Abstract

Mobile Genogram for Couples – GMC

The authors describe a technique for use in couple therapy. The Mobile Genogram for Couples (GMC) started as an idea of a tool in addition to the clinical experience acquired in the field of treating couples by Maurizio Coletti, one of the authors of this article. The GMC © is inspired by the classic genogram and aims at a deep understanding of how families of origin influence the dynamics of the relationship of the couple. The authors describe the tool (GMC ©) and give directions for its application, having first presented its bibliographic theoretical background and the clinical experience that inspired it. Consequently a practical example is given, explaining how to use the tool. One of the innovations introduced by GMC ©, which the authors define as “the fourth dimension”, is the possibility of being able to literally “put a hand” in the history of family relationships, by introducing a “practical” form in the narrative part which already exists in the classic genogram.

Key-Words: couple therapy, genogram, family relations, families of origin, procedure

 

Introduction

In treatment dealing with marital problems, we are confronted with the couple’s families of origin. Whether it is a separation or a divorce, an attempt to avoid the traumatic termination of a relationship, an effort to find a way out of a postponement, a state of tension, inconsistency, distancing or conflict, an investigation (and sometimes participation in reality) concerning the families of origin/FDO in the treatment process is inevitable.

The tri-generational (trigenerelazione) dimension for the investigation of schemes, where relational problems emerged, developed and stabilized within the couple, has its roots in the past as well as in both the theory and practice of systemic and family therapies.

Canevaro (1982), referring to this matter, states: “The theoretical basis is to understand the couple’s problems as coming from an intergenerational context consisting of the convergence of families of origin with their own relational style.”

This statement, through its simple and decisive clarity, is very important and opens the field for different interventions and protocols, all made to explore and use families of origin as a structural fundamental element either for the creation of the couple, for its development or even, finally, for its crisis.

On the other hand, family therapists’ interest in their patients’ families of origin in treatment is old and occurs early in the formulation of theories and techniques, which open up the idea of application of the family systems as a therapeutic framework for psychiatric, psychological, and relationship problems.

Below we will briefly mention some of the authors who have made a significant contribution to these approaches.

Murray Bowen was, perhaps, among the first to systematically address the inter-generational dimension of disorders and individual dysfunctions. According to Bowen, the passage called “self-differentiation from family” is extremely important for a functional growth and development for which he did not set a specific age, thus giving to this path a personalized dimension. The result of this process is what has been defined as the conquest of a “Mature and Conscious Ego” (Bowen, 1979).

Jim Framo, one of the pioneers of family therapy, has widely used families of origin as part of the treatment. In his view, families of origin could make a very positive contribution to treatment, as long as they are not transformed into the only direction in which all interventions converge. Framo widely used the intergenerational approach, even inviting families of origin directly during the family therapy session (Framo, 1996).

Ivan Boszormenyi-Nagy contributed in a prominent and key manner to the idea of a tri-generation transmission of relational models, as well as to the practice of investigating families of origin in the context of therapeutic work with families. According to the author, it is about “turning back to better departures“; that is, “take a step back, to make two ahead” (Boszormenyi-Nagy, 1988).

Maurizio Andolfi defines the “tri-generational family” as “a complex entity, full of contradictions and conflicts, which, however can become by an observer able to perceive the correlation between behaviours and experiences of the present and the unfulfilled needs of the past, elements for understanding its inner world”. The above writer pays great attention to the important contribution of family myths as fundamental concerning the relationships developed among family members. Finally, “The tri-generational approach is defined as a diagnostic tool that allows a broader meaning to psychopathological manifestations by referring to elements that go beyond the present relations to trace the roots of each one in their families of origin” Andolfi and Cigoli, 2003).

Returning to Alfredo Canevaro and his article on the problems of the couple, he says there are two typologies of family systems: cohesive and dispersive ,”according to their grouping, family systems have been described as cohesive-compact and diffusive, depending on whether there are centripetal or centrifugal forces inside them.

Reviewing the incomplete international literature on this subject, Kelsey-Smith and Beavers (1981) report that the concept of centripetal- centrifugal has been used by anthropologists such as Kroeber (1925), ethologists such as Wilson (1975) and by psychoanalysts like Erikson (1963), to describe a way of working without taking health or illness into account. Stierlin (1973) uses similar concepts when talking about teen release (distacco) from the family group, and Minuchin (1974) when talking about families “enmeshed” or “disengaged”. In general, all of these writers define the kind of relationships (stile relazionale) of the nuclear family without taking into account the family of origin “

The author continues: “My initial contribution to this issue (Canevaro, op.cit.) was to study the relationship between the two families of origin through the union of representatives, through the limitation of the alliance and that of studying the structural field, real or virtual, identified through the interaction between the system of the family of origin and the nuclear family system.

