, exploitation, pornography, exhibitionism, child prostitution, group sex, oral sex, or forced observation of sexual acts.
	Failure to provide for a child’s physical needs. This includes lack of supervision, inappropriate housing or shelter, inadequate provision of food, inappropriate clothing for season or weather, abandonment, denial of medical care, and inadequate hygiene.
	One individual is focused unhealthily (obsessed) on another individual.
	The two individuals never met. Again, this relationship is not used often but can be handy to explicitly confirm the two individuals never met. It is up to the creator of the genogram to give details about the relationship, such as “never met physically” but “met online”.
	An emotional relationship not defined in the list. Use a comment to elaborate on the details of the relationship

Creating Genograms

The following are questions to consider in creating a genogram. Review your personal history and the people, existing support systems, or events that may have influenced you.

1. Who lives in the household? Where do other family members live?

2. How is each person related?

3. How do other family members view you?

4. What are changes that have occurred in the family?

5. Has anyone else lived with your family? When? Where are they now?

6. Are there any family members who have had a medical or mental illness of any kind? Who are they and how are they related to you? When did the problem(s) begin? What kind of treatment was helpful for them or available to them?

7. Are there any family members who are very close? Friends who are close? Who are they?

8. Which members help out when you need them?

9. How do you get along with each member in your home? In your family?

10. Whom do you see as the strong one? The weak one? The sick one? The bad one? The mad one? The one with all the problems? The dominant one? The submissive one? The successful one? The failure? The warm one, cold one, caring one, distant one, or the selfish one?

11. Has anyone in your family had serious medical problems? Who and what did they have?

12. What roles have you played in your family?

13. How did the family react when a particular family member was born? When a particular family member died?

14. Are there any family members who do not speak to each other or who have ever had a period of not speaking? Are there any who were/are in serious conflict?

15. Are there any family members who are extremely close? Who helps out when needed? In whom do family members confide?

16. What sort of issues occurred between the couples in your family?

17. How does each parent get along with each child? Have any family members had particular problems dealing with their children?

18. Any job changes? Unemployment? How do you like your job? What is the economic situation?

Interpreting Genograms

There are many ways to interpret a genogram. As a rule of thumb, the data must be analyzed for the following:

1. Multi-Generational Issues: Repetitive symptom, relationship, or functioning patterns can be seen across the family and over generations. Thus, you ought to examine the genogram for repeated triangles, coalitions, cut-offs, patterns of conflict, over-and under-functioning, etc.

2. Dates: Dates provide information that helps put events in perspective. For example, coincidence of dates (e.g., death of one family member or anniversary of death occurring at the same time as symptom onset in another, or the age at symptom onset coinciding with the age of problem development of another family member. Dates throw light on the impact of sequential or simultaneous happenings whose relatedness may be otherwise hard to ascertain. For example, if you find out that an individual or family was dealing with several mishaps within a given year, you can see the effect these stresses would have on family members, such as a young baby or an older child leaving home.

3. Change and Life Cycle Transitions: Changes in functioning and relationships that correspond with critical family life events. Of particular interest are untimely life cycle transitions (e.g., births, marriages, or deaths) that occur “off-schedule.”

4. Traumas: Traumas can have a dramatic impact on people. Experiencing such events as abuse; war; natural disasters; etc., their timing, and how people reacted are critical to examine.

5. Gender: Gender beliefs and values do have an influential role in families. They often create complications within the context of cross-cultural marriages, especially when involving members of different gender beliefs. A common example of such a case is if a family has sent clear messages that men are strong and do not show emotions (especially hurtful ones), you may come to understand why a given younger-generation married couple would be struggling to communicate.

6. Secrets: Secrets in a family not only take energy away from a family, but may reveal important information about boundaries and communication patterns in the family system.

7. Losses: The issue of losses is a fundamental factor in genograms. Some of the points to note under this category are: the event of sudden and critical illness, economic hardships, sudden death, disabilities, unanticipated loss or shortage of income, miscarriages, divorces, etc. Even though the impact of such losses varies from person to person, the question is: “To what extent was this event perceived as a loss?” Not all these events are perceived as losses, and the depth of loss also does vary greatly.

Much of the information and materials in this document were taken from the GenoPro website such as the rules, symbols, family relations, emotional relationship pages. Permission was given to do so by the developer of GenoPro to the developer of this document.

GenoPro Software. www.genopro.com [permission to use symbols and other materials from

GenoPro has been granted to the creator of the document]

McGoldrick, M., Gerson, R., & Petry, S. (2007). Genograms: Assessment and intervention

(3rd ed.). New York: W.W. Norton and Company