Category: First Sessions

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Genograms

Honoring Your Context

The genogram is a kind of family tree that not only provides important names and dates, but also denotes patterns of relationship, mental health, and more. For certain personalities, it’s a very appealing way to begin the psychotherapy process. At minimum, a genogram represents three generations of one family. Some clients, though, can provide information that goes even farther back in time, which is ideal. More chronological depth means an opportunity to recognize more patterns.

When building a client’s genogram, I always start with when they were born. I represent them on the page with their name and a shape to designate their gender. Squares are for males, circles are for females, and a combination of one inside the other is for transgender individuals. I outline this shape again to denote that they are the index person around whom the genogram will grow. (Note in the hypothetical example above that Greg is this person.)

The next step is to add siblings, assuming there are any. If a sibling is older, they are placed to the left of the index person; if younger, to the right. This structure changes to accommodate multiple marriages. (See how Greg’s father remarried and had Greg’s younger half-sister with his second wife, Becky.)

In many cases, people need an entire session to start exploring the relational dynamics that existed and might still exist amongst them and their siblings. We typically take for granted that our parents have the most significant effect on our development. Genograms can help underscore the impact that siblings have, as well. 

Birth Order

In exploring sibling relationships, I like to provide clients with some psychoeducation on birth order. There are well-tested theories that make strong connections between personality and whether someone is a first-born, middle-born, or last-born child.

First-borns, for instance, tend to be perfectionists, leaders, over-achievers. They are conscientious and reliable, often utilize black-and-white thinking, and love to read. Unlike later-borns, these children only have adults to emulate and are therefore resemble “little adults” themselves. They’ve got some big shoes to fill.

Middle-born children take the opposite approach of their older sibling; they do their own thing. These individuals are often the ones who defuse conflict amongst other family members. They are very loyal and place a deep value on friendship, but at the same time they can be secretive. Middle-borns are typically not comfortable with being the center of attention because they never got a lot of practice in that role. 

Last-borns, on the other hand, love to have all eyes on them; they tend to be the funny, fun-loving sibling with good people skills. But in some cases, to some degree they’ve also endured bullying at the hands of their older siblings. Perhaps they received the message that they were stupid or inferior, or that their opinion didn’t matter enough. This can be a hard message to shake. 

Exceptions

Of course, not everyone fits the mold suggested by their birth order. But usually the reason behind a given discrepancy is relatively predictable. For example, gender can make a big difference. If a last-born individual presents more like a first-born, it might be that he is a first-born son with one older sister. One must also consider the physical and mental health of their family members. If a first-born daughter, for instance, has a major disability, her younger sister will probably display more first-born traits. Another exception occurs when more than five years separates the births of two children. If you were, say, seven when your younger sibling was born, that sibling will likely have some first-born characteristics. 

The birth order of one’s parents also plays a part. A middle-born mother is more likely to identify — and therefore favor — her own middle-born daughter than she is likely to identify with her first or last-born children. If both parents are first-borns, they will probably raise three children who all have a noteworthy amount of first-born traits, regardless of their actual birth order.

Talking about all of these nuances and how they apply to a client’s unique sibling constellation can often deepen understanding of and compassion for family members and help illuminate the hidden, pre-programmed motivations behind everyone’s behavior.

Relational Dynamics

Genograms use different kinds of lines to denote different kinds of relationships. For instance, if a client was very close with her older sister, I draw two solid lines connecting their respective shapes on the graphic. If she felt emotionally distant from her younger brother, I draw a dotted line to connect them. Jagged lines represent abusive dynamics between a pair of family members. Two lines with a bracketed gap in the middle denotes that a cut-off happened, or that communication completely stopped for a significant amount of time.

I am never surprised when a client reports a cut-off between two people in one generation of a family and later mentions another cut-off between two people in the previous generation. Such patterns are yet more proof that ways of dealing with pain and conflict tend to be passed down through the years. Mental illness (indicated by shading in one vertical half of a given person’s circle or square) and substance abuse issues (indicated by shading in the lower horizontal half) also tend to reoccur from one generation to the next.

Triangles on the Genogram

Triangles are another element of relationship in a family that genograms can include. One tenet of family systems theory is that a dyad, or a pair of people, is unstable. So when any sort of conflict arises, the dyad will enlist a third person for “support.” The nature of this support varies greatly from family to family.

A common scenario involves the two parents arguing and one of the children stepping in to defend mom or dad. Or a child might develop some sort of issue, like an eating disorder, and become the focus of one parent. (I denote this focus on the genogram by drawing a solid line between the two family members, with an arrow pointing to the child in question.) Meanwhile the other parent feels neglected by his spouse and might then seek emotional support from another child. In this way, an additional triangle forms.