On this background, we can imagine three possible types of encounter between partners:

– Both originate from merged families

– Both originate from disengaged families

– One partner comes from a merged family, and the other from a disengaged family.

However, this is not the right place to delve into how and when each of the above scenarios can end up in a crisis and cause problems in relationships between partners. Nevertheless, we would like to remind you that none of the above possibilities is a problem per se. A marital crisis is the result of many factors and co-factors, some of which arise from the relationship itself, others from the individual path of each of the partners, still others from the context of the extended family system (children, families of origin). Finally, some can also be identified in various exceptional situations (illness, mourning, financial problems, work).

However, (and this is the focus of our own contribution which emerges from clinical work with couples, as well as from research on couples’ relationships), it is of crucial importance to ask ourselves how the full spectrum of knowledge of the tri-generation approach could be used in the therapeutic process.

That is, how to make useful the information we have collected so far, and how to proceed to collect this information.

It is already known that the treatment of couples’ problems can be accomplished through multiple approaches and with different tools. Schematically, (perhaps too schematically), we could point out that two are the intervening ways through a simplified formatting.

The first of these approaches is based on developing advice and recommendations  aimed at addressing ways which are considered dysfunctional or pathological; that is, to “replace” the dysfunctional ways with types of interaction that hopefully can be healthier, more effective, less dysfunctional. Furthermore, to introduce new methods which, as such, allow partners to experiment in situations that facilitate the progressive and automatic abandonment of attitudes and relational dimensions that seem to be at the basis of the discomfort and pain between the couple.

The second approach attempts address -or at least confront- the dynamics that have been identified as the source of discomfort and difficulty through offering a framework of meanings and restructuring which could trigger new perceptions, experiences and emotions to the partners. These experiences and emotions could fight those that seem to be in the root of their difficulties.

When working with couples, it can be said that whether a more prescriptive-based approach is used or a more “interpretive” or “redefining” one, these are not mutually excluded and can be used by the same therapists on the same couples relations either as therapy or as counseling.

Also, when looking for an indication for behavior differentiation, the families of origin are an important ground for analysis and research. The reconstruction of the experiences and feelings that each of the two companions carries from his or her own family of origin is so important precisely because it permits both the overcoming of the present tensions and the understanding of some distant ones.

There are many and various methods of working around families of origin during the treatment or counseling of the couple, regardless of whether it takes place in the public or in the private sector.

Similarly, there are several ways of working with families of origin in family therapy. Sometimes in a case of treatment for specific problems (eating disorders, substance abuse, psychoses, problems with teenagers and young adults) or others when the involvement of the family is considered by common consent to be appropriate and useful. This is especially true in the case of synthetic work carried out in the context of public services.

Returning now to working with couples, it is indisputable that partners in couple treatment transfer their personal experience – in a positive and negative way – into their own families of origin.

But how can we make couples to re-experience narratives, feelings, events, and processes in therapy?

Even in this case, we may have different models.

Starting from the free narrative of specific features or specific situations that each of the partners may have experienced, passing through the genogram drawn on a sheet of paper of different dimensions (normally, a loose, large sheet is proposed), reaching the sculptures of the couple and the families of the couple’s companions.

In a designed genogram, the rendering of the history of families of origin can be facilitated by graphic patterns (geometric shapes, networks or lines of different dimensions and characteristics; each member represented in the genogram usually identified by its name and year of birth) which have been proposed several times in studies and textbooks concerning genograms. In this respect, it is important to mention Monica McGoldrick, who has extensively described and used this method as a way of intervention, and which at the same time becomes a source of information and a family therapeutic intervention (McGoldrick et al., 2008).

However, the design of the genogram on paper remains static. One of the authors of this article described another technique of working with families of origin in the process of a couple therapy or counseling, in a way that is useful in working with the companions (not with the whole family, although GMC © has also been used in family therapies). In this study reference is made only to its use in the treatment of couples.

The sculpture used in couple treatments does not necessarily have value as an “objective” investigation into families of origin. Instead, it is a very effective method of constructing different images of the couple’s relationship, through the use of words and stories in a creative and flexible way. However, sculptures in working with couples are unquestionably capable of triggering the mnemonic recall of the history and relational dimensions of the partners’ original families. In this sense, Philippe Caillé (2007) and Luigi Onnis (2012) have been pioneers.

The authors of this article, starting from their clinical experience with couples,  tried to focus on a method that could be used either as a response to the need for the couple’s relationship inquiry (in terms of the influence from the families of origin) or to allow partners an effective process of awareness of the influences of their families of origin for the creation, construction and development of their relationships.

The need was to propose an organized way and a protocol based genogram presentation, that would make the narration of the partners’ families of origin as lively, flexible and participative as possible.

