Chapter 3: Mapping Common Patterns in Chemically Dependent Families
Introduction to Family Mapping
Definition: Mapping is a therapeutic technique employing symbols to visually represent a therapist's impressions of a family's current structure. This "picture" illustrates emotional relationships, apparent power dynamics, closeness or distance between members, alignments, and conflicts.
Distinction from Family Genograms: Family maps differ from genograms in several key ways:
Maps are not always multi-generational.
Maps do not contain social history.
Maps provide more detailed information about current emotional relationships between members than a genogram.
Origin: This technique is adapted from the Structural School of family therapy for use with Chemically Dependent (CD) families.
Major Dimensions Represented:
Nature of Relationships: Depicted by various lines drawn between family members.
Apparent Power or Influence: Indicated by the relative size of the figures; a larger figure suggests more perceived power than a smaller one.
Map Legend and Symbols
Basic Figures:
Female: Circle \bigcirc
Male: Square \Box
Roles & Identified Patient:
Mother: M
Father: F
Identified Patient (CD member): IP (usually within the figure)
Relative Size: The size of the figures directly correlates with the apparent power and influence a member holds within the family (e.g., a larger figure implies more power).
Age: For children, age is noted inside the figure (e.g., 10).
Boundary Line: A horizontal line often separates parents from children, indicating generation boundaries (e.g., Line between "M" and "F" above and children below).
Relationship Lines (Indicating Nature of Connection):
Minimal connection: Single dashed line - - - -
Typical connection: Single solid line \text{---}
More connection: Double solid line =\text{---}
Enmeshed: Triple solid line =\text{---}=
Nature of relationship is unknown: Question mark on a dashed line ? - - - -
Conflict Lines (Indicating Nature of Conflict):
Unacknowledged conflict: Wavy line \sim \sim \sim \sim
Mild conflict: Single wavy line \sim \sim \sim \sim \text{o!}
Moderate conflict: Double wavy line \sim \sim \sim \sim \text{o!!}
Heavy conflict: Triple wavy line \sim \sim \sim \sim \text{o!!!}
Hypothetical Chemically Dependent (CD) Family Map Analysis (Figure 3.1)
Scenario: A sample map with an alcoholic father (IP).
Family Dynamics Depicted:
Father (IP): Appears emotionally distant but powerful (large figure) and is in open and moderate conflict with the mother and the 13-year-old son.
Mother: Is protective of the children, especially the son.
Son (13): Close to and protective of the mother, which exacerbates his conflict with the father, particularly during the father's active alcohol use.
Daughter (10): Identified as the "lost child" who attempts to avoid the conflict between the mother, father, and son.
Sibling Relationship: The nature of the relationship between the daughter and son is unknown after the initial interview.
Observations and Questions for Future Sessions: This initial map generates several critical inquiry points:
Son's Safety: The son's alliance with the mother could endanger him, especially during the father's periods of alcohol use. This prompts consideration of physical safety issues.
Mother's Stress: The mother likely acts as a "peacemaker" between the father and son. The therapist should explore if this role places her under extreme stress.
Daughter's Dilemma: The daughter may be caught in a stressful triangle with her parents, where siding with one parent means betraying the other.
Father's External Allies: It's important to ascertain if the father has allies outside the immediate family (e.g., parent, sibling, friend). The therapist must then consider if these external influences would be positive or negative for his recovery from chemical dependence.
Therapeutic Goal for Father: For stable recovery, the father may need to adopt a different, possibly more active, parenting role once he commits to abstinence. This raises questions about his and the mother's cooperation in this change and his desire to rebuild relationships with his children, particularly his son.
Constructing a Map: Therapist's Observations
Families typically do not come with an organizational chart; therapists construct maps by piecing together information from various observations, as families often don't think in structural terms.
Key Observational Cues:
Proximity: Who sits next to whom.
Communication Patterns: Who speaks to whom most often.
Non-verbal Cues: Who avoids eye contact with whom.
Verbal Dominance: Who talks the most and the least.
Emotional Expression: Who gives and receives anger, who comforts others.
Specific Incidents: For example, a husband rolling his eyes when his wife discusses their daughter, or the mother's reaction to the father's anger towards the son.
Synthesis: No single observation is conclusive, but the aggregate of these behaviors creates a general impression of the family structure that can be diagrammed.
Clinical Uses of Family Maps
Organizing Therapist's Perceptions: The act of drawing a map helps therapists structure their thoughts and feelings about the family unit, making their initial impressions and assumptions explicit and visible. This conscious awareness of assumptions is crucial as they guide the therapeutic process.
