Ms Uruj Anjum, Psychotherapeutic Counsellor, MBACP, Msc | 17/09/2024
In my past experience as a genetic counsellor working in the NHS, I often found myself delving into the intricate tapestry of family histories to better understand how genetic conditions are passed down through generations. One of the most valuable tools in this process is the pedigree, or family tree, which provides a visual representation of a family's medical history and relationships. In this blog post, I will guide you through the process of drawing a pedigree suitable in the therapeutic space and share how it can enhance our understanding of family dynamics and inheritance patterns for your counselling practice.
What is a Pedigree?
A pedigree is a diagram that shows the biological relationships between family members across generations. It uses standardized symbols to represent individuals and their connections, allowing genetic counselors like me to assess genetic risk, identify patterns, and gain insights into family dynamics. Lets adapt this for our counselling work.
Steps to Drawing a Pedigree
1. Start in the Middle
Begin by placing the client in the center of the page. This individual, known as the proband, or your client, is the starting point for exploring the family tree. The proband is usually marked with an arrow to indicate their position as the focus of the pedigree.
2. Use Symbols
Use standardized symbols to represent family members:
Squares for males
Circles for females
Diamond symbol for nonbinary/gender diverse and unknown
Diamond with P for pregnancy
This consistency helps quickly identify gender and simplifies the diagram's interpretation. Of course, there are many more symbols, however let's start with the most common.
3. Draw Relationships
Use horizontal lines to connect individuals who have children, representing their union. A marriage is depicted with a horizontal line connecting the two symbols, while children are connected to this line using vertical lines.
4. Draw Siblings
Arrange siblings from oldest to youngest, with the eldest on the left. This chronological arrangement helps maintain clarity and consistency in the pedigree.
5. Draw Cousins
Connect cousins to their respective parents using vertical lines. When depicting the children of siblings, follow a similar approach to maintain the pedigree's structure.
6. Indicate Conditions
Use shading or symbols to represent individuals affected by certain conditions. For instance, shaded symbols can indicate affected individuals, while unshaded ones represent unaffected individuals. This visual coding aids in quickly identifying patterns of inheritance. This can include genetic diagnoses, mental health conditions, and health problems. A legend is used to show the different diagnoses. See examples below.
To further enhance this pedigree, I utilise the following methods to visualise relationship dynamics, family patterns, and attachments:
Capture Relationship Dynamics
Highlight the quality of relationships using colors and line styles. For example, a green line can represent a strong bond, while a red, wavy line indicates a strained relationship. These nuances provide valuable insights into family dynamics and emotional connections.
Mark Endings and Losses
Indicate the end of relationships with a unique symbol (≆), and use a line to mark the passing of family members. This helps illustrate the number of losses experienced by the individual and how they have coped with these events. Losses include bereavement, miscarriage, stillbirth, termination of pregnancy, termination for medical reasons.
Diversity and Mental Health
Include information about diverse family structures and mental health histories. This might involve noting LGBTQ+ relationships, single-parent households, or family histories of mental health issues, trauma, and suicide. Understanding these aspects provides a comprehensive view of the family's dynamics and potential challenges.
Cultural Aspects
Include information about consanguinity as this is relevant to know for inheritance patterns. Cultural attunement is important when exploring this.
Identify Patterns
As you construct the pedigree, look for patterns such as single motherhood, absent fathers, caregiving roles, and communication styles. Recognizing these patterns can provide valuable context for understanding the family's history and current dynamics.
Reflections on Pedigree Drawing
Drawing a pedigree is more than just a technical exercise; it is a window into a client's world. It helps me see the broader picture of how a client fits into their family system, reflect on their relationships, and tailor my counseling approach. The pedigree is ever-evolving, providing a solid foundation for understanding clients' unique experiences.
Incorporating pedigrees into your counselling practice can offer a deeper understanding of family dynamics, inheritance patterns, and individual experiences. By meticulously mapping out these connections, we can uncover vital information that aids in providing personalized care and support.
Do you utilize a pedigree in your work? Would you be interested in an online class demonstrating the pedigree drawing process?
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