The intention was to make the narration so rich in elements that could give an idea of the dimension of time in family members’ relationships, of changes in relationships that arise at different stages of the family life cycle, and which could convey, through a perception of “plasticity” and evolution, the concept of proximity – alienation, alliance – conflict, central – peripheral.

At the same time, there was an evident necessity of devising a clinical tool that could be used by therapists in a user-friendly version, either in the context of public outpatient services (or, at least, in public care procedures including a treatment addressing the spouse) or in the private sector.

Thus, from an initial idea developed during a clinical laboratory, the “Mobile Genogram for Couples (Genograma Mobile per Coppie)” (GMC ©) was born.

Purpose of using the GMC © Tool

The use of GMC © in the treatment of a couple, according to the authors, is characterized as follows:

General objectives:

  1. To clarify the importance of heredity, so that it can be perceived in a subjective way, as originating from the families of origin, in the approach to the structure of the couple.
  2.  To allow the couple to identify the resources and critical issues coming from the families of origin.

 

Specific goals:

The narration of a personal story via the use of the tool allows:

  1. The patient to become a narrator, a constructor and an observer of his family;
  2. The partner to listen, observe and give new meaning to the correlation patterns that exist in the other partner’s family of origin;
  3. the therapist to listen, observe and give as a feedback to the patients the conjunction of the two previous levels through an epistemological frame of reference.

 

Deepening of the perception of the observers in the various phases:

  1. Allows, at the closing session, with the couple before the dashboard, to visualize the network of links, nodes, and cracks in their relationships.
  2. Allows the patient, using the characters provided by the tool, to project and co-construct with the movements of their hands, inside the dashboard, the photographic snapshot of the relationships that marked his story.

 

Description of the tool

As already mentioned, the tool is inspired from the use of the genogram (among other writers: Montagnano e Pazzagli, 2012).

As it is well known, the genogram, in a couple’s therapeutic process, aims to delve into how families of origin affect the correlation potential of the duality (and not of the couple constitution), since the pair is in fact structured by the cultural, historical and emotional reserves that the two companions have inherited from their families of origin.

The GMC © Mobile Genogram is molded on a wooden dash around which the protagonists of the genogram are animated. The dashboard has a square shape, and is divided into two fields, which represent respectively the inside and outside space (place) of the family.

The dashboard is completed with the use of small wooden characters representing the members of the narrator’s family, different in dimensions (small, medium and large), sex (male, female), and color (yellow, green, blue and red).

The choice of character dimensions can be guided either by a criterion based on personal data or by a criterion based on the importance of the specific individual in the narrator’s life.

Likewise, each set placed at the disposal of each member of the couple consists of small cylindrical shaped wooden articles which are used to illustrate a particularly problematic situation, or complementary events related to the narration (divorce, immigration, unemployment, institutionalization etc. …). In the case of mourning, the person is asked to place the character in a horizontal position on the dashboard, leaving him in the same position as he was initially in.

The use of the tool normally spans three meetings of approximately ninety minutes each: the two sessions are necessary so as to give the appropriate time to both partners to narrate their family story, where and the third for the feedback based on the points of the two narratives which the therapist deems most important.

To obtain the highest level of efficacy of the tool, it is advisable to introduce it to the couple in a phase of the treatment where the level of tension will be appreciably lower than in the first sessions.

Before the introduction of the application we ask the couple whether they are willing to investigate the issues concerning the relationship with families of origin? The question results in an instant shift concerning the routine issues of the couple, which aims to investigate, in the next three sessions as per the protocol, what we call “the heredity of the family.” During the first session, the therapist presents the GMC© tool to the couple, explaining the parts that compose it. The therapist proposes to the partners to refrain from intervening in any way during the other’s family narration.

Patients are given the opportunity to choose who will be the first to begin the narration, as well as the set of characters they wish to have.

Here is a verbatim example of the presentation and introduction of GMC © in a couple therapy:

“As I told you, today will be the first of three sessions devoted to the use of GMC ©. As you can see, we have two identical dashboards, and two sets of wooden characters, different in color, size and gender.

The dash represents the space (the field, the place) of the family, inside which you will place the wooden characters representing the members of your family of origin. The placement of the characters is indicative of the type of relationship that exists between them.

In addition, as you can see, the board is divided into two areas. The central area represents the area of the family, and there will be placed the persons who have played a crucial role in the history of the family; the outer (peripheral) region may be used for other relatives or persons who may have played an important role in the narrator’s life.

In the dashboard, as in real life, the dynamics of correlation among humans evolve, passing through the phases of proximity, collision, and rapprochement. So you can feel free to change the characters’ positions during the narration to reflect these changes.

Before we start, I ask the one in the listener’s position not to interrupt duringtheir partner’s narration.