Sharing with Colleagues: Maps serve as a visual aid for case discussions, allowing colleagues to see, point to, and discuss the family's dynamics without relying solely on verbal descriptions. They also provide basic family data (age, sex, role relationships, number of members).
Revealing Unanswered Questions: Mapping highlights gaps in the therapist's knowledge and points out unknown aspects of relationships (e.g., the siblings' relationship in Figure 3.1). This directs the therapist to specific areas for exploration in subsequent interviews.
Maintaining a Systems Focus: A map provides a global view, preventing therapists from becoming overly fixated on a single individual or relationship. It also reminds therapists to include external influences, such as extended family, school counselors, or other significant contacts, on the map.
Indicating Broad Direction for Therapy: Maps help therapists identify major power imbalances, splits, and alliances. For example, Figure 3.2 illustrates a hypothetical family with significant structural issues:
Power Imbalance: A large difference in size (power) between parents.
Inappropriate Child Power: The older child (16) is larger than the mother and placed above the parent/child boundary, suggesting power and influence disproportionate to her role.
Enmeshed Relationship: The father and daughter are overinvolved (enmeshed).
Conflictual Relationships: The daughter is in open conflict with her mother and brother.
Weak Bond: A weak son-father bond.
Identifying Potential IPs: In such a CD family structure, both the daughter (potentially enabled by the father and parental conflict) or the mother (isolating herself through substance use) could be the Identified Patient (IP).
Multiple IPs: With severe power imbalances and splits, it's possible for more than one family member to be the CD member.
Characteristics and Variations of Maps
Dynamic Nature: A family's map is not static; it can change over several sessions as the therapist gains more information and perceptions evolve.
Accuracy and Subjectivity: While different therapists often draw similar maps independently, suggesting a degree of shared understanding, maps remain subjective. They are the therapist's opinion and current working hypothesis, not objective facts, and must be open to revision with new information.
Ecomap Variation: A broader version of the map, the "ecomap," includes the entire social network: extended family, friends, school/church contacts, romantic partners, deceased family members, other helping professionals, and other internal or external sources of influence.
Therapist Self-Mapping: Therapists can also place themselves on the map to reflect on their own engagement, noting with whom they feel allied or distanced. This can provide valuable insight into therapeutic dynamics.
Value of Mapping
Dual Purpose:
To visually display impressions and assumptions for objective examination.
To foster systemic thinking about relationships and guide potential directions for therapeutic change.
Metaphor: A picture is worth at least a thousand words when interpreting family structure.
Case Example: The Shaw Family
Initial Presentation (Figure 3.3):
Members: Father (Frank), Mother (Sue), Son (Stan, age 19 - IP), Daughter (Beth, age 13).
Presenting Problem: Parents worried about Stan's drinking; father initiated therapy.
Dynamics: Frank (nominal head) was in open conflict with Stan. Sue and Stan were emotionally closer, leading to Sue's unintentional enabling of Stan's drinking and a coalition between them. No acknowledged parental conflict. Beth was the silent "good child."
Stan's Behavior: Consumed significant amounts of liquor daily but defended his drinking as controlled.
Interview Behavior: Frank dominated talking. Sue deferred to him. Stan was restless, defensive, and angry towards his father. Sue softened accusations and excused Stan's behavior despite her worry.
External Involvement: No reported involvement from extended family or external parties.
Initial Therapeutic Goal and Interventions: Stan refused treatment. The immediate goal became to help parents unite their influence to get Stan into inpatient treatment. The therapist referred parents to Al-Anon and a Family Orientation Program and encouraged them to agree on how to react to Stan's drinking, specifically refusing to allow alcohol use at home.
Map after Third Session (Figure 3.4) and Interventions:
Dynamics: The conflict between Frank and Sue became more open, and the father-son conflict intensified.
Intervention: The therapist began seeing Frank and Sue separately to encourage them to present a united front for Stan's inpatient treatment.
Map after Final Session (Figure 3.5) and Outcome:
Dynamics: Parental disagreements about Stan's drinking significantly decreased, leading to Frank and Sue becoming closer and more united. This created more distance between Sue and Stan, diminishing Stan's power. The father-son relationship remained distant and conflictual. Beth remained the "good child."
Outcome: After the fifth session, parents gave Stan an ultimatum ("If you continue to drink and refuse inpatient treatment, you cannot live with us."). Stan entered a 6-week inpatient program and later enlisted in the army. Parents declined further sessions.