The Drama Triangle

Another typical arrangement is the Drama Triangle. This occurs when one person takes on the role of bully, the other of victim, and the third of hero. Sometimes these triangles can get especially messy. The hero, upon swooping in to save the day, is then cast as the bully, while the original victim becomes the hero and the original bully becomes the victim!

Where Drama Triangles are concerned, a good step toward healthy change is for the person in the original hero role to resist coming to the victim’s rescue in the first place. The victim will then have no choice but to step into his own efficacy. I denote such dynamics on a client’s genogram by shading in a triangular space that connects three family members. Sometimes these shapes overlap, with one family member playing a role in two or more different triangles.

“If it’s heavy, put it down.” -Clem Snide

One other aspect of family systems that genograms help illuminate is how maladaptive beliefs, or “burdens,” are handed down. The genetic foundation of mental illnesses like major depression, schizophrenia, and bipolar disorder has received much attention in the world of clinical research. However, there are subtler cognitive behaviors that we all inherit from parents, grandparents, great-grandparents, and so on. The creator of internal family systems therapy, Richard Schwartz, uses the term “burdens” to characterize these unhelpful thought patterns.

Body Image

Body image issues comprise a good example of such burdens. Children of mothers who consistently convey dissatisfaction with their bodies will often subconsciously assume that they should feel the same way about their own bodies. Deep down in their basic nature, they might actually like their bodies. But they’ve inherited the burden of a poor body image! The negative self-talk that colors their internal world isn’t actually their own but their mother’s, and perhaps their grandmother’s.

Guilt

Do you find yourself feeling guilty on a regular basis? Think about your family context for a minute and see if you recognize any other relatives with a similar issue. Perhaps your grandmother was frequently guilt-ridden, causing her son (your father) to resist ever feeling guilty because even a little bit of such intense guilt was too much to bear. Later, upon having children of his own, he inadvertently projects his disowned guilt onto them, and the cycle continues.

Without a mindful awareness of how guilt is an inherited burden that spreads a false message, you could never take steps toward changing that painful pattern. Only when something moves into consciousness can we deal with it effectively. Genograms can help us see harmful patterns in stark relief, opening the floor for a conversation about setting our burdens down.   

“Taken out of context I must seem so strange.” -Ani Difranco

The various ways to use genograms in the therapy room are too numerous for the confines of this blog post. But the broadest and most important function they serve is to help clients literally see that they are part of a much bigger system than they might have realized. John Donne said, “No man is an island.” Applied to family systems, this statement suggests that everyone is connected to, affected by, and dependent on everyone else.

The nature of our parents’ upbringing has an undeniably huge impact on our own upbringing, which in turn affects how we raise our children. Even if every parental decision is a rebellion against how our parents did things, it is still the result of how our parents did things! Humans are contextual creatures. Therefore, to understand ourselves in a way that promotes healing, we must understand our unique context.

Resources

Galindo, I.; Boomer, E.; and Reagan, D. (2006). A family genogram workbook. Kearney, NE: Morris Publishing.

Leman, K. (2009). The birth order book. New York, NY: MJF Books.

McGoldrick, M.; Gerson, R.; and Petry, S. (2008). Genograms (3rd ed.). New York, NY: Norton Publishing.

Schwartz, Richard (1995). Internal family systems therapy. New York, NY: Guilford Press.

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Your Life Story

A life story in diaries.

Poet Richard Hugo once said that “a creative writing class may be one of the last places you can go where your life still matters.” The same could be said of the therapy room. No psychotherapeutic process is complete until you’ve told your life story in some form or fashion. 

Most of us aren’t used to our lives really mattering. In new social situations, we typically exchange the same small-talk questions about work, school, and extra-curricular interests. On social media sites, we share pictures, opinions, and anecdotes that are relatively superficial and that, more often than not, will hopefully give others the impression that we are smart, happy, and successful. And we probably are those things. But we’re also so much more.

In many ways, we are the living, breathing sum of our past experiences. Therefore, when new clients aren’t sure how to begin their healing process in the context of our sessions together, I often start by gathering a life history. First memories can provide great insight into a person’s past and how it persists in the present, but sometimes these are nebulous, their ultimate meaning evasive and mysterious. Concrete facts, on the other hand — the who, what, when, where, and why of various phases in one’s development —  can be invaluable when it comes to understanding someone in their unique context.

Six-word Memoirs

One especially fun and creative way to think about your life story is the six-word memoir. Larry Smith of SMITH Magazine came up with this approach to autobiography, but it originated with Ernest Hemingway. When challenged to write a piece of fiction only six words long, Hemingway’s beautiful mind conjured the following: “For sale: baby shoes, never worn.” In these eight syllables exists an entire tragic story that can take on a potentially endless number of lives, because the reader must fill in the gaps, and every reader will approach this task differently.