Rules for administering GMC 

  • Presentation of the tool: two 40×40 square shaped dashboards, separated into two spaces, representing the space inside and outside the family. Two rows (sets) of wooden characters, different in gender, color and dimensions. Small cylindrical objects that represent exceptional events.
  • Explanation of rules and settings: three consecutive meetings of about 90 minutes each; patients are asked to keep the already existing conflicts between them out of these three sessions; also, the listener is not to interfere during the narration of the other partner.
  • They are asked, using the tool, to go through the main phases of the couple’s life cycle.
  • At the end of each narration, the dashboard is photographed.
  • A “balanced feedback” is given to each of the partners using the representations of the two boards which are now placed side by side.

As expected in the classic genogram, the narrative unfolds starting with the third generation (i.e. from the grandparents of the narrator). The protocol does not foresee that the narrator’s grandparents will be placed inside the dashboard unless they had an influential role in his life. The same applies for other relatives or important persons.

A feature of the tool is the ability of the narrator to intervene during the narrative by changing the position of the characters on the dashboard according to the progress of the family story. These movements serve to indicate any changes within the dynamics of the relationships within the family.

During the narration the therapist invites the narrator to put on the surface of the dashboard the represented characters, father, mother, siblings, and possibly any other important characters as they appear in the narrative sequence.

Likewise, the therapist urges the narrator to use the existing space according to the type of the bond that exists between them by placing them closer or further apart. These movements will be possible throughout the narration, taking into consideration any developments or possible changes that the relationships present over time.

At the end of each of the two sessions, the therapist will photograph the dashboards so that they can both be reproduced in the third session. This last session is dedicated to reconstruction, during which the therapist will reset both dashboards as they were laid out by the patients in the sessions dedicated to their personal stories.

This gives them the chance of a second reading, which includes both vulnerable and strong points that patients inherited from their families of origin. All this allows a redefinition of the therapeutic context under the light of the new epistemology co-constructed through the protocol.

 Putting a hand on history (Le mani nella storia)

The classic genogram is based on the use of three dimensions: the narrative phase, during which the patient goes back to his family history; the active listening phase, during which the therapist listens carefully and records the major events, most likely to re-signify them; and finally the return phase, which highlights the reserves and the critical points on which the therapeutic intervention is based.

In our view, the substantial innovation introduced by the the GMC © is what we called the fourth dimension.

Specifically, via the use of the tool, it is literally possible to “put a hand” in the history of their own family stories, by introducing a practical level to the already existing narrative level of the classic genogram. The “hands-on” dimension of this genogram approach is useful, on the one hand for the person under treatment to be able to look at what they are saying, and possibly correct what they said in the process, to systematize it and even to change it by watching the developing phases of their family of origin; during the representation on the dashboard they can modify what they are not totally convinced of and thus gain another perspective.

On the other hand, it is useful for the therapist, who has the ability to observe, in addition to listening, what the patient is talking about. In this way, the therapist can ask questions to clarify some dark aspects, or at least to point out any discrepancies between the narration and the representational level. By reaching another dimension, it allows the therapist to come up with more accurate assessments, and work through images that exist both in his own and in the the patient’s visual fields.

In this sense, the fourth dimension contributes to place on the scene the story of the patient, who becomes a writer, a director and an observer of his own story. In addition, the co-construction of this fourth level allows some risks to be avoided: on one hand, the patient could tell his story just as he always did, and thus remain lost in a path made up from dysfunctional meanings familiar to him for a long time, and on the other hand the therapist, who has to “decipher” and interpret the story he has just heard, is in danger, re-reading it, perhaps to project in the story a lot of self-referential elements.

Finally, our view is that the playful experience which is inevitably caused in the imagination of individuals in the context of GMC © could help to make the patient relax, allowing him to “play” with his own story, making this experience definitely more enjoyable, and at the same time more alive in his eyes.

Practical example of using the GMC © tool

We will now describe the use of GMC © as part of the treatment of a couple.

The husband, A. is 37 years old, and wife K. is 38 years old; they have been married for six years and have a five-year-old son. The husband is a lawyer and works in a company, and the wife (an Economics University graduate) works in the office of an educational organization.

They request psychotherapy as they both realize that their relationship is getting worse; too much conflict between them in many cases, and the sexual relationship between them has gradually disappeared .

According to them, the problems began with the birth of their son, when K. reported excessive workload and a minimum contribution on the husband’s side. A. states that K. had been too devoted to the son, neglecting the marital relationship.

In the first four sessions (which allowed to frame and identify the general characteristics of the couple, and collect the different views of the crucial points), it became clear how high the tension was, without ever being decompressed, with conflicts which, in a strange way, couldn’t be considered as aggressive not even at a verbal level. There is a strong feeling of disappointment, more obvious and evident in K, who states that she is thinking more and more about a separation. On the contrary, A. does not even want to contemplate such a scenario.