Follow-up Intervention for Daughter: Eighteen months later, Frank reported Stan was doing well but struggling with drinking. Parents requested sessions for Beth's secretive behavior, poor schoolwork, and suspected drug experimentation. They repeated the process of "speaking with one voice" to Beth, confronting her. A year later, Beth had "straightened out."
Significance of Mapping in Shaw Case: Mapping helped the therapist maintain awareness of how family patterns (parental conflict, mother-son alliance) enabled Stan's problem. Sharing the map with colleagues refined the therapist's understanding and guided the therapeutic direction.
The "Ideal" Family Map (Figure 3.6)
Concept: Mapping implicitly relies on an "ideal" model of family functioning to differentiate healthy from unhealthy patterns. Therapist values about what a "right" family structure looks like are made explicit through this comparison.
Characteristics of an Ideal Map:
Marital Bond: The mother-father bond is the strongest relationship.
Parental Equality: Mother and father figures are of equal size, indicating balanced power.
Parent-Child Boundary: Children are positioned below the parent-child boundary.
Children's Size: Children are smaller than the parents, reflecting appropriate power differential.
Sibling Size: The older child is slightly larger than the younger, reflecting developmental hierarchy.
Absence of Conflict: No conflict lines are present.
Purpose: This ideal map serves as a model or standard for measuring positive or negative change and represents a goal for therapy with chemically dependent families.
"Normal" vs. "Enmeshed" Families (Figures 3.7 & 3.8)
Developmental Stage Impact on "Normal": What constitutes a "functional" family map varies with its developmental stage.
Example (Figure 3.7): A high degree of family closeness (enmeshed relationships) may be appropriate and healthy when children are young (e.g., ages 1 and 3).
Enmeshed System (Figure 3.8): The same degree of closeness, fifteen years later, when children are older (e.g., ages 16 and 18), would be considered an enmeshed system. This emotional fusion makes maturation and separation difficult for the children. Such patterns are dysfunctional if they hinder individual development.
Clinical Assumptions about Family Functioning
While ideas of "healthy" and "unhealthy" vary, most therapists agree on these fundamentals:
Primary Mother-Father Relationship: This bond existed before children and will persist after they leave. Parents are responsible adults whose decisions most impact the system. Conflict between parents has profound repercussions, affecting everyone more than conflict between any other two members. Conversely, a strong parental bond is critical for family resilience through crises.
Parental Authority and Responsibility: Parents should be in charge of and responsible for their children, with this responsibility gradually decreasing as children mature. A family is not a democracy unless parents deliberately grant children equal influence on specific decisions.
Parents Own the Home: Parents are responsible for what happens in their home. If a child's substance use causes chaos, parents have an obligation to intervene for the child's health and safety, and to maintain a decent living environment for themselves and other children.
Cross-Generational Coalitions are Problematic: An alliance between one parent and a child (or children) against the other parent invariably leads to trouble. For instance, a father consistently favoring a son can create conflict with the mother and resentment among siblings. If the son is a CD adolescent, this alliance likely involves protection and enabling from the father, empowering the son and progressing his illness. This often splits the family emotionally.
Mapping for Systemic Orientation and Recovery
Guiding Family Readjustment: Maps help therapists maintain a systems orientation and answer the central question: "How does this family need to readjust its relationships in ways that make successful recovery more likely for the entire family?" The answer directly influences therapy goals.
Circular Process of Exploration and Correction: Mapping supports an iterative therapeutic process:
Obtain information (interview).
Form a guess/hunch.
Explore the hunch.
Correct information.
Form a new guess/hunch, and so on.
This self-correcting process, aided by maps, allows therapists to assess the family's flexibility and willingness to change relationship patterns that hinder recovery.
Focus on the Family System: Although changes aren't simply made by moving symbols, this "organizational chart" approach keeps therapy focused on the family system rather than solely on individuals, helping therapists achieve systemic recovery goals. As therapists become accustomed to the systems approach, mapping may become less essential over time.
Sharing Maps with Families
Purpose-Driven Sharing: Maps can be shown to families, who usually find them interesting, but this should always be done with a specific therapeutic purpose.
Productive Use: For example, showing before-and-after maps can effectively illustrate how the Identified Patient (IP) was peripheral before sobriety and how their role is changing once sober.
Unproductive Use: It is not productive to attempt to "convince" a family of unacknowledged enabling, side-taking, or over-involvement by presenting a subjective map as a "factual" picture.
Conclusion: Maps as a Clinical Tool
A family map is fundamentally a clinical tool that helps therapists clarify their therapeutic direction. When therapy becomes unfocused, it often indicates that the therapist has lost sight of the intended goals, which the map helps to define.