Genograms in research: participants’ reflections of the genogram process

ABSTRACT The genogram is a visual, symbolic representation of multiple generations of a family, structured in much the same way as a family tree. Genograms emerged within systemic family therapy as an assessment and intervention tool, but in their ability to generate rich data, they are gaining traction as a research method. While the benefits of genograms in therapeutic practice have been well documented, the literature exploring their use in research is limited. This article aims to contribute to this knowledge by considering participants’ experiential reflections of constructing their genograms, a process they engaged in as part of a broader study that explored the intergenerational transmission of family violence. We illustrate that while genograms generated powerful qualitative data, they also had unintended therapeutic and transformative effects on participants which transcended the interview room. We consider the ethical complexities of using genograms as a qualitative method and make recommendations for future research.


Introduction
The genogram is a visual representation of multiple generations of a family, structured like a family tree (see Fig. 1 for example) (Iverson et al., 2005). Genograms can include the symbolic depiction of relatively objective 'factual' information, such as family structure, sociodemographics, deaths, disease and illness, as well as subjective information including relational dynamics, stressful life events, behaviours and culture (Castoldi et al., 2006;Mackay, 2015;Watts & Shrader, 1998). Genograms emerged within systemic family therapy as an assessment and intervention tool (Mackay, 2015;McGoldrick, 2016;McGoldrick et al., 2008), but are used in social work (Hartman, 1995;Piedra, 2016), medicine and health care (Leonidas & Santos, 2015;Werner-Lin & Gardner, 2009), and in education (Crowell, 2017;Hardy & Laszloffy, 1995;Keiley et al., 2002). In their ability to generate rich and immediate data, they are gaining traction as a research tool (Iverson et al., 2005;McGoldrick et al., 2008;Watts & Shrader, 1998). The benefits of using genograms in therapeutic practice have been well documented. Genograms can facilitate clients' deeper, more nuanced explorations of family and, as various authors have suggested, when co-constructed with clients, genograms can support engagement and enhance the therapeutic alliance (Altshuler, 1999;Burley, 2014;Mackay, 2015). The ability of the genogram to develop rapport has also been observed by researchers. Reflecting on their use of visual methods in conjunction with interviews, Rempel et al., (2007) maintained that co-constructed or 'interactive' genograms and ecomaps (a visual method which depicts the individual/family's broader social relationships), were particularly powerful in the research process because they aided rapport and promoted '...a relational process between researcher and participant ' (p.403). In sensitive research that invites participants to disclose information of a personal nature, the development of rapport is essential, and data collection dependent on it. However, as research may only involve a one-off encounter between the researcher and participant, encouraging the development of rapport introduces an ethical dimension, the likes of which is not present in the therapeutic process. In therapy, for example, sessions can run in the mid-long term and endings are regarded as an important part of the therapeutic process, and are carefully negotiated by the therapist. Managing rapport and the close of contact do not necessarily feature as integral components of research training. As such, tools which develop rapport, such as the genogram, may require careful consideration and planning by researchers, to ensure they can work sensitively with participants' (and their own) investments in the research relationship, and the feelings of abandonment that might emerge from the ending of that alliance.
As they provide 'systemic contextualisation', representation of the individual-in-family, genograms can support engagement with social constructionist understandings of reality, moving away from more realist perspectives (Iverson et al., 2005). However, because standard genogram construction typically represents ancestral descent through biological or spousal relations (Tasker & Granville, 2011), it has received criticism for its tendency towards excluding the depiction of counter-hegemonic 'family' compositions, such as non-kin, extra-familial, same-sex or adopted families (Singh, 2009). As it presumes western ideologies of 'family' in its biological preoccupation, it automatically disables the representation of different cultural conceptualisations of 'family' (Singh, 2009;Watts-Jones, 1997). Watts-Jones (1997) proposes an African American genogram, a genogram that transcends the assumption of 'family' as solely biological. Other authors too, have espoused ways that standard construction and notation might be adapted to better represent diverse family compositions and cultural contexts in sensitive and nuanced ways (Milewski-Hertlein, 2001;Tasker & Granville, 2011;Congress, 1994). Ensuring that genograms are capable of depicting participants' conceptualisations of family is an issue for researchers wanting to use them as a visual method, and one requiring careful consideration to avoid eliding or marginalising particular family structures.
In research, genograms have been used to study a diverse range of intergenerational aspects. Watts and Shrader (1998) found that genograms provided an effective visual summary of their data, and functioned as a reflexive tool for participants and researchers during follow-up interviews. Rempel et al., (2007) also attest to the value of genograms in research, and note their ability to facilitate researchers' understandings of participants' families. As a visual methodology, genograms may be particularly beneficial in sensitive research because they can function as an 'intermediary artifact' enabling participants to indirectly express 'difficult memories and powerful emotions' through their drawings (Prosser, 2013, p.188). As with other visual methods, genograms can promote both nonverbal and verbal reflections, enabling exploration of conscious or non-conscious issues and experiences, and uncovering experiences and memories previously unarticulated (Mitchell et al., 2011). Thus, together with interviews, as a visual tool, genograms can support the generation of rich data, both in raw visual form, and by facilitating verbal accounts.
Genograms can be a co-construction of several family members, but they tend to be individually constructed. Even when they are created on an individual basis, genograms represent and, therefore, involve (by proxy) immediate and extended family members and (ex-)intimate partners who are not consulted in how they are represented, nor privy to the consent process (Fontes, 1998;Langford, 2000). Because of this, using genograms in research raises a number of ethical challenges that need to be carefully considered and managed. Furthermore, as genograms incorporate details about a particular group of people, it may increase the risk of identification, (McGoldrick et al., 2008) and this in itself is a major disadvantage of using genograms as a research tool.
As illustrated here, genograms present a myriad of ethical challenges for researchers wanting to implement them. The value of genograms in therapeutic practice and in training has been well reported, and their utility in research is increasingly being recognised. However, literature exploring genograms as a method of qualitative research and, in particular, participants' experiences of the genogram process in research contexts, is limited. In light of their capacity to affect change in people's perceptions when used in therapy, it is crucial that we gain a better understanding of their potential impact on research participants. This paper aims to contribute to the literature on genograms in qualitative research, by considering a small group of participants' experiential reflections of engaging in the genogram process.