On the surface it seems as if the causes of conflicts and lack of understanding are trivial: on one side  (K), they relate to lack of support in everyday family life. On the other side (A), they concern the “perfectionism” attributed to the partner, and the absence of a personal space for relaxing and recharging.

Therefore, In the fourth session they are being proposed with the GMC © Protocol, its objectives and its general characteristics.

K. and A. accept to participate.

At the next session (fifth), K. decides to go first.

The story of K.

K. is the only daughter of a couple who divorced when she was six months old. According to her, her father failed to accept the new situation so after a very short period of tensions, he left home.

Ks’ mother was alone, and very soon got support from her sister. The aunt moves in with K. and her mother and will stay with them until her death. Because of the financial difficulties, the mother gives up her university studies and finds a job.

The narration is accompanied by a lot of passion.

K. states that her father (who died about seven years ago) was unavailable and quite irresponsible. The mother, by contrast, is described as a woman totally devoted to the needs of her daughter and her work (in a pharmaceutical company).

At this moment, K. moves the wooden character she had placed near her mother, while commenting on the tensions between the couple, and puts it away from the area identified as “the area of the family”.

There was also the aunt, at home, described as a “substitute mom” and in a harmonious relationship with her niece, in our case a “mother” of K. Thus, K. added another “big” wooden female character of the same color next to her mother’s.

At this point, and until the end, the board and characters will remain as follows:

What the narrator recalls about the relationship between her father and her mother are memories related to the triangulation: during the time spent with him, her father would insist on sharing with her his strong criticism of his ex-wife. At the same time, when she was about to go out to meet her father, her mother frequently asked her to remind him to pay the amount due for his alimony.

K. continues her story, in a very emotional manner. She was a good student throughout her school years. However, she says that her mother (and her aunt) chose for her religious schools from primary school to college. Mainly in elementary and high school, she remembers a certain suffering because she was not well seen by the teaching staff, characterized as “daughter of divorced”. Her stories concerning home remain hooked on her mother’s mental strength, on the efforts she made for the household, the aunt’s support, her financial and physical status. K. constantly speaking about the characters on the tableau, she says that she was always touched by these efforts and that this model of “sacrifice” inspired her. It seems that everything had worked as a powerful “imprinting”. K. struggled to study as much as possible, achieving good results more or less for the satisfaction of her mother and aunt.

As for the father, K. says that when she was about fifteen, he moved to an Asian country, had a new family there and died about seven years ago. In these years, the relationship between daughter and father was totally episodic.

K., prompted by the therapist, refers to the field of relationships with peers. She had normal, real friendships in early and late adolescence years: a sufficient number of girlfriends and friends, sufficient number of outings (always accepted by mother and aunt) and gratifying and enjoyable experiences.

The choice of University studies (Sociology major) was well accepted by the mother.

While K. was moving towards the final phase of her university studies, her aunt began to suffer. This illness affects the mother very strongly as well as K., both indirectly and directly.. Her aunt dies after a few months. K. narrates how her mother experienced this loss very severely, suffering from depression, which was treated with medication. K. tries to balance everything: studies, friendships, boyfriends andher mother’s support. For her it is a very difficult period, followed by her decision to go to Milan and get a Master’s degree.

K. narrates that she left full of doubts, “with Xanax in the suitcase”. She returns very often to Rome because her mother is still suffering from depression. She manages to complete the master’s degree and returns to Rome. Although she is very present in her mother’s life, she tries to live alone. At this stage, she meets her future husband, and their story begins.

Narration, according to protocol, ends here.

Finally, the therapist asks K. the following questions.:

What do you think you got from mom? And what from dad?

K. says that she got almost nothing from her father, whereas from her mother she got almost everything.

The therapist asks also (according to the protocol) the question about the “type of daughter” that her mother would describe her as. The answer is “according to my mother, I am an obedient and very responsible daughter”.

On the other hand, the father could have said that she was “a good daughter, but too involved with her mother”.

At the end, the therapist dismisses the couple, commenting that it was a very emotional story, that K. showed great willingness and that A. respected the request to listen and remain silent.

After two weeks, the couple returns and now it is A.’s turn.

A. is the second child of a couple that he defines as “very poorly matched” in terms of characters and families of origin. The father comes from a family that is considered as “very academic”: several university professors and considerable haughtiness. The mother, on the other hand, comes from an urban family with fewer claims. A. has a brother who is two years older than himself.

