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Cebu Doctors’ University

College of Nursing

NCM 117
Care of Clients with Problems with Maladaptive Patterns of
Behavior

RLE 1M:
Genogram and Transactional Analysis

Submitted by:

Amante, Vanessa
Amores, Kate
Basalo, Danica Kate
Besin, Chast
Borces, Nicole Mykaela
Dandasan, Dave Antoni
De Gracia, Dominic
Eslit, Denzelle Kate

Facilitator:
Ms. Angela Perez

Date Submitted:
February 6, 2022
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Course Learning Outcomes

CLO#1: define the terms related to a genogram and transactional analysis.

● Genogram ● Transactional Analysis

- Family - Transactional Analysis
- Nuclear Family - Transaction
- Extended Family - Complementary
- Multigenerational Family - Transaction
- Generation - Crossed Transaction
- Genogram - Ulterior Transaction
- Ostensible/Overt Level
- Ulterior/Covert Level
- Duplex

CLO#2: State the importance of making a genogram and transactional analysis

CLO#3: Enumerate the information needed in making a genogram.

CLO#4: Illustrate the different symbols used in making a genogram.

CLO#5: Enumerate the guidelines in constructing a Genogram.

CLO#6: Differentiate the kinds of transaction utilized by clients

CLO#7: Discuss methods of time structuring in Transactional Analysis

CLO#8: Analyze situations illustrating each method in time structuring in Transactional

Analysis

CLO#9: Appreciate transactional analysis as a tool in promoting effective client

relations.

CLO#10: Demonstrate the beginning skills in constructing a three-generational

genogram.
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TABLE OF CONTENTS PAGES

CLO#1: Define the terms related to a genogram and 4

transactional analysis.

CLO#2: State the importance of making a genogram and 10

transactional analysis

CLO#3: Enumerate the information needed in making a 11

genogram.

CLO#4: Illustrate the different symbols used in making a 12

genogram.

CLO#5: Enumerate the guidelines in constructing a 17

Genogram.

CLO#6: Differentiate the kinds of transaction utilized by 18

clients

CLO#7: Discuss methods of time structuring in Transactional 18

Analysis

CLO#8: Analyze situations illustrating each method in time 19

structuring in Transactional Analysis

CLO#9: Appreciate transactional analysis as a tool in 21

promoting effective client relations.

CLO#10: Demonstrate the beginning skills in constructing a 22

three-generational genogram.

References 23
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CLO#1: define the terms related to a genogram and transactional analysis.

(ESLIT, Denzelle)

● Family: Members who are related by birth, marriage, or adoption.

● Nuclear family: A family group consisting of a mother, father, and children.

● Extended family: A family group that extends beyond a nuclear family

consisting of grandmothers, grandfathers, aunts, uncles, etc.

● Multigenerational family: Family households consisting of three or more

generations.
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● Generation: All of the people born and living at about the same time, regarded
collectively.

● Genogram: A diagram illustrating a person’s family members, how one another

is related, and their medical history/patterns.

● Transactional Analysis: Psychoanalytic theory developed by Eric Berne where

social interactions (or transactions) are analyzed in order to identify which ego
states are present
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● Transaction: Communication exchanges between people

● Complementary Transaction: When two people's ego states are sympathetic

to one another in that what one says and the response that is expected to be
received, and actually what's received, are aligned/parallel.

● Crossed Transaction: When a person says something from one ego state, and
receives a different response than he/she is expecting. These may lead to
breakdowns in communication and/or conflict.
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● Ulterior Transaction: When two messages are conveyed at the same time
consisting of a social message (overt level) and a psychological message (covert
level)
○ Ostensible/Overt Level: The social aspect including one’s words

○ Ulterior/Covert Level: The psychological aspect including emotion,

history of relationship, etc.

○ Duplex: Two level transaction in which beyond the obvious transaction,

there is a hidden transaction between the two ego states of the persons
concerned.
■ Example:
● Person #1: "I need you to stay late at the office with me to
complete my work." (Adult words) - body language indicates
sexual intent
● Person #2: "Of course." (Adult response to Adult statement).
(Child accepts the hidden motive).
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○ Angular: One person gives an open message accompanied by a hidden

message, and the second person gives an open message which is a
response to the hidden message.
■ Example:
● Sales man: "This one is better, but you can't afford it" -
(Adult-Adult but Adult-Child)
● House wife: "That's the one I will take". I'll show that
arrogant guy I'm as good as any of his customers
(Child-Adult)

○ Locked: Transactions in which communication seems to be stuck or

unbreakable.
■ Example: There may be different variations of the person indicating
the child is bad or the child claims that they are not bad, but they
are overall still stuck within the Child or Parent ego states.
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● Bulls-Eye Transaction: Skilful series of transactions where the person

consciously chooses from their Adult to address all three ego states of the other
person
○ Example: First addresses the emotion held in Child, then allows the person
to feel heard and understood (Parent), and then addressing Adult and
inviting the person to begin thinking and problem solving.

