Introduction: Blood, ties, and potentiality

The genogram is a family tree which uses standardised symbols to represent individuals and relationships. It is used by some art therapists (see Horovitz, 2014), but it is not un-problematic. In this article, I use queer theory to explore the ways in which the genogram reproduces structures of oppression within the therapeutic relationship. I query how art therapists can use the genogram whilst remaining aware of, and disrupting, these structures as culturally sensitive art therapists, particularly referencing critiques from other professions and areas of specialty. I intersperse the discussion with anecdotes from my own experiences as a trainee art therapist in order to show how this seemingly innocuous practice re/produces oppressive experiences.

The genogram: A story of creating (his)stories

A genogram, as defined by Horovitz (2014), is a visual mapping of a client’s family tree, typically showing three generations using a series of standardised symbols. These symbols enable genograms to be ‘read’ by various clinicians, whilst providing potentially extensive detail of the client’s family. This detail can serve to illustrate intergenerational patterns, family or household structure, and family dynamics (Taylor, Clement, & Ledet, 2013). The genogram has numerous applications within mental health, such as in case-notes and service referrals, and provides a common language for various service providers to communicate with each other.

Horovitz (2014) recommends art therapist trainees learn the genogram as a part of their training, preferably by doing their own. Although Horovitz (2014) refers specifically to art therapist training in the United States of America, art therapists in other countries have also been exposed to the tool. For example, an autobiographical genogram is the basis of a compulsory assignment in the first year of the Western Sydney University Master of Art Therapy programme.

When tasked with creating my own genogram as part of my training, I baulked. It was discomfiting to reduce my experiences, and the hugely complex relationships with my immediate and chosen family, to a series of lines and squiggles. What family did they want? What about the complex interplay of society and culture on my family – both blood and chosen? I felt erased.

The genogram does not exist in a vacuum. As with many assessment techniques used in mental health, it evolved from a modernist empiricist paradigm and, as such, carries assumptions of neutrality, objectivity, and accuracy (Iversen, Gergen, & Fairbanks, 2005). Iversen et al. (2005) also note that the genogram is linked to the (similarly modernist) medical model in which binaristic notions of health (no treatment necessary) and pathology (treatment necessary) are normalised. Assessments, such as the genogram, emphasise ‘problems’ and are part of a discourse of deficit (Iversen et al., 2005). Moreover, the genogram is not an objective tool, but one which is culturally located within paradigms that valorise causal structures.

Trying to construct my own genogram, I felt my alterity come into sharp relief. There were no standard symbols which matched aspects of my life, and the insistence of the genogram in producing the sperm donor of my child made it feel as though my entire concept of my own family was false. I could not represent my partner without situating them as ‘normal’, I could not represent my own growth. How could I show the family that aren’t blood, but to whom I would give my blood? I felt so invisible, even as a student, I wanted to scream “THIS CAN NEVER BE ME”.

In the genogram, clients’ issues are viewed as products of causal mechanisms, with other family members defined as good or bad influences (Iversen et al., 2005). This can act to suppress the agency of the client. In their critique of the genogram, Taylor et al. (2013) point out that the genogram fails to account for the client’s goals, desires, strengths, and supports. The genogram also fails to account for cultural systems and marginalisations, and the impact these have on development and mental health.

Queer: An interrogation

Queer theory seeks to disrupt the systems and cultures that enforce binaristic and essentialising notions of value, especially in relation to gender and sexuality, by rejecting normalcy as fixed and by highlighting the structures that enforce normativity (Peterson, 2013). Ferguson (2004) describes the systemic processes that lead to enforcement of these cultures as rationalisation as a process of interpellation; only identities that reinforce the dominant culture are recognised and validated, while others are considered ‘irrational’ (p.83). Queer, however, does not seek to ‘rationalise’ difference. It is not interested in simply adding differences to normative structures, but rather in seeking to disrupt the very idea of normalcy through legitimising differences on their own terms (Peterson, 2013).

Mental health practices, including the genogram, are informed by these processes of rationalisation. In order to see how the genogram replicates and enforces kyriarchy (cultural/social systems reliant on dominant/oppressive binaries, and their enforcement or rationalisation), it is essential to understand specific queer critiques of traditional understandings of family and development.

A ‘traditional’ (read: normative, Western, legitimate, rational) family is regarded as two cisgendered [1] heterosexual, white, middle-class, Christian, parents, who co-reside with their cisgendered children. It denotes systems of coupledom, procreation, marriage, inheritance, and biological relatedness (Peterson, 2013). This is rationalised as the ideal, against which all other families are pathological, or at least irrational/illegible (Peterson, 2013). Embedded in this picture of a traditional family are assumptions around gender, sexuality, race, as well as issues of relationship valorisation, importance of wealth, housing accessibility, and health – sociocultural structures that intersect in people’s lives. These are assumptions that are replicated in the design of the genogram.