A. says that his parents were always in constant conflict. “Playing” with the wooden characters, e places them progressively distant. At the beginning, he places himself near his mother, but as his story goes on he moves to the side of the father. He defines his older brother as “capable” of getting away from the quarrels between the two parents and “doing his own thing”; while he was either in the middle in order to take one or the other side or sat in front of the television watching children’s programs, totally unnoticed, without anyone looking after him. The repeatability of conflicts between father and mother was so intense that the whole family barely had social relations. The causes of the conflicts varied, and the quarrels began as the father returned from work early in the afternoon and went to rest. When he would wake up, he and his mother would start their “dance”. One of the repeated causes of conflict was the father’s habit of smoking and drinking alcohol, which the mother considered excessive.

A. reports that these episodes as extremely tough, although they were an everyday event.

The only other person around the house was the father’s sister who had a certain capacity for mediation between the two. In fact, he adds her as a character to the four members of his family. The only opportunity to contact other people in the house were some meetings between adults, whose theme was the state of the relationship between the  parents. Besides the aunt, there was another couple of relatives on the father’s side that participated. In a special way, he remembers another uncle whom he represents with a character out of the close family circle.

He claims that as a student he was just adequate and that school was the only context in which he could meet other peers. Around the age of fourteen, he became passionate with volleyball and, miraculously (according to the narrator), his parents allowed it. Thus began a very intense commitment in sport, in which, however, the parents are totally uninterested; A. states that his father never attended a single game, despite his satisfactory achievements.

The dashboard, after these instructions, looks like this:

The impression is that A. likes to acknowledge his role as a “victim” of his two parents, who – without being separated – have always been bitterly opposed in their relationship, and that they sometimes put him in the “middle” or, most of the times, simply ignored him. In the end, he also said that he had a relationship of indifference with his older brother. He felt his absence as an ally and considered him unable to mitigate the state of abandonment he had experienced with his parents.

The narrator speaks about a more recent event (about eight years earlier): they were at the seaside, in a residential center, he was on the beach and was urgently called because his father felt ill. The mother (according to A.) was in another house and was not notified until quite later. A. finds his father lying on the road, almost breathless. Then he tries to help him with artificial respiration and the father recovers. An ambulance finally arrives and is taken to the nearest hospital. The father seems to recover for the moment but then he is seized by another ischemic attack and dies after ten days.

A. says that this was an emotionally extremely intense situation for him. And that his opinion about the situation had already started to change even before that: from a perception that all the tension was his father’s responsibility to a new, more balanced perception of his mother as actively fuelling the marital conflicts.

The therapist asks A. the same questions he had asked K. in the end.

A. answers that from his mother he has taken the stubborn and strong-natured character, while from the father has taken his introverted nature, the tendency to be lonely as well as a certain nobility of spirit.

A.’s father could say that he was a son “identical with his mother,” while the mother could think of him as a “very introverted” son .

The therapist ends the session and makes a new appointment for the “feedback” session.

This session begins with the request for feedback from the couple: how did they perceive the narrative sessions? Both claim they were very pleased, excited and touched.

The reinstatement is based on the following points:

a. Both partners, as they say, come from families in which they experienced emotional deprivations, although of a different type.

b. Both were triangulated in the parental conflict.

c. Both had “strong mothers”.

d. In the story told by K., the male model appears to be very weak while the female model (mother and aunt) appear very strong. Thus, K. is very demanding with men and approaches them with a certain mistrust.[1]

e. K. experienced a family system that was based on the absence of a male model and on separation. Therefore, for her, the separation “is not a big problem”.[2]

f. In the story told by A., there is a continuous, and partly failed, attempt to get away from the tensions between the parents. Therefore, A. has always feared tension; and with K. he tends to avoid it, trying to minimize both the differences and the misunderstandings.[3]

g. The story of K. features both the difficulties related to differences (the exclusion experienced in the Catholic school), and a very “judgmental” approach, which signifies an attempt to please her mother and aunt for their efforts.

h. Also for K.: her departure from the mother provoked guilt; that, followed the period of great support offered to the mother after her aunt’s death.

I. The experience of A. in his narrative is that of the son and that of the brother, who is either neglected or enmeshed (between two). His fear of separation and of increasing tension with his wife could relate to this experience.

j. For A. his family of origin was a closed and isolated one. From which he managed to get away only through volleyball. However, even in this area, his narrative shows an almost total lack of recognition and support from his parents

k. The narrative of A. presents a suppressed anger over the whole family situation. Specifically, against his brother who deprived him of support and alliance.

l. For A., the important points are both the dramatic attempt to revive the father, and the balanced accountability of the responsibility for the conflicts between his parents (from all the fault being his father’s to mother having her own share of responsibility).


[1] at the moment of this reinstatement, declares that she agrees. She narrates that even towards all of her friends she had a very cautious and fairly mistrustful attitude.

[2] Even here K. makes a gesture and says that she is not afraid of divorcing A.

[3] Here it is where A. completely agrees with the reinstatement point.


