CHAPTER TWO:

CHAPTER TWO: Gathering Client Information, Constructing A Genogram, Ethical Considerations and Releases

“The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind.” – William James

Genogram: Visual Mapping Family Systems
The quote above was prophecy. In essence, James, the prominent, nineteenth-century American psychologist, was talking about epigenetics, the study of heritable changes in the gene activity which are not caused by changes in the DNA sequence; in effect these changes in gene expression (or cellular phenotype) evolve from other causes. Epigenetics renders our brains (and bodies) as flexible, capable of adapting, evolving and change. Given how important mapping out the psychosocial background of our clients is in understanding their psychodynamics and life story, creating a 3-generation genogram is the first step toward that end. That is the first step that I have been teaching my students for over 30 years. The reason is simple: we do not exist in isolation from one another. We are a product of not just our genetics but also our upbringing (McCartney, Harris & Bernieri;1990).

In completing an art therapy assessment on a client, one ought to first create a genogram. A genogram is a three-generation (minimum) visual map of an identified patient’s (IP) family system. According to Butler (2008) and Jolly, Froom & Rosen (1980) and Wikipedia (http://en.wikipedia.org/wiki/Genogram):

A genogram (also known as a McGoldrick-Gerson study, a Lapidus Schematic or a Family Diagram) is a pictorial display of a person’s family relationships and medical history. It goes beyond a traditional family tree by allowing the user to visualize hereditary patterns and psychological factors that punctuate relationships. It can be used to identify repetitive patterns of behavior and to recognize hereditary tendencies.

Additionally, this construct can include psychological scores (intelligence quotient scores such as a WISC-R), strengths and weaknesses, DSM V information from the attending psychiatrist, and visual symbols that help you and your supervisor track conflicts handed down from generation to generation. As well, a chronological time-line can be created which maps out any nodal events that have affected the patient’s history. These days the instructions are so simple that the most basic steps can even be found on the Internet. While simple instructions may be offered, after combing through different programs, I have settled on using the program Genogram Analytics software program (http://www.genogramanalytics.com/) created by Loie West, Ph.D, psychologist, and her software/engineer husband, Tom West.

The reasons are ease of use, including tutorials on YouTube and the software’s ability to be understood by educational and professionals alike. This software program easily allows for pertinent information to be added to the visual map.

Should more information be necessary to complete an identified person’s (IP) timeline, a separate addendum can be created. The Genogram Analytics Software package automatically creates a key in the document for occupation, education, cause of death, disease, etc.
Symbol Conventions
While all these symbols pop up automatically with the Genogram Analytic software program, below are some “standard” symbols:
• Use circles for females, and squares for males. Use dashed circles and squares, or slashed or “X’d” symbols, to represent dead, missing, or psychologically-detached people.

• Horizontal solid lines show legal marriages, and dashed lines to show committed unmarried primary relationships, and important friendships, dependencies, hero/ines, and supporters. A horizontal line with a ——//—— or ——X—— can indicate a psychological or legal divorce.

• Vertical or slanted solid lines show genetic connections. Dashed slanted lines can show adoptions, foster parents, or other special adult-child relationships. Option — use double, triple, or colored lines to indicate the importance or relative strength of the connection between two people.

• Zigzag, double, or wavy lines can symbolize strong emotional, legal, financial, or other kinds of current relationship connections, including lust, grief, anger, fear, physical and /or sexual abuse. For example, an arrow towards that person creates directionality signifying a victim. Again, all of these symbols can be automatically created with the Genogram Analytic Software program.

• An “X” through a circle or square indicates death.

• Include names, dates, pets, extra-important current friends, sponsors, or authorities, major illnesses and disabilities, addictions, arrows for child visitations, and any other symbolic or text information that adds clarity and meaning to your map.

In the editors’ opinion, the best source for truly understanding this book was recently re-edited by McGoldrick, Gerson, & Petry (2008). This book gives you numerous samples and in depth cases to understand the importance of this visual map as well as more complex samples such as miscarriage, suicide, and other nodal events that are either effecting the IP (identified patient) and/or family system.

Again, it is important to note that we do not, by any means, live in isolation and we are affected by not only our family system (thus making the term IP almost contradictory), but we are also affected by an even larger system that impacts are entire personality including the macro-system.

All of these factors contribute to who we are and what we become as individual players within our society. So while the reader might be mapping the IP’s genogramatic system, it is paramount to note that we not only do not operate in isolation, but also, the therapist needs to work from a family system’s perspective, even if the family is not present. This can be done through artwork, empty chairs, and then some. So as the reader will see, the thrust of this book views the individual through the eyes of the collective whole and all of its influence.

In order to understand this concept, as a professor and author, I always make the first assignment in my assessment class for each student to create a three-generation genogram of him or herself. The reason is multifaceted: (a) it initiates the student’s understanding of exactly how these factors above contribute to his or her shaping as a human being operating in this world; (b) it sets the stage for the student (or intake workers) to be able to ask the proper questions of clients to construct a genogram to understand that client’s genogramatic system; and (c) most importantly, it allows the student to hold onto his or her own genogram and take a good hard look at exactly how the psychosocial issues of his or her family system impact both the transference and counter-transference with each individual case that he or she sees. I also encourage each student to then share this genogram in the confidential setting of academic supervision in order to extract maximum supervision. After over 30 years of teaching, this has proven to be an enormous asset to student understanding and processes.