Queer theory, however, offers us ways of challenging these assumptions of family normativity, as well as understanding how this picture is harmful to those who do not conform (McDowell, Emerick, & Garcia, 2014).

To understand why this is so important even in the tiniest interactions, I need to give context, to help you see the world from the eyes of a person trapped by a society which erased their existence in a maze of systems and codes. When I ‘found’ queer theory, I felt liberated. I could finally stop pretending to try and fit in, I could embody my difference. I no longer had to fight who I was in order to beg for respect.

In their paper, Blumer, Gavriel Ansara, and Watson (2013) discuss how cisgenderism is enmeshed with this traditional image of family and replicated in family therapy. Cisgenderism assumes that experiences of gender are universal, which serves to erase the identities of trans and gender-independent clients (and/or their families), and delegitimises the client’s self-designation and self-expertise (Blumer et al., 2013). This denial of self-expertise is also seen in the way that medical professionals are often the gatekeeper to treatments and ‘official’ recognition (McGregor, 2014).

Trans people are expected to conform to a particular narrative – one of a troubled childhood, persistence of cross-gender ‘behaviour’, and the desire to ‘medically’ transition – and they are expected to repeat this narrative on demand (McGregor, 2014). This reflects, however, not the truth of the stories of trans people, but rather the inability of others to process narratives that are not based on cisgender norms (McGregor, 2014). A genogram, then, even one which includes specially designated symbols for trans people, replicates what McGregor (2014) terms a ‘trans autobiographical demand’ – a circle with a square inside it for ‘man to woman’ and a square with a circle inside for ‘woman to man’. This serves to erase the myriad experiences of trans people, particularly those that do not conform to this narrative.

These assumptions and demands are based on binaristic classifications of gender, which, while they may help therapists to make sense of relational systems (or in the case of the genogram, of familial systems), in fact contribute to “heterosexism, heterosexist privilege, sexism and gender stereotypes” (Blumer et al., p.268).

How could one symbol denote the complexity of my gender? How could one symbol represent the years I spent as a pre-teen convinced I was intersex, how I came to terms with the idea by deciding to be a drag queen, and when my sex was confirmed how I mourned the possibility of becoming a drag queen? How when I found femme as a gender I realised I could finally be myself, in all my camp glory? How the simplicity of a circle can only encompass a small part of the way my assigned gender has shaped my world? What does this symbol stand for if not a crass shorthand for the daily enforced performativity of a gender that could rightly be an infinite fractal?

Cissexist, heterosexist, colonial, and racist assumptions are inherent not only in the constructed idea/ideal of family, but also in the construction of the genogram; as Talwar notes (2002) these assumptions contribute to a system in which the therapist-client relationship echoes other hierarchical relationships.[2]

But what about art? Imag(in)ing links, embodiment, and de(con)struction

Marginalised people, according to Talwar (2010), make up the majority of clients for some art therapists. Art therapy has a unique potential to disrupt kyriarchical social structures by making visible the invisible, and empowering clients to find ‘embodied liberation’ on their own terms. The physical act of creation, inherent to the art process, serves to subjectify the creator and can allow clients/artists to reclaim their place in the world independent of ‘rationality’ (Fabre-Lewin, 1997).

I can’t help but relate art-making to Hegel’s dialectic of lordship and bondage. There seems a parallel between the slave’s coming into existence through working the land – physically shaping their world – and the creation of art. When I make art, some physical proof of my existence, of my subjectivity, becomes manifest.

Art therapists must be able to examine how their practice colludes with kyriarchy through alignments with modernist medical practice, and through unquestioned assumption and bias, and how the therapist-client relationship re-enacts cultural power dynamics (Talwar, 2010). In other words, art therapists must be able to challenge and confront hegemonic ways of seeing people (Talwar, 2010). Thus, if, as Ellis (2007) says, art therapists must develop “sensitivity to the specific effects on the individual of particular forms of discrimination” (p.61), we must ask whether using a tool that has been shown to replicate oppressive social structures is harmful to clients (and, indeed, therapists), and whether it is even ethical. Can the genogram ever be an appropriate tool for art therapists?

An art therapy that aligns itself with aspects of queer theory (an alignment that reflects the codes of ethics of professional organisations such as ANZATA [3]) would seek to disrupt the hierarchy of the modernist medical model, but this might not be possible if we use tools developed by, and that reinforce, this hierarchy.

In her ground-breaking speech, Lorde (1984) states that “the master’s tools will never dismantle the master’s house. They may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change”. Reflecting on this idea, Brown (2012) notes that beginning with socially constructed categories allows central assumptions to go unchallenged; more than that, they serve to re-enact oppressive social structures. This reinscribing, invisibilising, illegitimising, becomes a ‘normalising technique of power’ (Brown, 2012, p.49). When a client is forced to ‘out’ themselves as non-normative and explain their identity against assumptions of bias, we are forcing them to be occupied with our concerns – a tool for keeping the oppressed in their place (Lorde, 1984).