Participants
Participants were recruited as part of the first author's doctoral research (supervised by J.C & L.F) which explored women's accounts of the intergenerational transmission of family violence. This study included a small and specific sample of women who identified as having experienced family violence in multiple generations. Fifteen in-depth individual semi-structured interviews were conducted with nine women aged 22-50 (see appendix 1 for participant table). The study adopted a pluralist qualitative approach (Frost & Nolas, 2011) and incorporated genograms, ecomaps, and individual semi-structured interviews. This paper focuses on interview data directly relating to participants' experiential reflections of constructing and engaging with their genograms.
Women were recruited via two UK-based domestic violence (DV) agencies and professional networks. Inclusion criteria for participation related to safeguarding, and required women to be 'immediately safe' (Sullivan & Cain, 2004) and away from violence at the point of interview and, where relevant, to be deemed by agencies working with them as such. At the time of interview, the majority of participants were either receiving or had historically received support from specialist domestic violence services (n=8), only 1 woman had never received any specialist DV support. Two women were residing in refuge at the time of interview. Others were attending counselling, or had access to less formalised support systems such as church or peer support groups where they were used to talking about their experiences of violence and their intimate relationships.

Recruitment
Recruitment was a relatively slow process, and some women who were initially interested decided not to participate, largely due to concerns around anonymity. Safeguarding issues also cropped up during recruitment, for example, one woman wanted to bring along her new partner to the interview, and another said that she would have to ask permission from her family before she agreed to take part. These examples illustrate the complexities in family violence research, and show the potential vulnerability and safeguarding issues (for researcher and participant) that family research -involving family by proxy, might entail. During the recruitment phase, the first author contacted a total of 12 organisations, nationally and locally, that were either dedicated DV or family services. The recruited cohort consisted of 8 White British women and 1 White Italian woman. As this sample comprised white and heterosexual women only, it is limited in its capacity to reflect the diversity of the target population.

