Magazine "Research" · Reading time approx. 9 min

One of the oldest studies on the genogram doesn't come from therapy, but from a family doctor's practice. And one of the most original applications doesn't map a family at all.

A Look Beyond One's Own Field

Anyone searching for research on the genogram usually ends up in family therapy. There, the evidence base is thin.

One field is easily overlooked in the process: health services research. It doesn't ask whether a method heals, but whether it improves everyday care. Does it capture more information? Does treatment change as a result? Does knowledge reach the people who need it?

For the genogram, the answers to these questions are older and more concrete than one might expect.

The Study from the Family Doctor's Office

In the 1980s, Rogers and Durkin studied what happens when a genogram is taken as standard practice during a patient's first visit to a family doctor. The paper appeared in Family Medicine.

The finding: a structured family history brought more clinically relevant information to light than an unstructured one. Not because patients knew more, but because the questions were asked systematically.

That sounds trivial, and it is the heart of the matter. An open-ended question about the family yields whatever comes to mind. A structure also brings out what no one would volunteer on their own.

When the Genogram Doesn't Map a Family

A considerably more unusual application was described by Crabtree and colleagues in 1998 — also in Family Medicine.

They applied the logic of the genogram to medical practices themselves. Who has worked here, and since when? Who hired whom? Where do loyalties run, and where do old conflicts linger? They called the result a practice genogram — an organizational map in the visual language of the family genogram.

The idea behind it is simple: a practice, too, has a history, founding generations, and successions. Anyone trying to understand why a change isn't taking hold often finds the explanation there — not in the org chart.

Abatemarco and colleagues carried this line of work forward in 2012 in the Journal of Child Health Care. They used genograms to assess pediatric practices' readiness for change.

Family History on Screen

A third line of work concerns technology. The MeTree project, described by Orlando and colleagues (2011), collects family health history via computer and derives treatment recommendations from it.

The approach targets a well-known problem. Family histories are useful, but collecting them takes time, and time is scarce in everyday practice. When patients enter the information themselves and the system generates recommendations from it, the burden shifts.

This only partly transfers to genogram work. A medical family history asks about illnesses. A genogram in counseling asks about relationships. The data collection is similar; the underlying question is not.

Hypothetical case example: A social service agency introduces a structured intake interview with a genogram. Six months later, staff notice that foster or guardianship arrangements and previous residential placements are documented far more often than before. Not because the client population changed — but because no one had asked about it before. Management takes this as a reason to apply the new intake grid to existing cases as well.

What Makes This Interesting from a Research Perspective

These studies sidestep a problem that trips up effectiveness research.

They don't ask whether the genogram heals. They ask whether it improves the information available. That is measurable: you can count which pieces of information are documented with a structured intake and which without.

Such questions are smaller than "does the genogram work" — and answerable. For a tool that above all provides structure, they may be the more fitting ones to ask.

What This Means for Practice

Three takeaways emerge.

Structure beats open-endedness — when it comes to intake. Asking systematically yields more information. This holds regardless of whether a genogram ends up on paper at all.

The method also works for organizations. Anyone trying to understand an institution, a team, or a network of helpers can use the same visual language. This isn't a clever trick — it has been tested in health services research.

The time investment is a legitimate argument. If an intake takes twenty minutes, it needs to justify itself. The question of what it yields is a fair one — and answerable, if someone actually asks it.

A Gap That Remains Open

Little of this has been studied for German-speaking countries. The papers cited here come from the Anglo-American healthcare system, which is organized differently.

Whether a structured family intake brings the same gain in a German family practice or social service setting remains unstudied. This would be a study that could be done with manageable effort — and one that would be worth more to practitioners than yet another contribution to the effectiveness debate.

Sources

• Rogers, J. & Durkin, M. (1984/1987): Impact of a screening family genogram on first encounters in primary care. Family Medicine.
• Crabtree, B. et al. (1998): Using practice genograms to understand and describe practice configurations. Family Medicine.
• Abatemarco, D., Kairys, S., Gubernick, R. & Hurley, T. (2012): Using genograms to understand pediatric practices' readiness for change. Journal of Child Health Care.
• Orlando, L. et al. (2011): Protocol for implementation of family health history collection and decision support into primary care (MeTree).