 

The two partners agree with the therapist’s comments. They also agree that these “impressions” are very important in their current crisis. The feedback session ends with the idea of still working on these issues.

In the two sessions following the feedback, there was an increased tension between the couple due to K.’s choice to pay a rather expensive holiday for the mother who, in the meantime, had lost her job. The holiday had been booked prior the mother’s dismissal and that’s why K. adds that she does not feel like depriving the mother of the cruise. A. is very angry and says that, at a time of economic difficulties, you could have made a less expensive choice. He insists that his position is purely rational.

The therapist refers to the two previous sessions and confirms that K. still feels obligated to her mother, and that A. feels his wife is too bonded to her mother.

A. Confirms and he lets slip the revelation that he feels envy of his wife and her relationship with her mother.

Reflections, thoughts, remarks on the GMC © tool as applied to this clinical case.

The use of this tool while working with patient’s family histories has enabled both therapists and patients to identify more elements regarding family relationships in terms of distancing/proximity, allowing them, in this way, to get in touch directly through the use of the wooden figures, with the emotions associated with their life stories. The emotional involvement was very intense (and it still is, as the treatment at the time of writing this article is still in progress), and the directions used even in the feedback session are widely used in the present treatment.

Conclusions

The GMC © tool is a simple and effective application in couple therapy, as its most important aim is to introduce in a dynamic and simple form the history of the Families of Origin of the partners as a fundamental aspect of the constitution and construction of the conjugal couple and as a ground for research and focusing on events, habits, expectations, roles played in the past which have a significant role in creating difficulties between partners.

GMC © has been used both in the treatment of couples in a private context, as well as in treatment,mediation or couple counseling carried out in public services. No differences of any kind were found in the use within the two different contexts. In the case of public services (these are two family counseling centers) the patients expressed a somewhat greater curiosity and interest in the GMC © path. Therefore, the systematic use of GMC © appears to be quite possible and practicable (when all of the aforementioned criteria are met) in working with couples in public services.

All patients who experienced the use of the tool expressed interest, participation and curiosity. Up to now, at the time this article is written, the GMC © has been submitted to 56 couples; no matter what where the circumstances, there has been no instance of rejection by patients. The use of GMC © took place at different timing: all but two cases took place between the fourth and the sixth session. In one of these, GMC © was used in session number ten (out of a total of twenty-one); in the other, GMC © was proposed at the end of a course of twenty-three sessions, from a different slant: as the conclusion of a journey during which the importance of the families of origin in the couple’s history has been repeatedly recalled. The 56 couples’ therapeutic paths have had different outcomes and durations. This shows that GMC © is a useful and appropriate tool, but it is certainly not able alone to determine or even explain the progress of a couple’s therapy.

The family history of each of the two partners was always accompanied by strong emotional involvement and participation, except in three cases in which one of the partners referred to his family of origin without any emotional involvement. Even the listening on the part of the other spouse is participatory; even if the elements of the story are known, the fact of listening to them in a new context and dimension creates interest. Many couples say that, after the sessions, they found themselves talking and discussing what was said by each of them.

The use of the tool is flexible and can be shifted in time during the treatment process without great difficulty, although it is still ideal to introduce it in the first part of the path, after the first three or four sessions, as already mentioned, once a therapeutic alliance is established that enables focusing to the main critical elements reported by the partners.

The interval of three sessions time during which the couple will not talk about daily crises, tensions and the usual stalemate situations, far from accumulating elements of confrontation, seems to produce an experience in which tone can listen and narrate elements of their personal history in a way that confrontations, accusations and other dramatic elements can be avoided.

The protocol that has been established and developed for the use of the tool works in a clear and simple way.

The restoration (of meaning) is presented as a real therapeutic intervention which, at the same time, reduces the extent of each person’s guilt, by attributing decisive aspects to the problematic dimensions of the family histories rather than to the single individuals and their conscious choices. During restoration, moments of intense participation and requests for further research are reported while there have been very few cases in which one or both partners disagreed with the therapists’ observations.

Furthermore, a dimension of usefulness of the data and information collected during the three sessions is reported in the continuation of the therapy. Frequently, during the following phases of the treatment, there was reference to the indicative aspects contained in the stories and the restitutions, both by the therapists and the patients. From this point of view, the return of the protocol in the third session is configured as an intense and focused therapeutic intervention, answering the question on which aspects of the respective families of origin have been, in some form, the origin of the couple’s difficulties.

For its use, the GMC © requires (apart from the set of figures and the board) a very short period of training, from eight to ten hours.

In conclusion, the GMC is characterized as a simple and effective tool, based on clear theoretical and clinical data that are generally accepted.