Ethical Considerations
This project received ethical approval from The University of Northampton's Social Sciences Research Ethics Committee. Researchers adhered to the ethical standards of the British Psychological Society (BPS, 2009). We intend to discuss the ethical complexities of this project in greater depth in a separate publication, but outline the key ethical considerations, here.
To ensure that potential participants were fully informed, (first author) met with each potential participant in person to explain the nature of the research, genogram construction, their involvement, and ethical rights and protections.
As this project required participants to share material of a highly personal nature, there was a risk of inducing secondary traumatisation and emotional upset in participants. There are risks associated with recollecting traumatic incidents (Carter-Visscher et al., 2007), such as violence, and of genogram production (Crowell, 2017). However, various authors indicate that while interviews might induce a low level of distress, quickly afterwards, participants typically recall their experiences positively (Bunnell & Legerski, 2010;Carter-Visscher et al., 2007). The interviewer (first author) had prior training and experience of working with families affected by violence in a research capacity, was cognizant of the complex safeguarding issues inherent in research of this nature, and was experienced in utilising a distress protocol. Following participation, where necessary, participants were signposted to relevant agencies, or referred to organisations directly for onward support. One woman was signposted to a rape counselling service, another to a DV counselling service, and additional support was sought for 1 woman accessing DV services.
During participation, mindful that the material could be emotionally challenging, women were offered breaks at appropriate points in the research process, or where signs of upset were visible. Women were also offered the opportunity to break down genogram construction/interview over a number of sessions. It was envisaged that this would not only help to minimise distress by giving women a break between sessions, if they wanted it, but it would also help to generate a greater level of complexity in the data, representative of family and intimate partner violence. Four women attended once, four others attended twice, and one woman attended on three occasions.
To ensure that participants did not interpret intergenerational trends in their genograms as fixed and unchangeable, or as prophetic of their own futures, (first author) was transparent about the limitations of genograms from the outset. Participants were informed that their genograms provide only one perspective, a symbolic representation of a given time, and that they are limited in their capacity to fully and holistically reflect the complexities, contexts or transience of relationships over time.

Genogram Construction and Interviews
To ensure participants had a good understanding of how to create genograms, they were shown examples and provided with an explanation of how to construct them, and informed of how they would be used to guide the interview. Participants were also shown an electronic example of a genogram (created using GenoPro 2011 software) to give them an idea of how their hand-drawn genograms would look after they had been electronically re-created and anonymised by the researcher. The study was designed so that genogram construction would be, to a certain extent, informed by the GenoPro software, and the symbols made available to participants were determined by its legend which included 36 'emotional relationships' such as 'harmony', 'close', 'distant', 'conflict' etc. In order to represent changes to family structure and relationships over time, the women were invited to construct two genograms each, one 'Retrospective', depicting family composition and relational dynamics in childhood, and the other 'Active', representing family at the time of interview. Typically, the women identified experiences of violence in 4 generations of their families.
(First author) provided step-by-step support to help participants represent relationships technically accurately, for example ensuring that a line was drawn vertically to represent a child rather than horizontally, which could represent a marriage. Despite this, the technical construction elicited some anxiety in several of the women. In these cases, genograms were produced as a co-construction, and the researcher drew them as participants talked through who they wanted to include and what they perceived the relationships to be. To ensure the researcher accurately captured the information, they echoed participants' instructions both before and as they drew to enable participants the opportunity to correct or make changes. A member-checking phase was also implemented after interview which enabled participants to contact the researcher with amendments to their electronic genograms. Because of the issues in interpreting genograms (Rohrbaugh et al., 1992), and visual methods generally (Banks, 2012), genograms were used in this study as a graphic elicitation tool, and were not themselves analysed. While interviews focused on family violence, questions relating to genogram construction were also explored. This allowed the documentation of women's experiences of engagement in the genogram process.

Data Preparation and Thematic Analysis
Interviews were audio-recorded and transcribed verbatim, and genograms were electronically recreated. Transcripts and genograms were anonymised, and all names, locations and identifying information were either replaced with pseudonyms or omitted. Women's transcripts were coded for reflections related to the genogram method, including experiences of construction, limitations, and feelings about depicting families/relationships. For the purposes of this paper, all textual data relating to genograms was extracted from the women's transcripts/reflections and thematically analysed (Braun & Clarke, 2006). Cross-coding formed part of the doctoral research, and during preliminary analysis all three authors coded the same extract of a 39-page transcript, and discussed observations and coding in supervisory meetings.

