Refugees often live in an acute, unresolved trauma situation: family members are missing, dead, scattered across third countries, or living in life-threatening circumstances. The classic genogram requires its own symbols for unresolved fates, sensitive settings with interpreters, and the humility to accept that not everything we wish to know may be asked.

Stabilisation before Exploration — The Ethical Ground Rule

In the acute phase of a refugee biography, genogram work is often not indicated. The National Association of Psychosocial Centres (BAfF — since 2026, Federal Association of Psychosocial Centres) states clearly in its guidelines: Biographical methods belong in the phase after safety has been consolidated, not in the acute phase. Anyone who, in an initial reception centre, asks a newly arrived woman about three generations of her family — parents, siblings, uncles, aunts — when at least one of these people is dead, missing, or in acute danger, risks re-traumatisation rather than providing help.

In practice, this means: In the first weeks or months, what Judith Herman described as Phase 1 of trauma treatment predominates — safety, stabilisation, symptom control. Genogram work can be useful here in a minimal, closed form ("who is here with you in Germany?") — a resource map, not a multigenerational exploration. Full biographical work should only follow when clients request it or are clearly able to cope with it.

Symbolism for Unresolved Fates

The McGoldrick standard repertoire uses □ (male), ○ (female), crossed out for deceased. This is insufficient in the context of forced migration. Introduced — not standardised, but common in transcultural practice — are:

  • Question mark notation for persons with unknown fate ("missing since…"). Important: Do not depict as half-deceased, but as a separate category. The fate is unresolved, and must be allowed to remain so.
  • Violence symbolism (small symbol next to the cross) for those deceased through war, torture, or targeted killing. Some practitioners mark this separately from "natural death", as the meaning for survivors is fundamentally different.
  • Geo-marker for family members remaining in third countries — country written next to the symbol, possibly with a dashed line across a drawn border. This visualises the transnational family structure, which in many cases is the defining feature.
  • Timeline anchors for moments of flight: "Family dispersed 2015", "last message 2022". These markers translate biographical time into the otherwise timeless image.

Important: Such extensions are not standards, but locally negotiated conventions. When handing over to other agencies, it must be documented what the symbols mean.

The Interpreter Setting

Triadic relationships — client, interpreter, practitioner — fundamentally change genogram work. The interpreter is not a "neutral tool", but a participant in the system. Practical consequences:

  • Pre-meeting with the interpreter without the client: briefly explain the method, discuss symbolism in advance, clarify which terms even exist in the target language. Words like "foster child", "blended family", "civil partnership" have no equivalent in many languages — this is methodologically relevant.
  • Seating arrangement: Interpreter to the side, not between practitioner and client. Eye contact between practitioner and client should remain possible.
  • Confidentiality agreement: Clients from smaller diaspora communities often have well-founded concerns that the interpreter knows them or knows their neighbours. This concern must be taken seriously — it can block entire areas of discussion.
  • Consistency: Work with the same interpreter over several sessions if possible. Genogram work requires relational depth, which also develops with the interpreter.
  • Symbol agreements should be labelled directly on the sheet — in the clients' language, if they wish. This is appropriation, not folklore.

Complex Family Constellations

Family structures that are considered "special cases" in the German context are the norm in many countries of origin. The genogram must be able to depict them without pathologising.

Polygynous marriages (one man, several wives) are legally or traditionally permitted in parts of West and East Africa, the Middle East, and Central Asia. The genogram should depict all marriages as equivalent partnerships, with clear assignment of children to their respective mothers. Important: In Germany, legally unrecognised second marriages remain effective in family life — simplifying them in the file distorts reality.

Clan and tribal structures organise loyalties, obligations, and decision-making processes in many societies (Somalia, Afghanistan, Kurdish regions). A genogram that only depicts the nuclear family overlooks who actually makes decisions. Here, an additional clan marker can help — without turning it into folklore.

Adoptions and foster arrangements are often informal in many cultures and are not necessarily legally documented. A child raised by an uncle often has a parental relationship with him that is not recorded in any registry office. The genogram must be able to show both.