BIBLIOGRAPHY

Andolfi M. e Cigoli V., a cura di (2003). La famiglia d’origine. L’incontro in psicoterapia e nella formazione. Milano: Franco Angeli. ISBN: 9788846448453

Bogliolo C., Capone D., Genovesi I., Puleggio A. (2012). Dalla scultura alla rappresentazione spaziale della famiglia. Trasmissione transgenerazionale, evocazioni, emozioni nella formazione e in psicoterapia. Roma: Armando Editore. ISBN: 9788866770220

Boszormenyi-Nagy I.,Spark G.M. (1988). Lealtà invisibili. La reciprocità nella terapia familiare intergenerazionale. Roma: Astrolabio Ubaldini. ISBN: 978-88-340-0924-6

Bowen M. (1979). Dalla famiglia all’individuo. Roma: Astrolabio Ubaldini. ISBN 9788834006399

Caillè P. (2007). Uno e uno fanno tre. Roma: Armando Editore. ISBN: 886081049-6

Canevaro A. (1988). Crisi matrimoniale e contesto trigenerazionale. Un modello sistemico di terapia breve. In: Andolfi M., Angelo C. e Saccu C., a cura di, La coppia in crisi. Roma: ITF.

Canevaro, A.A. (1982). El contexto trigeneracional en terapia familiar. Terapia Familiar.9:101-118

Coletti, M. , Alberti, F., Bellucci E.M., Patruno, C., Viscosi, A. (2015) Coppie e famiglie di origine genogramma mobile per coppie (GMC © ©). Un metodo esplorativo e terapeutico . Psicobiettivo, 2015 Fascicolo: 2  Franco Angeli Editore. DOI: 10.3280/PSOB2015-002006

Eckblad, G. and Vandvik, I. H. (1992). A computerized scoring procedure for the Kvebæk Family Sculpture Technique applied to families of children with rheumatic diseases. Family Process, 31: 85-98. DOI: 10.111/j.1545-5300.1992.00085.x

Erikson E.H. (1963). Youth: Change and challenge. New York: Basic Books. HQ796 .E65 1963

Framo J. (1996). Terapia intergenerazionale. Un modello di lavoro con la famiglia d’origine. Milano: Raffaello Cortina. ISBN: 88-7078-405-3

Gil E. (2003). Play genogramsIn: Sori C.F. and Hecker, a cura di, The therapist’s notebook for children and adolescents: Homework, handouts, and activities for use in psychotherapy. New York: Haworth Press.

Goldbeter-Merinfeld E., Linares J. L., Onnis L. , Romano E.e Vannotti M. (2012). La terapia familiare in Europa. Invenzione a cinque voci. Milano: Franco Angeli. ISBN: 9788820403249

Jefferson C. (1978). Some notes on the use of family sculpture in therapy. Family Process, 17: 69-76. DOI: 10.1111/j.1545-5300.1978.00069.x

Kelsey-Smith M., Beavers W.R. (1981). Family assessment: centripetal and centrifugal family systems. American Journal of Family Therapy, 9: 3-12DOI: 10.1080/01926188108250419.

Kroeber A.L. (1925). Handbook of the Indians of California. Bureau of American Ethnology Bulletin 78. Washington: United States Government Printing Office.

McGoldrick, M., Gerson R. (1985). Genograms: Assessment and Intervention. New York: W.W. Norton. ISBN: 9780393705096.

Minuchin S. (1977). Famiglie e terapia della famiglia. Roma: Astrolabio Ubaldini. ISBN: 9788834000946

Montagano S., Pazzagli A. (2002). Il genogramma. Teatro di alchimie familiari. Milano: Franco Angeli.ISBN 88-204-3389-3

Onnis L., Di Gennaro A., Cespa G., Agostini B., Chouy A., Dentale R.C., Quinzi P. (1994). Sculpting Present and Future: A Systemic Intervention Model Applied to Psychosomatic Families. Family Process 33:341–355. DOI: 10.1111/j.1545-5300.1994.00341.x

Onnis L. Bernardini M., Leonelli A., Mulè AM. Vietri A., Romano C.. (2012).Les sculptures du temps familiale. Un method de “narration analogique”. Cahiers critiques de thérapie familiale et de pratiques de réseaux. 48: 31-57. DOI: 10.3917/ctf.048.0031.

Onnis L. Bernardini M., Leonelli A., Mulè AM. Vietri A., Romano C. (2013). Le sculture del tempo familiare. Un metodo di “narrazione analogica”. Ecologia della mente 1: 5-27. DOI: 10.1712/1323.14665

Stierlin H. (1973). The adolescent in family therapy. New York: The Guilford Press.

Vallario L. (2008). La scultura della famiglia. Teoria e tecnica di uno strumento tra valutazione e terapia. Milano: Franco Angeli. ISBN: 9788856836643

Wilson E.O. (1975). Sociobiology: The New Synthesis. Cambridge: Harvard University Press. ISBN 9780674002357