Participant Reflections
Thematic analysis of women's reflections on the genogram process identified three key themes: 'Reenvisioning Family, Reframing Self'; 'Simplifying the Complex: The Limitations of Labels'; and 'Genograms as Transformative'. The first theme offers insight into how genogram production functioned as a reflexive tool for participants, facilitating renewed understandings of themselves and their families. The second, illustrates participants' struggles in attempting to symbolise their histories of violence and highly complex family relationships in genogram formation. The final theme describes how some participants used their genograms outside the research space, to connect to family or to instigate changes in their relationships. We discuss these findings below, considering the value of genograms in the data collection process, and the ethical implications they bring to the research context.

Re-Envisioning Family, Reframing Self
In this theme, we explore how genograms shifted the women's conceptualisations of family and self. Renewed understandings were expressed by some participants as positive and empowering, but by others as surprising. We consider the capacity of genograms for inducing new insights and 'altered perceptions' (Hartman, 1995), and discuss the implications for research.
Constructing her genogram enabled one of the women (Naomi) to see her family from a more reflective and balanced perspective: The symbolic depiction of the family's relational dynamics enabled Naomi to view her family system in its entirety, and to see how other members had been touched by violence. It also facilitated an understanding that violence was perhaps more embedded within the family system than she had previously understood, or perhaps, than had been expressed in the family narrative. As Naomi alludes, genograms might make the individual's lived version of the story visible for the first time.
Understanding that violence originates from maternal as well as paternal relations, makes space for her to alter her identification of paternal relations as the source of all familial discontent. In this sense, Naomi's genogram allowed her to move polarised stories of family violence, which individualise and blame certain members, towards a more integrative account which considers violence and victimhood across the whole family system.
Like Naomi, Georgia's genogram helped to illuminate other family members who had suffered violence as she had: Quotes above exemplify how participants' genograms helped to uncover or validate other family members' experiences of violence. As a visual method, they generated information that verbal accounts alone may not have produced. In making particular aspects of family visible, they illuminate distinctions between lived and narrated stories, and the gaps -the aspects/persons that participants elide from depictions or accounts (Rempel et al., 2007), the information that they do/do not know, and what they can/cannot articulate. The key purpose of genograms in systemic therapy is to elicit new insights by highlighting relational patterns across the system. Quotes indicate that genograms had a similar therapeutic effect on research participants, and this signals a blurring of the boundaries between clinical and research impact. Indeed, one participant directly remarked on the likeness between genogram production and therapy: By drawing a parallel with counselling, not just a 'regular' session but 'a huge counselling session', Jenny gives us a glimpse into the emotive and embodied experience of the research process, and specifically, of depicting her family on 'paper'. While this quote supports genograms' capacity for therapeutic impact, it also illuminates the possible emotional toll on research participants. It is this potential for instigating a metaphorical opening of Pandora's Box in the research space that carries with it the greatest ethical challenge for researchers wanting to implement genograms. Perhaps these effects are an inevitable consequence of using a therapeutic tool in research. Nonetheless, they necessitate our attention, and demonstrate the need for greater investigation into the impact of using genograms with research participants.
Isla's Retrospective genogram (see Fig 2.) sheds light on the physical abuse running through the family from the 4 th to the 2 nd generation. Reflecting on her genograms enabled Isla to link her own behaviours in adulthood with intergenerational patterns in her family-of-origin: Here, Isla makes a connection between her behaviours in adulthood and her family's history of physical abuse. This demonstrates an awareness that her response to physical restraint when being arrested in adulthood ('I've actually lost control and attacked whoever's coming towards me') might be linked to her early experiences, perhaps to those which saw restraint on her movement and freedom ('She used to lock me in the cellar', 'I was always locked in my room most of the time'). Engaging with her genogram, elicits a shift, an 'altered perception' (Hartman, 1995)  personality trait ('like I am'), she can see it as a co-constructed, congruent response to her family history.
Constructing their genograms, led some of the women to identify one individual as the root cause of the disharmony in their family systems. These revelations were accompanied by a strong sense of injustice and polarised language which represented those identified as wholly malevolent: Jenny: So when it's down here on paper and you're going, oh my God, and she was abused by him and I was abused by him, and -you know, and he was just evil, my dad was just evil, you can see all the people he's abused, including my auntie in a way.
Depicting her family makes the intangible (and unarticulated) tangible, more concrete, and the 'truth' of this visibility seems incontrovertible, for Jenny. She expresses a sense of shock ('oh my God') at seeing her family symbolically 'on paper', and the renewed perspective of her father that this induced ('he was just evil, my dad was just evil'). Methodologically, genograms seemed to generate new insights from participants which may not have been produced without this kind of visual tool. As such, insights are a co-production, created in the context of the researcher-participant encounter, and in the interactions between participant and methodology.
Echoing Jenny, Sue expressed a similar sense of surprise. Sue's interview was peppered throughout with references to the 'closeness' of her family. Reflecting on the final image of her genogram though, instigated a re-framing, a movement from a narrative about closeness to one which better aligned with the distance represented in her visual depiction: Rather than inducing a more systemic framing of the family system, sympathetic with all members, Sue's genogram resulted in an identification of one person as pivotal in the damage and dissolution of what she considered to be her 'close family'. Sue's experience of her genogram as 'scary' signals a level of shock at seeing a visual representation in stark contrast with her verbal narrative of 'closeness'. These kinds of contrasts cultivate space in which to explore discrepancies, and generate rich interview data. However, epiphanies, or indeed, the unveiling of 'myths' induced by genograms, illuminates their power to shift realities of relationships (Iverson et al, 2005). The strong expressions of surprise, as expressed by Sue and Jenny, highlight the potential risk of inducing emotional upset or anxiety (Crowell, 2017) when using genograms in sensitive research.
When used in conjunction with interviews, genograms have enormous potential to generate rich qualitative data. They can aid researchers' understandings of family structures and relationships and, as a visual methodology, they make visible the previously unidentified and unarticulated. They highlight discrepancies between family narratives and participants' lived stories and, as a result, can lead to renewed insights of self and family. This kind of 'therapeutic effect' presents an ethical challenge, and highlights the risk of inducing lasting effects and emotional responses in research participants.