● Ego State: Consistent pattern of thinking, feeling and behavior.

● Time Structuring: Eric Bern believed that human beings need to structure time
and relationships with other people in some way. There are six possible ways to
structure this: withdrawal, rituals, pastimes, activities, psychological games, and
intimacy.
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● Ritual: highly structured and stylised ways of interacting

○ Example: “Hello, how are you?” and “Thanks, good, and how are you?”

CLO#2: State the importance of making a genogram and transactional

analysis (AMANTE, Vanessa)

Importance of making genograms:

● More information regarding the medical history of a family is revealed.
○ Creating a genogram reveals a pattern related to past and present
illnesses, enabling individuals to immediately see their susceptibility to
certain diseases that run in the family.
○ If there are any hereditary diseases and common medical conditions it
allows them to adjust their lifestyle and seek medical attention to live a
healthier life.
● It depicts the emotional bonds that exist between members of a family.
○ The genogram gives us the added ability to indicate bonds between
relationships, such as emotional qualities where it can depict emotional
connections between each family member.
○ To reflect emotional relationships, it uses symbols and distinct line
designs.
● Provides a better understanding of the family dynamics.
○ Most of the culture practiced within the family can be attributed to lack of
motivation and even low self-esteem. A genogram helps families
understand these aspects, as well as the strengths and limitations within
the household members.
● It aids professionals in making better assessments.
○ Genograms give clinicians a snapshot of the entire family's medical history,
helping them to identify potential medications and complications that may
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arise during therapy. With this, the underlying variables that influence the
patient's behavior can be seen immediately by therapists.
○ Professionals can make better assessments of the problem and design
methods to benefit everyone involved in the case by using the information
offered by the genogram.

Importance of Transactional Analysis:

● Transactional analysis can be used to help improve other psychological aspects
such as self-efficacy.
● Provides greater understanding of an individual's communication behaviors and
how these impact on their relationships.
● It helps people to be able to gain deeper insight into their own reactions,
thoughts and emotions which they might not have been aware of before,
providing them with greater self-awareness.
● It can help eliminate unhelpful thoughts, feelings, and actions.

CLO#3: Enumerate the information needed in making a genogram. (AMORES,

Kate)

Making a genogram:
● Determine the purpose for the genogram.
Knowing the purpose for making a Genogram will also make it easier to
determine the kinds of information you need to look for. It is also important to
have an idea who to approach and how to introduce the questions to them.
● Make a questionnaire to gather information.
Before gathering the data, it’s best to formulate a set of questions that will help
to extract the needed information as quickly, as accurate, and as detailed as
possible.
● Do research in the field.
This step is about getting into contact with possible sources of information.
● Gather document-based information.
Seek documents, family books, albums, medical records,or even the internet to
gather more info about your family. You can also use these reference materials
for cross-checking what you’ll learn from interviewing family members.
● Know the symbols.
Genograms use a variety of symbols to represent family members and their
relationship with one another.
● Draw the members and connect them with each other.
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Each generation is drawn below the previous one, with grandparents at the top,
parents on the next level below, and the children at the bottommost portion of
the genogram. The male parent is always drawn on the left side while the female
is on the right. Children also follow a drawing direction, with the eldest placed on
the leftmost portion and the youngest on the right in descending birth order.
● Dive deeper into detail.
After doing the basic connections, it’s time to delve further into detail and include
the specifics of each relationship.

CLO#4: Illustrate the different symbols used in making a genogram. (BASALO,

Danica Kate)

Basic genogram symbols carry necessary information of a person: gender, birth,

and age, immigration, sexual orientation and pregnancy situation, etc. Genogram
symbols usually display the date of birth (and date of death if applicable) above the
box, and the name of the individual underneath. The inside of the symbol will hold the
person's current age or various codes for genetic disease or user-defined properties:
abortions, still-births, SIDS, cohabitation, etc.
In a genogram, males are represented by a square and females by a circle. An
index person, which is known to be an individual affected with the first known case of
an infectious disease or genetically transmitted condition or mutation in a family, is
represented by either a square within a square if male and a circle within a circle if
female. Additionally, the birth year of an individual is indicated above the symbol while
their age is placed inside it.

