r The Association for Family Therapy 2008.

Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. Journal of Family Therapy (2008) 30: 247259 0163-4445 (print); 1467-6427 (online)

Drawing a family map: an experiential tool for engaging children in family therapy

Raymonde H. Dumonta
Inclusion of children in the treatment process is a central aspect of the discipline of family therapy. Young childrens verbal skill and level of abstraction may not be suited to talking therapy, but they have an intuitive grasp of family life which is invaluable, and their views and needs should be considered when effecting change in the family system. A method is offered to engage young children, adolescents and adults of divergent verbal skills into a shared process. It requires no special set-up or tools, only paper and markers. Distance and proximity are represented in a simple map of the family, adding symbols for affection and conict. A spatial representation of the family system is created, and may be referred to in the course of the therapy.

Introduction
The philosophical stance of the discipline of family therapy, and its early inuential gures, emphasize the importance of participation of all family members in the process of therapy (Ackerman, 1970; Minuchin, 1974; Satir, 1983; Whitaker, 1982). In the years since, several authors have elaborated on the reasons to view children as essential participants in the treatment. They inuence the function of the parent system, which can only be partially understood if one works without the children. Their spontaneous and intuitive grasp of family life provides invaluable information. Children are deeply affected by their family, and their needs should be considered in effecting change (Gil, 1994; Keith and Whitaker, 1981; Villeneuve and LaRoche, 1993; Zilbach et al., 1972). In addition, the outcome of therapy is worse when youngsters view their family as more dysfunctional than do the parents (Dancyger et al., 2005). Childrens representations of their family have been shown to be stable over time and to predict their adjustment (Roe et al., 2006).
Work initiated as Senior Clinic Physician, Joslin Diabetes Center, Assistant Clinical Professor of Pediatrics, Harvard Medical School, Trainee, Kantor Family Institute. Correspondence to: Raymonde H. Dumont, MD, Family Therapy and Behavioral Medicine, Tamarack Place, PO Box 470, Hancock, ME 04640, USA. E-mail: raedumont@gmail.com.
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Although most family therapists would acknowledge the importance of including children in their work, a comprehensive review by Lund et al. (2002) notes that family therapists often treat families in the absence of younger children. A number of authors have addressed the factors which contribute to this (Johnson and Volker, 1999; Korner and Brown, 1990; Miller and McLeod, 2001; OBrien and Loudon, 1985). The evidence suggests that the therapists own comfort level with children and with play has a stronger determining inuence on whether children are included in the therapy process than the therapists theoretical views on the issue. Certainly, in order to work with young children, ones approach has to be less cognitive, less verbal and more playful. Otherwise, the bored child may well become disruptive of the therapy process (Chasin, 1994; Scharff, 1989; Villeneuve and LaRoche, 1993). OBrien and Loudon (1985) found that therapists often lack condence about how to adequately engage children, and Korner and Brown (1990) pointed out that training often lacks in this respect, compounding the attitudes therapists may have brought to their work from earlier life experiences. Although there have been recommendations as to how this could be addressed in training (Sori and Sprenkle, 2004) a literature search found little to indicate the emergence of new methods. The following tool is offered in the hope that therapists will nd it easy to use, whether or not they were extensively trained to work with children. Building on various other techniques, the author has developed a simple method for engaging younger children in joint exploration with older family members, and accessing their intuitive grasp of family life. The procedure involves drawing a schematic map of family interactions. It relies on standardized elements and instructions, which most children as young as age 3 can grasp, and which can be equally used by teenagers. The information gathered is made visually clear to all as it unfolds in a non-threatening and somewhat abstract way. The map thus created is not treated as objective truth, but rather as the childs experience of the family system. It blends verbal with non-verbal communication. It can serve as a framework for future wishes and a touchstone to evaluate future growth.