Simplifying the Complex: The Limitations of Labels
This theme explores the limitations of genograms in enabling accurate depiction of participants' families, and the struggles that emerged for them in trying to symbolise their complex relationships and histories of violence.
Below, Amy articulates the difficulties of symbolising familial relationships and roles when they subvert normative, hierarchical family structures: Int: Anything you want to add within these immediate family relationships?

Amy: I haven't really put how I felt, but I don't think there's anything that -because it's such a complicated feeling, and this is where it gets really difficult because I took on a maternal role in that situation but it wasn't necessarily out of love but it was more of a necessity, so maybe I could just make a little note somewhere?
As genograms typically represent genealogies via hierarchical and linear ancestral descent, they risk neglecting different cultural and economic contexts of family that prioritise, or that require-out of necessity, shared family responsibility, community involvement, or the subversion of traditional hierarchical roles, that might more accurately represent 'family' for some (Krause, 1998;Singh, 2009). As they created their genograms, participants tried to navigate these kinds of restrictions to ensure their experiences were made visible, and represented graphically. As Amy discovered, this was not always possible through the symbols alone. In order to circumvent some of the limitations, the research process was flexible, allowing participants to make notes on their genograms, or to date particular interactions, and to communicate this information dialogically in interview.
Depicting ambivalence, a feature of violent relationships (Sammut Scerri, 2015), was also difficult for some of the women:

Int: What do you mean?
Amy: Well, when we were doing this map [...] I was really struggling to -because of how complex my relationships are with people that they could be abusive and loving in the same time, which makes absolutely no sense to anybody who is outside of that situation. How you can love someone who is so horrific to you, and how they can love you, and they do love you, which is the most twisted thing in the whole -as close as they can understand love I suppose. And it's hard to say.
Amy's quote, not only illuminates the limited capacity of genograms to be representative, but also how the process of working through genogram construction can generate valuable research data. In this case, we get a glimpse into the turmoil accompanying ambivalent relationships and we learn that Amy's relationships, affected by violence, are counter-hegemonic, and as such, are difficult to articulate lest to label. The frustration of the reductionism of genograms generated data in its own right, provoking participants to further elaborate on the complexity of family relationships, and to identify, navigate, and reconcile the reductionism of their genograms with detailed verbal accounts.
Participants also struggled to represent relationships retrospectively, especially where they considered them to be volatile and unstable over time. For example, Kerry illustrates how family 'truths', dependent on context, are changeable: As genograms are generally reflective of a specific time, it is more difficult for them to be fluid, capturing the temporal and transitory nature of family relationships and composition over time. As such, they can be somewhat static, risking the portrayal of family dynamics as a-contextual or 'timeless'. In sensitive research, this risks entrenching unhelpful discourses involving intergenerationality, especially around proclivity to repeat family patterns.
This theme has illustrated that while genograms can generate rich research data, they can also mute the visual depiction of dynamic and rapidly changing relationships, of those that subvert hierarchical structures (such as caring roles), and of ambivalent relationships. Without sufficient symbols or techniques to notate the complexity, variation and transitory nature of family contexts and relationships, especially those counter-hegemonic, we risk disabling the representation of families as participants envisage them. Genograms provide a 'snapshot' of family, and are, to a certain extent, necessarily limited in the information they symbolise. In isolation this 'snapshot' is overly simplistic and reductionist, and presents a difficulty for researchers hoping to analyse genograms in isolation. However, interviews can counter these restrictions by giving participants the opportunity to talk about the difficulties they experienced in trying to symbolise their families. In this way, the restrictions themselves can enrich participants' accounts, allowing them to identify and talk about the tensions between their family-of-origin and normative, depict-able 'family'.