I see an art therapist myself. I start talking about my partner. I use the singular they as their pronoun. “They?” asks the therapist. “Yeah, that’s their preferred pronoun.” “Oh, so they have GID?” (A disorder that is no longer listed in the DSM) “No, they just prefer they.” In one question the therapist positioned me, as well as my partner, as not normal. We weren’t able to be seen for what we are, but rather, what we are not. It jolted me. It broke trust. It was added on to the picture that gets painted every time someone reads me as straight, every time some ignoramus yells out “dyke” in Newtown, every time my opinions are invalidated because I’m an angry queer. When we try to fit our clients into the genogram, this is what we do, we add another splotch of colour to the picture of otherness already crystallising in our client’s head.

As Brown (2012, p.47) says: “Socially constructed differences are too often simply reified, and the approach becomes one which re-inscribes existing differences rather than challenging social categories as social, historical, and political constructions.” There exist ‘queer’ genograms, but how queer can they truly be? They might include symbols for all manner of genders and relationships (see Keith, 2013), but the symbols are based on ‘norms’; heteropatriarchal families are still the standard against which difference is conceived.

This critique is not without precedent. Watts-Jones (1997) provides a comprehensive critique of the genogram in relation to its application with African-American people. As with the queer critique of the genogram, Watts-Jones (1997) points out that the assumption of biological family erases African-American experiences of kinship.

I’ve had to do them for clients, of course I have. Writing referrals, assessment notes. I’ve been asked to, and I’ve chosen to. And I cringe every time I do, and redouble my efforts to hold the client as they are, to let their stories of families flow through their art. I work mostly with children, and the creative ways in which they depict their families never fails to ignite my curiosity.

How, then, do we approach this as art therapists? Especially considering that we may work in contexts where the genogram is a necessary tool for inter-departmental communication. In my experiences working with the New South Wales Department of Health, genograms are a required part of many service referrals. When a client is seen by multiple departments and service providers, information must be communicated efficiently. For this reason, Horovitz’s assertion (2014) that trainee art therapists learn the tool holds some weight.

There do exist alternatives to the genogram. Taylor et al. (2013) suggest a number of alternative genograms – allowing clients to design their own symbols, drawing a support tree, or amoeba family – any of which might be appropriate in an art therapy context. However, situating the client as the expert on their life and disrupting the therapist–client binary must be the primary concern. Talwar (2010) suggests adopting an ‘intersectional perspective’, described as “locating individual differences within the specific social and cultural experiences of individuals, rather than within a linear, unifying theory of human growth and development” (p.16).

If I had to. And sometimes we all have to do things we would rather not – for an assignment, for a referral, because it is the way things are done. So I did it. I created a genogram. The beginnings of it, the learning, the mapping, they were painful. I felt disempowered and invisible, yet all too visible. The map showed trauma, but not survival. Intimate violence, but not intimate friendship. Not those moments of pure platonic love that saved my life. It showed me as the daughter of a migrant, but not the daily racism I experienced as a young wog. Other. Other, but not whole. I ripped it up. I put it together. I ripped it.

Questioning the genogram within art therapy practice would mean questioning the limited ways in which a family can be legitimate (Peterson, 2013). An art therapy practice that integrates this perspective would concern itself not only with constructions of family trees, but with how the client experiences their family, how the familial relationships have appeared to them, and how society and culture have impacted their family. It would make space for families far removed from ‘the norm’ without pathologising them, with an understanding of the positive possibilities of any family structure. Peterson (2013) notes that expanding definitions validates and legitimises alternative support networks, and could have positive consequences in areas such as foster care practices and immigration policies. Something as simple as discarding an assessment tool has the potential to empower both art therapists and clients, to disrupt taken-for-granted oppressive systems.

Conclusion, or what (the) Butler saw

The genogram, whilst largely un-critiqued in art therapy literature, though firmly critiqued in areas such as family therapy and counselling training, is a tool that can be seen to replicate oppressive social structures. Its use in art therapy can serve to invisibilise and illegitimatise clients who do not fit heteropatriarchal familial norms. Using the lens of queer theory and the ideas of Lorde (1984), the genogram can be understood as a binaristic, oppressive tool of the medical model and kyriarchical social structures. Considering queer critiques of the genogram, however, provides art therapists an opportunity to create therapeutic spaces in which a range of familial and social experiences are seen as legitimate, and the client is centred as the expert on their own lives. In disrupting the therapist–client hierarchy, the therapeutic relationship can become truly liberatory.

I made my genogram, begrudgingly at first, but transformed it with maps, tissue, sewing patterns. The lines and circles of these maps echoing those on the genogram itself, but representing far more of my story. I didn’t Asha Zappa: What’s blood got to do with it? have the choice not to make it, so I hacked it, discarded it in my own way. I don’t see a simplistic story of a troubled family, rather; I see walking down Portobello Road in search of old botanic prints. I see a young child and her mother sitting at a sewing machine creating outrageous costumes. I gave them what they wanted, but I also gave them me.