ABSTRACT
A more advanced way of using family trees as exploratory tools is to involve the whole family. They can all, on a big piece of paper or on a board, draw their family. The clinician may ask the parents whether they would want the children to start drawing whatever they know about the family. It is often startling to see how much small children know and this can be quite a surprise to the parents who may have always believed that they had shielded their offspring from some important, allegedly ‘harmful’ secrets. Starting with the children also allows the clinician to form a picture of family interactions, for example, how the children obtain information from their parents, how much the children are controlled or interrupted by the parents, who is the main parental caretaker, or in what way father and mother give different signals to their children. By giving the children the lead, it is possible to find out how much they know themselves and it is then left to the parents whether and how to fill in the missing gaps. However, it is very important to state at the outset that the parents are in charge of their children and that it is up to them to stop any topics or questions which they regard as inappropriate or harmful. This deals with an important issue, namely that patients often feel that clinicians are entitled to every possible piece of knowledge about the family – including intimate details about their sex lives. It is good practice for clinicians to repeatedly state in consultations: ‘I may want to ask you quite a few questions. I hope these questions are sensitive, but if I ask an inappropriate question, or a question you don’t want to answer, feel free to do so – or just say “pass”.’