Genograms as Transformative
This theme represents how some participants, of their own accord, re-created or engaged with genograms outside of the research space. There is some cross-over between this final theme and the first. Both touch upon the ways that genograms impacted on participants; however, this theme explores direct reports from participants about the active ways they used genograms, or insights garnered from construction, outside of the research space. We explore the capacity of genograms to impact on people's lives in the long term, and consider the ethical implications of this for research.
As a risk-reduction measure, research-related paperwork was restricted and women were made aware that they were not required to carry out any research into their family histories. In spite of this, two of the women informed the interviewer that they had created their own genograms at home, one prior to interview, and the other, in-between sessions. Below, Claire notes the practice run she did with her sister (Candace), the day before her interview: Showing her 'family tree' to her son's girlfriend gives Sue a way of articulating the danger of Bob, her worries about Darcy being in the house alone with him, a worry she 'would never have said'. Her genogram then becomes a powerful non-verbal tool which supports her indirect dialogical communication of the history and of her concerns.
Taking part in the study inspired both Claire and Sue to engage with their histories through the partial (re-)creation of their genograms. By constructing them outside of the research space, it enabled both women to connect with their 'family' members in ways they may otherwise not have done without participation in the study. This is an unintentional effect of the research that enables us to envisage how using genograms can elevate risk.
Two participants felt that their first interviews were transformative and instigated new ways of relating with family members. Below, Kerry suggests that her genogram made her more conscious of the distance that had grown between her and her family, which allowed her to actively foster those relationships, on her terms: The research process seemed to be especially meaningful for Kerry, giving her a reflex space in which to take stock of relationships and to envision and instrument a rebuilding of relationships. Further, she implies that engagement with her genogram triggered a sense of empathic understanding and an acceptance of family members' difficulties. Her renewed perspective establishes her as part of the family, but not bound by it, not defined by its history. More importantly though, is the empowered way she positions herself, as an agent for more fulfilling, and healthy relationships. Discussing the use of genograms and ecomaps in social work practice, Iverson et al (2005) maintain that they can '... challenge the delimiting realities of the present and open up new possibilities for understanding and action. ' (p.16). Similarly, Rempel et al., (2007) propose that genograms and ecomaps can uncover unrealised potential in family systems and social networks. Kerry's quote indicates that in research, even in one-off encounters, genograms can similarly uncover potential and instigate participants' renewed understandings of self and other, and alternative ways of relating.
Similarly, Bettina maintains that since participation in the study, the relational dynamics in the mother-daughter relationship altered: Perhaps like Kerry, Bettina's engagement with her family's history inspired a more systemic envisioning of the family, and with it, an understanding that all members are navigating their own difficulties. While Bettina's quote speaks of finding strength and feeling empowered, it highlights how investigating personal aspects of people's lives might remain with them and in effect beyond the researcher-participant encounter, leading to marked changes in their lives. This theme demonstrates the ways that genograms (or insights garnered) spilled outside of the research space and into the lives of participants. These are the kinds of therapeutic effects that genograms would be used to promote in therapeutic practice. In the context of research though, they are in essence a disruption, unintended effects that we may not be prepared for as researchers. This gives us insight into the therapeutic power of genograms, of the ethical complexities of applying a therapeutic tool in research, and highlights the need for further investigation into the possible impacts on research participants.