For a diseased individual, an “X” mark is placed inside the symbol to indicate that
they have already passed away. If their age at the time of their death is known, it may
be written in the center of a symbol with an “X” mark. Moreover, if the year of birth and
death is indicated, it is placed above the symbol.
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One’s sexuality can also be displayed in a genogram. A symbol with an inverted

triangle represents homosexuality. On the other hand, an inverted dashed-triangle
represents bisexuality. Furthermore, a square inside a circle represents a male to female
transgender and a circle within a square represents a female to male transgender,
whereby their original gender is indicated inside their current gender.

A triangle is used to represent a pregnancy, a miscarriage or an abortion. In the

case of a miscarriage, there is a diagonal cross drawn on top of the triangle to indicate
death. Abortions have a similar display to miscarriages, only they have an additional
horizontal line. A still birth is displayed by the gender symbol; the diagonal cross
remains the same size, but the gender symbol is twice as small. As for the children,
there are three different types: biological/natural child, adopted child and foster child.
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In the case of multiple births such as twins, triplets, quadruplets, quintuplets,

sextuplets, septuplets, octuplets, or more, the child links are joined together.

For individuals who have lived in more than one culture, a single squiggly line is
indicated above their symbol. On the other hand, individuals who have experienced
immigration have double squiggly lines instead of one.

A genogram can also indicate the type of relationships in a family. It can be

illustrated whether a couple is married, engaged, common-law, divorced, or separated
with simple color-coded lines and symbols.

Emotional relationship symbols are used to describe the emotional bond between
any two individuals in the genogram. One can tell whether a couple is in love or not by
checking the connecting lines' colors. Usually, green means a couple is in a harmonious
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relationship, while red implicates the conflicts between them. If there are blue lines in
the diagram, then it is implied that domestic abuse is present in this family.

Medical genogram symbols play the most crucial role in genograms. Medical
genograms provide a quick and scientific context that indicates the possibility of an
individual's health risks. For Monochrome Medical Genogram Symbols, they can denote
certain addictions, and physical or mental Illnesses that an individual may have.
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Colored Medical Genogram Symbols consist of all common genetic diseases, such
as heart disease, diabetes, cancer, down syndrome, depression, and asthma, etc.
Different colors denote different addictions and medical conditions.
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CLO#5: Enumerate the guidelines in constructing a Genogram. (BESIN,

Chast)

Guidelines in making a genogram

● The genogram should go back at least two generations and include all first-order
relatives to provide as clear a picture of the family as possible.
● All family members, living and dead, should be included. This means you may
have to ask directly about miscarriages, stillborn infants, and children who died
in infancy.
● Any hereditary or recurring illness, both medical and mental, should be noted.
● The male parent is always at the left of the family and the female parent is
always at the right of the family.
● In the case of ambiguity, assume a male-female relationship, rather than
male-male or female-female relationship.
● A spouse must always be closer to his/her first partner, then the second partner
(if any), third partner, and so on...
● The oldest child is always at the left of his family, the youngest child is always at
the right of his family.

CLO#6: Differentiate the kinds of transactions utilized by clients (BORCES,

Nicole Mykaela)

Transactions occur when the ego states of two people interact. The transaction can be
verbal or non-verbal.

One person initiates the communication (the stimulus) and the other replies (the
response).

Three Types of Transaction:

1. Complementary Transactions: is when two people's ego states are
sympathetic or complementary to one another. This means that what you say
and the response you expect to receive, and actually receive, are aligned.
2. Crossed Transaction: is when ego states of two people interacting do not
match, when the ego state of the sender does not reach the desired or intended
ego state of the respondent, thus they respond to the sender in a conflicting way
3. Ulterior Transaction: is when we say one thing but mean another. It's the
other. message that gets picked up. The most well known example is “want to
come in for coffee?” after a night out with a new partner.
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CLO#7: Methods of Time Structuring in Transactional Analysis (DE GRACIA,

Dominic)

Whenever people get together in pairs or groups, there are six different ways in which
they can spend their time.

Methods of Time Structuring

● Withdrawal
- Is sometimes a rational adult decision wherein the person needs time to
be alone , to relax, to think and construct their own thoughts.
- When a person withdraws, he/she may stay with the group physically, but
does not transact with other group members.
- Withdrawing person tries to avoid psychological risk of rejection
- When a person withdraws psychologically, it is often into a fantasy world.
• These fantasies are likely to be of uncensored pleasure or violence,
creative imaginings or of learned fears and catastrophic expectations.