Can you encapsulate your life in just six words? Check out lots of great examples here, where you’ll find the following and much more:

“I kept loving. She stopped calling.”

“My responsibilities run faster than me.”

“Sixty-two and I still crave validation.”

“Offered myself too quickly, too thin.”

“Puppy’s needle teeth puncture my heart.”

As evidenced by these examples, the style and scope of six-word memoirs vary greatly from one person to the next. What you write — and the questions your therapist asks when attempting to fill in the gaps — could be just as unexpected.

Elaborating on the Life Story

A friend of mine recently came up with this micro-memoir for herself: “Listened a lot, talked a little.” If she were my client instead of my friend, these six words could guide the way for at least one hypothetical therapy session, as they inspire a lot of questions. For instance, why hasn’t she talked much? Also, where did she learn to listen like that? What were conversations like in her family of origin? Was there room enough for her to speak, and when she did speak, did people really hear her? Has she struggled with intense shyness all her life, or does she simply not have much to say? Can she imagine a scenario in which she would have a lot to say? If so, how does she feel about the version of herself in said scenario? Does she believe that what she says will matter to others? 

As you can see, there are many rich directions to explore. And chances are that a client will only address a fraction of the above questions, as one answer could potentially uncover another, totally unexpected realm of discovery, leading to deeper questions and more provocative answers. That’s where therapy gets good: when you find yourself talking about something you never guessed would come up, but whose impact on your current life is suddenly undeniable.

Formative Experiences

The six-word memoir is ideal for people with a natural inclination to play with words and who might already have explored the main themes of their lives, either in previous therapy or on their own. When, however, this approach doesn’t interest a client, I will simply ask a few basic questions about their formative experiences and relationships.

What do you know about the conditions of your birth? What was happening in your family around that time? If you have siblings, where in the birth order are you? Can you recall the births of your younger siblings? Are your parents still married, or were they ever? Have any of your loved ones died? Did you move around as a kid, or did you grow up in the same house your whole life? Did you go to college? What kinds of jobs have you worked? What kinds of romantic partners have you had? Have you ever been hospitalized for any reason? Have you ever been arrested? What’s the farthest you’ve ever traveled?

At a glance, these questions are all very basic and not terribly probing. If clients are only comfortable with providing bare bones-type answers in the beginning, that’s fine; I’ll have a lot of valuable information to draw on in future sessions. However, as is the case with the memoir-inspired inquiries, a single response — its content, but also its delivery via tone of voice, body language, and facial expression — can often open doors that people never knew existed. It’s like they say in creative writing classes: “No surprise for the writer, no surprise for the reader.” In composing your own life story, be it in a therapeutic conversation or on the page, you might be stunned by how much it really does matter.

Resources

Michalko, M. (2014, April 10). Describe your life in six words. Creative Thinking.

Tartakovsky, M. (2011, January 6). The story of your life in six words. Psych Central, World of Psychology.

Shippey, G. (2011, November 28). A client’s history. Counselling Resource.

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Your First Memory

Before exploring your first memory, make sure you’ve read the disclaimer.

Let’s Start at the Very Beginning

When clients aren’t sure how to begin the psychotherapy process, I will sometimes ask them about their first memory. What they share often provides me with astonishing (not to mention time-efficient) insights into their most formative experiences. The brain holds onto the information that it needs. This data informs how we make our way through the world and how we see ourselves in relation to others.

While many people have what Freud coined “childhood amnesia,” or the inability to recall our earliest experiences, others can recount vivid scenes from when they were three years old (but anything younger than that is quite rare). The degree to which people can access early memories depends on a variety of factors. For some, trauma might be a main cause of amnesia; painful experiences are repressed or relegated to the unconscious realm. Others might have had parents who didn’t ask them a lot of elaborative (open-ended) questions about their day in order to help their brain remember. Studies have also shown that the durability of early memories can be culture-dependent.

Find Your First Memory

Regardless of how far back one’s memories reach, everybody can access their first memory, whether they were six or sixteen at the time of its encoding. In other words, however far back you can remember: that’s your first memory. Some people need only a few seconds to pinpoint theirs. If you, on the other hand, need more guidance, first ask yourself if you can remember anything about elementary school. Use this as a starting point and either move forward or backward in time until you land on something that feels like your earliest recollection. Make sure this memory is truly your own and not the result of being told the same story repeatedly or seeing the same family photos.

Deciphering between authentic memories and those that are more externally constructed can be tricky, but trust your gut on this one. People can usually sense on an intuitive level which recollections are their brain’s own creation. Furthermore, less authentic memories are often characterized by people seeing themselves from the outside, as opposed to seeing a scene from their own perspective. Another aspect of false memories is that they lack any element of emotion.

