Familiogram: what it is, parts and characteristics.

A summary of the functions and uses of the familiogram, and how its parts are used.

In family medicine as well as in systemic family psychotherapy and other health fields, it is necessary to know what kind of relationships and family dynamics the patient(s) who come for consultation have.

These relationships must be put in context and understood by knowing who are the members of the patient's family or the individual under study and, therefore, it is very important to know what their family tree is.

Familiograms are a tool widely used by professionals who care for families.They are an instrument that allows us to see what families are like with just a quick glance. Let's discover more in depth what they are and with what symbols they are made.

What is a familiogram?

The familiogram, also known as a genogram, is a tool widely used in family medicine, family therapy, and family therapy. a tool widely used in family medicine, family therapy, and any intervention and any field of intervention in which the family environment of a patient or individual needs to be studied. This tool is ideal for the family physician, since just by looking at it he/she can obtain information about all the members and relationships in the patient's family environment.

Familiograms can be defined as graphic representations of the development of a family over time, taking into account a minimum of three generations. These graphs are family trees that provide information not only on the members of the family visiting the consultation or being studied, but also provide data on those members of the family who cannot attend the medical consultation but who are important in the dynamics of the family nucleus to be intervened.

Among the data recorded in this type of tree are the more general demographic aspects such as age, sex, family typology and pathological antecedents, among others. In addition, they are also useful to know the life cycle by age, sex, family type and pathological history, they are also useful to know the life cycle the family is going through, life events experienced, family dynamics and affective relationships, data that are generally represented as a general rule in the family tree.These data are generally represented on the same sheet so that, with a simple review, the characteristics of the family can be understood.

How to make a familiogram

To elaborate a familiogram is really easy and it is not necessary that we dedicate ourselves to family medicine or systemic family psychotherapy to be able to make one. However, it is worth mentioning that its use is of special interest in the field of health, since it allows us to detect possible hidden emotional problems or significant psychosocial affections.It is possible to find dysfunctional relational patterns if the dynamics between several individuals are captured on paper.

The main data collected are:

• Family members
• Biological and legal couple relationships
• Subsystems within the family
• Cohabitant unit
• Demographic information
• Illnesses and problems
• Stressful life events
• Family resources
• Family relationships

We can distinguish two components within the familiograms. On the one hand we have the more structural part, which refers to the members that make up the family, their names, ages, gender and type of relationship (couple, children...). On the other hand, we have the functional part, which highlights the type of interpersonal dynamics, style of interaction between family members and possible problems they may have had.

Familiogram symbols

In order to make a familiogram correctly, it is necessary to know the appropriate symbols to use.

1. Sex, gender and main subject

We begin the familiogram by representing the members of the family. Male members are represented by squares, while females are represented as circles.

The person we are working on, our patient or main study subject, is identified with a double line or, alternatively, with an arrow that makes him stand out from the others.

To indicate that a member of the tree has died, an X is drawn inside its symbol and, if desired, the date of birth and death can be indicated on the left and right side of the upper part of the figure, respectively. The current age of living persons and the age at death of dead members is indicated by placing it inside the corresponding symbol.

There is the option to indicate whether a member is homosexual, bisexual or transgender. This should be indicated only if it is considered important to be taken into account during the intervention. Otherwise this information may be unnecessary.

Homosexual men and women are indicated by placing an inverted triangle inside, while bisexual people are indicated by drawing the same triangle but using a dashed line.

Transgender people are indicated by putting their gender in large and inside the gender they were assigned at birth. If it is a transgender woman (from male to female), a circle is drawn with a square inside, and if it is a transgender man, a square is drawn with a circle inside (from female to male).

2. Couple relationships

Couple relationships are represented using two vertical lines coming out from the partners and connecting horizontally, placing the man on the left side and the women on the right side in the case of heterosexual couples.

Marriages are represented with a solid line, separated couples are represented by putting a diagonal line on the solid line, divorces are indicated with a double diagonal line and premarital relationships are represented with a dashed line.

The year in which they were married may be indicated by putting the letter M followed by the date of the union. When there is little likelihood of confusing the century, the year of marriage is indicated using only the last two digits of the year. In the case of separation or divorce, one may also choose to indicate the date of those events.

To represent multiple marriages, the following type of scheme should be used, representing the marriages in order from left to right when only one of the spouses is remarried. In the case of both remarriages, the most recent union should be placed in the center.

3. Children

In case there are children, these will be represented by joining them with a vertical line to the line indicating the couple relationship. The children are always placed from oldest to youngest, from left to right.

In case there are twins, they will be represented by placing the line that comes out of the line of the couple relationship in the form of a diagonal, having the same origin. In case one of the children is adopted, the vertical line will be drawn dashed.

It is also possible to indicate whether the twins are bivitelline or univitelline.

Current pregnancies and miscarriages, both spontaneous and induced, are also represented in the familiogram. In the case of pregnancies a triangle is used, in the case of unwanted miscarriages a darkened circle is drawn and in the case of planned miscarriages an X is indicated.

If there has been a death at birth, this is indicated by a square or circle depending on the sex of the infant and an X inside it.

4. Cohabitation

To indicate that several persons live in the same household, these members of the family or household unit are grouped together by drawing a dashed line around all of them. The reason why dashed lines are used to indicate household units is that they are open systems.

5. Type of interpersonal relationship

The most subjective part of the familiogram is its functional part, since the relationships in the family are the most inferential aspect of this type of graphs, in addition to the fact that the family members themselves can offer different views and contradict each other. The functional familiogram involves trying to delineate the relationships between family members, and this is done from information obtained from reports of family members and direct observation.

To represent a relationship that is close, two lines will be used horizontally and, in case it is very close, three. If it is very close but, at the same time, conflictive, the same three lines and a fourth zigzag line are used to represent the ups and downs of the relationship. If the relationship is only conflictual, only the zigzag line is used.

If the relationship is distant, a dashed line is used, but with long dashes so that it is not confused with cohabitant relationships. If the relationship has broken up, in case it is not a couple relationship, it will be indicated by breaking the line by putting two lines vertically separated with a little space.

Close, close, close conflictive, close conflictive, broken relationship, conflictive relationship and distant relationship.

Finally, there are some symbols to indicate the type of relationship that the person has with agents outside the family nucleus. We can indicate them 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 elaboration of the familiogram:

Now that we know what symbols we should use to make a family tree and how to represent the relationships between its members, we should keep in mind the following reference points.

• Minimum three generations and indicate each generation with a Roman numeral on the left side.
• The paternal family of origin is placed on the upper left margin, and the maternal family on the upper right margin.
• The family of the main study subject(s) is placed in the center.
• The proper names of the family members are placed below their symbol.
• Professions, pathological antecedents and other relevant aspects of interest can be indicated on the left side of each family member's symbol.
• The family name is placed in the upper central part of the familiogram.
• The meaning of each symbol should be specified if necessary.
• The date of elaboration of the familiogram will be indicated in the lower right margin.
• The full name of the person who has made the family tree should be written down.