● Rituals
- These are highly structured and stylised ways of interacting.
- Ritual transactions are simple and stereotyped, complementary
transactions, like everyday hellos and goodbyes.
- All children learn these ritual appropriate tin in the family
- The good thing about rituals is that they give us a lot of structure and
security and a possible way into more intense contact. On the downside,
they contain little emotional value: you could exchange hellos with a
complete stranger without much, if any, emotional contact.

● Pastimes
- Pastimes are similar to rituals wherein it is a level of interaction where we
make easy and polite conversations/ interactions that are culturally agreed
topics we can talk about, knowing we won’t get into hairy situations with
our partners in the exchanges.
- In pastime, the participants talk about something but engage in no action
concerning it.
- This level of interaction fits with casual acquaintances and people you
have only just met. It might be amusing for a while, but most people will
get quite bored with it sooner rather than later.
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● Activity
- Is an interaction wherein many of us spend a lot of time with others.
- This is a “goal directed activity” where we spend doing things with others,
rather than just being with them.
- Adulthood is the predominant ego state in activity. This follows from the
fact that activities are concerned with achieving here and now goals.
- The degree of psychological risk perceived in activity can be greater or
less than in pasturing depending on the nature of each.

● Games
- games are played from any negative ego state parts – negative adapted
child, negative controlling parent or negative nurturing parent.
- In games we exchange a sequence of transactions that lead to both
experiencing bad feelings at the end of it.
- One advantage of playing psychological games is to structure time.

● Intimacy
- This is an authentic encounter with another, a moment of shared
openness, trust and honesty. Intimacy means emotionally intimate, not
necessarily sexually intimate
- Games are sometimes used as a substitute for intimacy. They involve a
similar intensity of stroking but without the same degree of perceived risk.
In a game, each person shifts the responsibility for the outcome to the
other. In intimacy, each accepts his own responsibility.
- Intimacy means attachment and letting somebody into one’s heart and
soul. It means we are allowing the other person to impact us and change
us. If relationships don’t work it is often, maybe even always, caused by
lack of shared intimate time.

CLO#8: Situational Analysis in Transactional Analysis (DE GRACIA, Dominic)

Situations in Time structuring

Withdrawal

● a man threatened by conflict with his wife may withdraw as his father did when
his mother got mad.
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● People spend time fantasizing and in autistic thinking - thinking to harm another
or to harm oneself or for working out plans to get at another in a particular way,
at a particular time or upon a given event presenting.

● When a person withdraws psychologically, it is often into a fantasy world. These

fantasies are likely to be of uncensored pleasure or violence, creative imaginings
or of learned fears and catastrophic expectations.

Rituals

● These are parent programmed, well mannered and are decent ways of
interacting with pleasant exchange of greetings and niceties

Examples of interactions between oneself and the other

Good Morning. Good Morning.

How are you. I am fine and you.

How are folks at home. They are fine, thank you. And yours.
Mine too are fine.

You getting along well. Not much change.

Chow see you again, bye. Bye.

Pastimes

● People participating in pastime aimlessly or doggedly speak about politics,

policies, newspaper articles and news, scandals, sports, cars, bikes, children, and
other types of undirected gossip.
● People participating in pastimes know each other or are introduced to the group.
Serious talk, discussion, at times leg pulling, and making jokes

Activities

● Activity may include work, or at home it could involve running a household or

looking after the children. It’s shared time, and may include having a lot of fun,
but it may also mean we are avoiding really being with the other and meeting
them fully.
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Games

● In games participants usually blame the other and justify themselves. Games
result in the parties moving away with their favored feelings of pain, hurt, insult,
put-downs, guilt, feeling ashamed, taken for a ride, treated unfairly, not
understood, and the like.

● Games players participate energetically. Games generate and foster pseudo

intimacy. Games help to generate intense racket feelings

Intimacy

● It takes place between people in moments of open hearted exchange of

thoughts, ideas, feelings, opinions, free of ulterior transactions. It happens due
to the participation of “Free Children and Nurturing Parents”. There is a great
sense of understanding and acceptance between the people. They foster respect,
regard, acceptance, and esteem for the other.