Take a Look Around

Once you’ve found your first memory (or something that feels as close as you’re going to get), let yourself explore. However, if such exploration feels dangerous because your memory is traumatic, please pause here. Consider seeking the assistance of a professional counselor. You don’t have to do this kind of work alone, and in some cases it’s best that you don’t. 

If continuing this journey solo feels safe, it might help to close your eyes so you can really hone in on the details. Are you alone in this memory, or are other people involved? Are you indoors or outside? What sensory elements are at play? What is the emotional tone of your memory? How were you feeling at the time of the experience’s unfolding, and how do you feel now, looking back on it?

You might consider writing your first memory down or drawing the scene on paper and seeing what other nuances become clear. You might also play with perspective. For instance, what would this memory look like in the eyes of an objective observer? If your memory involves your younger self experiencing painful emotions, you might rewrite history and bring a nurturer into the scene who says or does something that would have made all the difference.

Make Some Connections

Give yourself ample time to explore your first memory in whatever way suits you. Then ask yourself this question: What does this recollection say about me? In other words, how does it reflect what I believe about myself and others? How does it inform my view of the world as an essentially safe or unsafe place? Are the key emotions in the dream still playing a significant role in my life? Perhaps you don’t see how any of it plays much of a role at all. If this is the case, consider sharing your memory with a trusted friend or family member and ask them what they think. Their perspective might surprise you!

Anna’s Memory 

This week I asked a couple of friends to share their first memories with me. One of them, Anna, recalled being sick and resisting the medicine her mother kept offering. Finally her mother broke a capsule in two and sprinkled its contents on my friend’s ice cream. Anna felt betrayed (her ice cream was ruined!) and became very upset. So in this memory, we have the themes of illness (something Anna dealt with a lot as a child and would deserve close, careful attention in therapy), authority, resistance, and betrayal. Perhaps this experience was the first of many in which Anna refused to accept what would make her feel better, what was good for her. There’s a lot to work with there.

Bryan’s Memory

Another friend, Bryan, described his parents fighting in the kitchen and sending him to his bedroom. This forced seclusion and the continuation of his parents’ screaming exacerbated Bryan’s already intense anger. For some reason there was a bowl of tomatoes in his room (it was a gardening household), and he threw every last one of them at his bedroom door. The smashing sound they made upon contact surprised him, as did the color contrast of the tomato guts against the white paint. He felt satisfied and frightened at the same time. This experience definitely reflects Bryan’s current relationship with anger and a pattern of feeling shut out of intense relational dynamics, powerless to effect any real change.

Anna and Bryan’s memories both involve parents, but not every first memory will. Some, like mine, don’t involve anyone else at all (except a fuzzy caterpillar). But studies show that the majority of first memories do involve family life, and they are often quite colorful and vivid. Whatever yours looks like, exploring it and other early recollections is a worthy endeavor. Chances are you’ll see yourself in a bigger context, uncover some hidden patterns, reconnect with your own story, and deepen your self-compassion.

Please leave any questions or comments below.

Resources

Batcho, K. (2015). What your oldest memories reveal about you. Psychology Today.

Nelson, B. (1982, December 7). Why are earliest memories so fragmentary and elusive? The New York Times, Science.

Shellenbarger, S. (2014, April 7). The power of the earliest memories. The Wall Street Journal, Work & Family.

Stern, V. (2014). What’s your first memory? Scientific American Mind, Cognition.

Winerman, L. (2005). The culture of memory. American Psychological Association, 36(8), 56.

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Getting Started

The First Sessions

Initial psychotherapy meetings tend to be exciting and deeply informative, often rich with emotion and discovery. My approach to the first therapy sessions varies from client to client. If the client is comfortable with leading, I let him or her lead. Some people are dealing with an issue that feels very urgent, and they talk about that issue for the entire hour, crying a lot. Others don’t feel this urgency at all and seem content to give the background details that feel relevant to their current situation. But others aren’t really sure how to begin, and they need some scaffolding.

So these next few blog posts will be for those folks, the unmoored among us. With that population in mind, I will share some approaches that provide clients with structure and get the therapy ball rolling. In particular, I will discuss the importance of exploring a client’s first memory, gathering a personal history, and creating a genogram (a type of family tree). I don’t necessarily do all of these things in the initial sessions. Nor do I execute them in a particular order. But since it’s the beginning of the beginning, an exercise on first memories seems like a good place to start this series of posts.

Not to mention that memories in general are fascinating. I’m sure that yours are no exception. Find out for yourself here. But first make sure you’ve read the disclaimer.