PSA6669 - SECTION 4: GRAPHIC ASSESSMENTS
In addition to narrative representations of the information gathered in a psychosocial interview, there are also ways to represent important information in a more immediately accessible visual form. These approaches can present certain kinds of information – such as important relationships and interactions within families – more quickly concisely, and complexly than in a written narrative. These are called Graphic Assessments.
One such graphic approach is the genogram. A genogram is tool for making a graphic or visual representation of a family tree that details information on the structure of the family and the nature of the relationships among individuals. [McGoldrick M & Gerson R (1985) and Genograms in Family Assessment. New York: Norton] This type of assessment is based on the Family Systems Theory introduced by Murray Bowen. [Bowen MD (1978) Family Therapy in Clinical Practice. Northvale NJ: Jason Aronson Inc].
The guiding theory for use of a genogram is Family Systems Theory. This theory proposes that each member of a family has a role to play and rules to follow.
Within the boundaries of the system, patterns develop based on behaviors of the members. These patterns are predictable. Maintaining the same pattern of behaviors within the system leads to balance, which decreases overall tension. Changes in roles can work either to maintain the balance or to create disruption and dysfunction.
According to Bowen’s Family Systems Theory, there are 8 concepts that are predictive of possible areas of challenge that can be clearly identified using the genogram model of assessment. The first is the smallest stable relationship system called the Triangle where two participants operate in harmony while a third party operates in conflict with the other two.
The second area of possible challenge is the variability in the individuals’ ability to differentiate themselves from their dependence on others for acceptance or approval. The third area includes the four relationship patterns within the nuclear family—marital conflict, dysfunction of one spouse, impairment of one or more children and/or emotional distance.
The fourth area is concerned with the transmission of emotional problems from parent to child. The fifth area revolves around the differences in the levels of differentiation or enmeshment between parents and their children. The sixth area is the act of reducing or eliminating contact – called "cutoffs" - as a means of managing unresolved conflicts.
The seventh area is the impact of birth order or sibling position in development and behavior. The eighth area includes how the family's emotional life influences behavior on a societal level.
The family members and their relationships are represented in a pictorial fashion. Usually a minimum of three generations are represented. The act of studying patterns of behavior and how they relate to the multigenerational family often reveals options for alternative responses and problem solving. [McGoldrick M (2007) Genograms: Assessment and Interventions (3rd Ed.) New York: Norton].
Visually it is very similar to a genealogy chart - with extra features that indicate emotional bonds, and areas of strength and conflict, while providing insight into how emotions influence behavior and how family behavior patterns interact with the general society.
If you would like to view how to develop genograms for use in the psychosocial assessment process please refer to the following web based sites:
A pedigree chart is another graphic assessment tool. This is used in medical settings and is restricted to depicting relationships by blood to identify patterns in transmitting genetic conditions. Relationships by marriage or adoption are excluded because these members will not influence the transmission of an inherited condition.
An echomap or sociogram is another type of graphic representation of relationships. It is a depiction of the individual and family within the context of their social connections to groups, associations, organizations and other families and individuals.
The ecomap provides an ecological perspective of the nature of the relationship with the larger society. [http://www.headstartinfo.org] It is an overview of the complexity of the network of family, friends, and professionals that are engaged with the individual or family.
An echogram represents the same type of information for a specific individual. In addition to family members, it can include friends, mentors, activities and connections with neighbors, social networks, cultural influences, spiritual or religious affiliations. A version of the echogram is called a Life Map.
A Life Map is a pictorial representation of an individual’s journey through life up to the present. It can also serve as means of planning for the future. It can be focused on a specific aspect of your life or be a general representation. Life Maps can be useful in helping the individual focus on the important aspects of their life and develop a plan to reaching what goals are identified.
There are many possible applications for developing a life map. These include improving communication and planning skills, identifying life satisfaction goals, and/or defining a connection with a cultural or spiritual influence. For more information on developing a Life Map please refer to the following sites:
Graphing Your Life http://www.iveybusinessjournal.com/view_article.asp?intArticle_ID=593
There are benefits to using a visual format for developing a psychosocial assessment. For most people, the visual format is easy to understand. It reduces the risk of practitioner bias as the development of the chart requires significant input from the individual.
It is an opportunity to highlight areas of strengths as well as emphasizing the importance of viewing the assessment as a process. Complex information can be presented in a structured and consistent manner which identifies opportunities for improvement.
However, not everyone is comfortable with the visual format. Often when an individual comes into the process of psychosocial assessment, it is because of some negative or uncomfortable event or situation. The individual is aware that they are in a vulnerable position and may have some reservations about increasing their exposure risk.
As a practitioner, it is your responsibility to be sensitive to the individual’s preferences and to whether you or your organization can accommodate these preferences. It is equally important to have sufficient knowledge of how to use a graphic tool with sufficient expertise that it actually enhances the assessment and treatment process. Otherwise, it is a superfluous exercise that uses up the therapeutic time without providing any positive benefit.