How to evaluate the family dynamics

• Carefully observe family members interacting.

• Invite the whole family to a counselling session (if possible).

• Visit the home: an impromptu home visit (with some pretext such as a concern about a blood test result) on the way home from work may be very revealing.

• Prepare a genogram (Fig. 2.2): family dynamics and behaviour can be understood by drawing a family map—genogram (a diagrammatic representation of family structure and relationships). 3 4

The genogram

The genogram is a very valuable pedigree chart that usually covers three generations of a family tree. 3 It is a simple and disciplined way of gathering data about an individual, couple or family, especially for inheritance patterns. The data has to be gathered with tact and care. Genograms are also a useful strategy for involving family members who may have been reluctant to be involved in discussions on family matters. 4 An example including the use of symbols is shown in Figure 2.2 .

suicido

good relationship

cn poor relationship

I I patient CD unaffected nale O unaffected female H affected male % affected female

#< propositus * {origiral case st jdy)

oi- rxj dead

spontaneaus abortion or stillbirth induced abo-tim carrier corsann'- neous TFirriage separated divorced

Fig. 2.2 Genogram: Illustration of family tree for an inherited disorder

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