Discussion
Genograms are used in therapeutic practice to promote clients' deeper reflection, elicit renewed understandings of self and family, and to identify alternative ways of relating (Mackay, 2015;McGoldrick et al., 2008). They enhance the therapeutic alliance, developing client-therapist rapport and trust, and contextualising the client's lived experience of the micro system (Altshuler, 1999;Burley, 2014;Mackay, 2015). Despite gaining traction as a research tool, the literature exploring participants' experiences of engaging in the genogram process is limited. This paper contributes to this literature by providing insight into the experiences of a small cohort of research participants.
The cohort of women were recruited to participate in a qualitative study investigating the intergenerational transmission of family violence. This study included a small (n=9) and specific sample of women who identified as having experienced family violence in multiple generations. The women had contact with formal domestic violence or counselling services, or non-formal support systems (such as peer-support and church groups), where they had experience of reflecting on and talking about their histories of violence and intimate relationships. This study required participants to share personal aspects of their lives, and as such, it likely attracted a particular cohort of women, who had experience of and were keen to engage in their family histories.
As a visual method, genograms provided the women with a material object through which to indirectly express 'difficult memories and powerful emotions' (Prosser, 2013, p.188). They helped to anchor interviews, to contextualise participants' within their micro systems, and prevented participants from having to provide long-winded descriptions of family members and their position/relationship to others. The generative capacity of genograms was a prominent feature of this study, and used in conjunction with interviews, produced a wealth of rich data which could not have been generated using interviews alone. While participants in this study expressed feeling restricted by the reductionist labels of genogram construction, interviews enabled them to provide detailed accounts which expanded on their genograms, and explored tensions and consistencies between actual and symbolised family. This paper illustrates the numerous ethical challenges that genograms bring to the context of research. While the women in this study reflected on their engagement in the genogram process in predominantly positive ways, it is also evident that constructing their genograms had unintended therapeutic effects, induced a deep level of reflection on family history, and transformed the ways they envisaged and understood themselves, their family members, and the role of violence within their family system. These transformative effects (altered perception and renewed insights) transcended the interview room, out of the control of researchers, and into participants' lives. This signals a blurring of the boundaries between clinical and research impact, and troubles the idea that research, such as this, which explores highly personal material, remains within the researcherparticipant encounter. This locates genograms as an ethical challenge for researchers wanting to use them, and highlights the need for further investigation into their application in research.

Conclusion
When used in research, genograms present a range of ethical challenges that necessitate researchers' attention. The transformative effects reported by participants involved in this study highlight the potential for genograms to elicit emotional responses when used in research. In order to reduce the risk of emotional distress, we provide five key recommendations for researchers wanting to use genograms: Firstly, we suggest that researchers are explicit about the potential therapeutic effects of participation in studies involving genograms, particularly around their capacity to elicit renewed understandings of self and family and, as a result, to induce strong emotional responses.
Secondly, researchers should ensure that participants either have existing contact with support agencies, or are able to access support if necessary. Genogram studies may attract participants interested in connecting with their histories, or in understanding more about the 'patterns' that they have already observed within their families. In sensitive research, it will be especially important that they are able to access onward emotional support to explore issues brought to the fore by the research. In this case, following participation, several of the women showed a desire to access specialist emotional support (e.g. for DV and rape). While the research did not initiate this need, it did centralise it as an issue for the women's attention. As such, it was important that the field researcher was aware of appropriate services, and could signpost/refer participants as and when they were ready to access support.
Genogram construction is time-consuming, for this reason, this study was designed to be flexible enough to enable women to break down the visual method/interview process, or to have follow-up interviews over a number of sessions. This allowed women to have a break between sessions, facilitated a sense of rapport, and better captured the complexities and transitory nature of relationships. The structure and duration of data collection sessions requires careful consideration from researchers to prevent over-taxing participants.
We recommend researchers make the limitations of genograms explicitly clear to participants at three points; prior to consent, during construction, and in debrief. This is with a view to preventing participants construing their genograms as a 'map' of their family past, present and future. In sensitive research, in particular, envisioning proclivity to repeat family patterns could prove incredibly distressing to participants. Explaining the limitations around the genogram's lack of ability to represent extra-normative family compositions and temporality, would be especially helpful in establishing a sense of the inherent issues of symbolising family.
Finally, we suggest that researchers consider alternative ways that participants might represent their families beyond biology and hierarchy, whether this is through graphic of textual notation, or verbalised in interview.