CLO#9: Appreciate transactional analysis as a tool in promoting effective

client relations. (DANDASAN, Dave Antoni)
● The transactional analysis approach is effective in the patient-nurse
communication process and ensures achieving certain targets both in terms of
the individual and the advisor. These targets are autonomy, awareness, being
able to give normal reactions and sincerity, and can be considered as the focal
point of the philosophy and practice of the transactional analysis approach
(Lister-Ford, 2002).
● To appreciate transactional analysis as a tool the nurse should see its importance
and that the patient communication process is efficient and effective. When it
comes to providing health care, being successful is crucial. It's thought that
under the transactional analysis technique, having knowledge and skills. A
successful therapeutic communication process with the patient can be formed in
assisting this procedure
● Nurses have access to information and conduct research to learn how
transactional analysis can help you be more effective in communicating abilities
through influencing the patient's communication and environment. At the same
time, the nurse can observe the patient through the lens of this therapeutic
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communication technique (which ego). When communicating, what state is used,

what life position is employed, and so on. The impression of this, the evaluation
of the transactions used, and so on) may help to assure creating more effective
nurse diagnosis and intervention steps appropriate for the patient

CLO#10: Demonstrate the beginning skills in constructing a

three-generational genogram. (DANDASAN, Dave Antoni)

1. Determine your reason for creating a genogram

2. Understand what you are looking for
3. Decide how many generations you need to represent in your genogram.
4. Develop a set of questions to ask yourself and your relatives
5. Write down what you know already.
6. Talk to family members
7. Search through family books and documents, and the internet
8. Look at your own history
9. Learn the familial relationships
10. Learn the emotional relationships
11. Design your genogram
12. Use standard genogram symbols to represent family members and relationships,
both normal and dysfunctional
13. Organize the chart based on family interactions beginning with the oldest
generation you want to represent at the top
14. Look for patterns

● Genograms can also be used with plant and animal species, to find mutations
and survival skills, etc.
● Keep your completed genogram in a secure place. The information represented
in the diagram could be embarrassing or harmful to some family members.
● Always maintain the confidentiality of family members when sharing your
genogram with non-family members.
● This can be an excellent classroom exercise; have the students select a famous
person and research this person's background and family to try and assemble a
genogram. This should be made easier using the Internet, but recognize its
limitations too — this should be treated as a research exercise, but not
necessarily exhaustive (or exhausting).
● Genograms are also known as a McGoldrick-Gerson study or a Lapidus Schematic
● How to make a genogram: https://youtu.be/bdlunUM3Rdc
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References:

A step-by-step guide to making a genogram. Exploring your mind. (2018, March 24).
Retrieved February 5, 2022, from
https://exploringyourmind.com/step-by-step-guide-genogram/

Bull's-Eye Transaction. Ebrary. (n.d.). Retrieved February 6, 2022, from

https://ebrary.net/158997/management/bull_s_transaction

Edufocus. (1970, January 1). Transactional analysis. TRANSACTIONAL ANALYSIS.

Retrieved February 6, 2022, from
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GenoPro. (n.d.). Genogram Symbols - GenoPro. Retrieved February 5, 2022, from

Genopro.com website: https://genopro.com/genogram/symbols/

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2022, from
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%20and%20age%20of,the%20purpose%20of%20your%20genogram.

Lynch, A. (2021). Genogram Symbols | Edraw. Retrieved February 5, 2022, from

Edrawsoft website:
https://www.edrawsoft.com/genogram/genogram-symbols.html

Manu Melwin Joy Follow Research Scholar. (n.d.). Options - transactional analysis.
SlideShare. Retrieved February 6, 2022, from
https://www.slideshare.net/manumjoy/options-34233063

Merriam-Webster Dictionary. (2020). Retrieved February 5, 2022, from

Merriam-webster.com website:
https://www.merriam-webster.com/dictionary/index%20patient

Murray, H. (2021). Transactional Analysis - Eric Berne. Simply Psychology.

https://www.simplypsychology.org/transactional-analysis-eric-berne.html

Time Structuring Theory: Crowe Associates. Crowe Associates | Committed to people

development. (2019, April 11). Retrieved February 6, 2022, from
http://www.crowe-associates.co.uk/psychotherapy/time-structuring/#:~:text=all
%20of%20us.-,Rituals,structured%20and%20pre%2Dprogrammed%20way.
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Tracy Evans, S. A. C. (n.d.). Cultural anthropology. Lumen. Retrieved February 6, 2022,

from
https://courses.lumenlearning.com/culturalanthropology/chapter/types-of-familie
s/

What is a Family? National Council on Family Relations. (n.d.). Retrieved February 6,

2022, from
https://www.ncfr.org/ncfr-report/past-issues/summer-2014/what-family

Wikihow, W. (2020, July 7). How to make a genogram. Google. Retrieved February 5,
2022, from
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