Within each chapter, the reader will be presented with a genogram and timeline (nodal events) for each client and be able to understand the parameters of that client’s psychosocial, educational, medical, and cultural, developmental/ cognitive and /or spiritual background as it pertains to the case and assessment(s) administered.

Case Study:
Client: Pam
DOB: August 1954
CA: 52 (at testing, currently 59 yo)
Testing Dates: September 27, 2006; March 21, 2007; March 28, 2007
Administrant: Julie Riley

Pam is a single, white, 52-year-old female. Currently she lives with five housemates who help compose Pam’s support system: these also include friends at DayHab, her staff at PRALID, and her advocate (literacy volunteer). Her remaining family consists of two older sisters who live in New York State, although not in the Rochester vicinity.

Pam suffered a traumatic brain injury (TBI) following a head-on collision motor vehicle accident (MVA) at the age of 16. Her boyfriend, who was driving, died. Pam was in a coma for four months and received intensive medical attention and interventions. Between the time of the accident and 1986, her history is vague; but beginning in 1986, Pam rotated through several group homes in Connecticut until 1997 when she was moved to Rochester, NY as advocated by her social worker. In 2002, she was monitored for a possible breast tumor. Also in September of 2002, Pam began stating intentions of self-harm and suicidal ideations. However, this was concluded to be attention-seeking behavior and she counseling was recommended. During counseling, it was determined that Pam was having difficulties around issues of mourning and loss: the death of her boyfriend, her deceased parents and her life prior to her accident and subsequent TBI.

Behavioral Observations
Pam displayed a vibrant sense of humor and keen intellectual ability; she mentioned that she liked mathematics and occasionally spoke French (her mother was French). She appeared very fashion conscious and made efforts to “look good.” Pam used a wheel¬chair (left hemiparesis) and subsequent to her TBI, she suffered visual impairment. Her memory was primarily limited to proximity and events prior to the MVA (motor vehicle accident). Her medical chart indicated that she occasionally struggled with distinguishing reality from imagination. However, in art therapy sessions, this writer observed imaginative expression on several occasions during which Pam was oriented in reality.

Ethical Considerations and Release Forms

While there are numerous release forms that abound on the Internet, my colleague, Dr. Renee van der Vennet (2013), graciously provided a checklist that she based on the writings of Corey, Corey, & Callanan, (2011). As she described in a personal communication, she uses this as a template for plugging in information based on her client(s). I suggest that all art therapists adopt such measures when working with any population. According to the Code of Professional Practice that regulates the art therapy and board certification credentialing, section 3.0 Standards of Conduct and specifically section 3.1.11, stipulates having a “professional disclosure statement”, (e.g., an informed consent) and outlines the parameters of the document to be used:

3.1.11 An independent practitioner of art therapy must sign and issue a written professional disclosure statement to a client upon the establishment of a professional relationship. Such statement must include, but need not be limited to, the following information: education, training, experience, professional affiliations, credentials, fee structure, payment schedule, session scheduling arrangements, information pertaining to the limits of confidentiality and the duty to report. The name, address, and telephone number of the ATCB should be written in this document along with the following statement, “The ATCB oversees the ethical practice of art therapists and may be contacted with client concerns.” It is suggested that a copy of the statement be retained in the client’s file.
(http://atcb.org/home/code)

Below is the checklist that Dr. van der Vennet uses to guide the ATCB
(Art Therapy Credentialing Board) recommended format:
Checklist for Informed Consent
(Corey, Corey, & Callanan, 2011, p.166-172).

1. Voluntary participation
2. Client involvement
3. Counselor involvement
4. No guarantees
5. Risks associated with counseling
6. Confidentiality and privilege
7. Exceptions to confidentiality and privilege
8. Counseling approach or theory
9. Counseling and financial records
10. Ethical guidelines

11. Licensing regulations
12. Credentials
13. Fees and charges
14. Insurance reimbursement
15. Responsibility for payment
16. Disputes and complaints
17. Cancellation policy
18. Affiliation membership
19. Supervisory relationship
20. Colleague consultation

Content of Informed Consent

(Corey, Corey, & Callanan, 2011, pp. 166-172)

1. The therapeutic process
2. Background of therapist
3. Costs involved in therapy
4. The length of therapy and termination
5. Consultation with colleagues
6. Interruptions in therapy
7. Clients’ right of access to their files
8. Rights pertaining to diagnostic labeling
9. The nature and purpose of confidentiality
10. Benefits and risks of treatment
11. Alternatives to traditional therapy
12. Tape-recording or videotaping sessions

In order to give the reader an idea of the varying types of informed consent forms, one need only peruse the Internet to cull something that it is a fit; making certain the language of the letter for the participants (and/or their guardians) is fairly straightforward and user-friendly.

To continue reading, please purchase this book.


Reviews

College-level collections strong in art therapy psychology will welcome The Art Therapists’ Primer, sharing the author’s 29 years of experience as she and her colleague link art therapy processes with medical terminology, offering a primer on everything from producing art therapy assessments and sessions to making translatable documentation to dovetail with medical models.

A step-by-step methodology reaches across disciplines from mental health to medical models and offers detailed and in-depth analysis key to placing art therapy in the professional realm. Midwest Book Review

An excellent piece of literature. As a student of Art Therapy this book will be a very useful resource well into the future for me. Frances Windsor

Great book, Dr. Horovitz is my professor at Nazareth College in Rochester. Great resource guide with useful templates included. Aubrey H. Thompson

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