Levirate and sororate (widow marries the deceased's brother, widower marries the deceased's sister) exist as cultural practices; in conversations, they may be experienced as self-evident or as coercive. Both perspectives must be taken seriously.

Implications for Residence Law

Genogram work plays a dual role in asylum and residence law. On one hand, it is a therapeutic tool; on the other, it can become a document — for example, in asylum proceedings (family reunification, § 36a Residence Act), in guardianship cases for unaccompanied minors (UMA), or in family court proceedings.

This creates a difficult tension: What clients share in a therapeutic setting is meant to remain confidential — but as soon as it is recorded in a genogram, it could theoretically end up in official files. Practical consequences:

  • Clarification at the outset about what will and will not happen with the genogram.
  • Strict separation between the therapeutic genogram and any "official genogram" (e.g. for medical statements). If clients request the latter, it is created separately and with their consent.
  • Sensitive information (undocumented family members, previous political activities, sexual orientation in homophobic countries of origin) should not be included in documented genograms without explicit instruction.

Practitioner Self-Care

Genogram work with refugees is regularly confronting. Secondary traumatisation — the transmission of trauma symptoms to helpers through narrative exposure — is not just one risk among many in this work, but a central one. Consistent supervision, peer intervision, caseload limits, and personal therapy are not luxuries, but essential professional safeguards.

Genogram work has a particular feature: it condenses trauma information into a visual form. A genogram with three crosses for murdered siblings, two question marks for missing persons, and a geo-marker for an imprisoned daughter carries an emotional weight that is not as direct in a narrative text. Practitioners should consciously schedule breaks after such sessions — and avoid immediately following them with care planning meetings or family court hearings.

Practice Vignette

A 28-year-old Syrian client, in Germany for three years, seeks psychosocial counselling for sleep disturbances. In the fourth session — after stabilisation work — a first genogram is created. It shows: father killed in a bombing in 2014, mother with two siblings in Turkey, an older brother missing since the siege of Aleppo. The client cannot say whether he is still alive — the last message is three years old. The counsellor marks him with a question mark, not crossed out. "We’ll leave this open as long as you’re not sure." The client cries. A week later she says: "It was the first time someone understood that I don’t know." The counsellor works with the ambiguity, not against it. Pauline Boss described this as "ambiguous loss" — a distinct grief complex in cases of unresolved loss, which requires specific methodology.

Research Status & Discussion

The prevalence of PTSD among refugees in Germany varies by study and population, ranging from about 30 to 50% — the range is wide and depends heavily on country of origin, migration trajectory, and time of assessment. Comorbidities (depression, somatoform symptoms, substance use) are common. There is consensus in trauma- and migration-sensitive research: the phase-oriented approach (Herman) applies; biographical methods belong in phases 2/3, not in the acute phase.

The question of how much cultural adaptation of the method is necessary is debated. One position (cultural psychiatry around Hegemann/Salman, transcultural family therapy) emphasises the cultural specificity of symbolism and setting design. Another position warns against culturalisation — the risk that social, economic, and legal problems are framed as "cultural" and thus depoliticised. Both perspectives are valid; the methodological line is to work in a culturally sensitive way without losing sight of structural conditions.

The issue of interpreter qualification is well established in research: trained interpreters (language and integration mediators, cf. SprInt network) are clearly superior to family members or lay translators — ethically, methodologically, and in terms of outcomes. The reality of funding in counselling centres often looks different.

Cross-References

  • M4-Lesson 2 (Migration)
  • M4-Lesson 14 (Trauma/Epigenetics)
  • M3 "Trauma-Sensitive Work"
  • M4-Lesson 1 (Cultural Genogram)

Further Links

  • https://www.baff-zentren.org/ — Federal Association of Psychosocial Centres (formerly BAfF)
  • https://www.unhcr.org/mental-health-psychosocial-support — UNHCR MHPSS
  • https://www.dgsf.org/themen/transkulturelle-systemische-arbeit
  • https://www.psychiatrie-verlag.de/ — Hegemann/Salman, Handbuch Transkulturelle Psychiatrie
  • https://www.sprachundintegrationsmittler.org/ — SprInt Federal Association