Description of the method

The therapist begins the map session by designating whose view of the family system will be represented, and who will serve to assist in the process. When there is more than one child in the sessions they
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will often cooperate on their map of family politics. Sometimes (e.g. when one child seems to dominate the others thinking), each draws a separate map. The therapist gets down to oor level, makes a large circle on oversized paper, and indicates that there will be room in this space for each family member (and important pets). If the parents are separated, two large circles may be traced instead, to represent both households. Outside the circle are school, work, neighbourhood and so on. The children then select a colour for themselves and for each parent or other person in the household. Each person is given their marker, while the therapist keeps those of absent people. The child is then asked to consider whom to represent rst with a colour circle, how large and where. Even very young children grasp that the largest circle is not meant to represent the largest person, but rather to represent someone who takes up the most space. The example is given of how a baby might in fact get the biggest circle. Often, the mother is drawn rst and at the centre. Other circles are placed inside the family space, one at a time. The child ponders the exact location and size of each circle, tracing it on the paper with a nger, and then directs the family member (or the therapist) until the drawing is right. Others are reminded that they need not agree; they are merely assisting the director child in drawing her representation. Thus, the child has the experience of empowerment as all help in realizing her ideas. When several children cooperate in one project, time is allowed for debate, and before anyone draws what the child(ren) have instructed, the therapist asks: Are you sure? When all family members are situated, connections are drawn on the map. Yellow double lines (warm fuzzies) are used to connect any two people who are particularly close to each other. Brown zigzagging lines (lightning) are traced between any two people who are prone to arguments. The children are reassured that there is no need to make all connections equal, but the point is not belaboured if a child seems reluctant to make distinctions. It may be helpful to enquire about sequence. The interaction lines may then be labelled 1-2-3 and so on, or the spread of the emotion traced with arrows across the map, as is further explained below.

The interpretation of the map, and the wish

The interpretation of the map may or may not be concurrent with the drawing, is given more than one session if needed, and initiates the therapeutic process as previously unnoticed alternatives become
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apparent. The therapist notes the relative size and closeness of various family members, and gives the child a chance to make corrections. The therapist creates an atmosphere of joint enquiry as curiosity is encouraged in all, and judgement or defensive protests are gently redirected. In tracing the sequence of interactions, specic examples and predictable patterns are cited, such as: Suzie teases Adam, Dad gets upset at the noise, Jimmy feels compelled to silence his younger siblings, Mom tells him to mind his own business, and then they ght. The alliances are noted. A more peripheral family members position can be interpreted in light of roles and developmental tasks (e.g. a teenager might be home less; one parent may work longer hours). A childs sensitivity to tension will emerge as she equalizes all the connections in the family. Another childs sense of exclusion or a parents peripheral role can be seen. It is helpful to remind the parents again that it is not objective reality which is being depicted, but a childs experience of her family. Children are often apprehensive about a parents reactions to their knowing. The therapist models appreciation of the childrens perceptiveness and thanks them for contributing to make things better for all concerned. Parents may need support as they discover how much their children see that was assumed to be beyond their years, learn of a childs discomfort, or get depicted as peripheral or overpowering. It may be best to spend a few minutes without the children before the end of the session, to give parents a more explicit interim interpretation of the ndings, and re-establish ground rules about how to interact with the children until the next session. Finally, the child(ren) may be asked to modify the map or draw a new one about their wish for the future. There are times when they state it is OK this way, but rarely are they unable to identify any improvements to the family system. The wish may be used to construct the goals of therapy, and be referred back to at a later date to monitor progress.

Case examples
Case 1 (See Figure 1.) Kathy and Dan had been in marital therapy for some time. They were contemplating divorce, and were both very concerned about the impact this would have on Sarah, 3 years old, and Willy, 6 years old. They believed that the children knew nothing of their parents difculties, and would be better served with the status
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Figure 1. Kathy and Dans family map

quo. The children were brought in and drew a family map together. They agreed that Dad, the at-home parent, should be in the centre. Mum had been responding to the problems by working more, and was depicted near the edge of the family circle. The children, unasked, drew stick gures of themselves inside both parents circles. Sarah was placed very close to Mum, nearly touching her circle, and Willy closer to Dad, representing himself as a boat. Warm-fuzzy lines were carefully and equally distributed. The children needed much reassurance before drawing conict lines between Mum and Dad. Both then sent fearful glances to their parents and Sarah suddenly covered her own circle with thick black lines, and climbed into Mums lap for the rest of the session, hiding with her hand at her mouth. Willy asked for more paper to draw more boats, insisted on telling us about them in great detail, and interrupted all further talk until we moved to more neutral ground to close the session. Kathy and Dan, in follow-up, came to terms with the fact that the marital conict affected their children. They separated, and made
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housing and parenting decisions based primarily on the childrens needs. The general tension decreased, though Willy continued to demonstrate somewhat obsessive preoccupations, and was entered in a successful course of individual therapy for anxiety. Case 2 (See Figure 2.). After a few sessions of couples therapy, Dick and Joanna brought in their three children to explore the effects of the fathers debilitating chronic illness. Dad was in pain much of the time, depressed by his progressive disability, and irritable. Farm and household chores fell increasingly to Mum, 14-year-old Emma and 10-yearold Amy, less so to 8-year-old Johnny. In a session with all ve family members, Amy did not engage until she was invited to draw the family map. She portrayed Dad as a large circle covering half of the available family space, placed herself and Mum both within Dads circle, then Emma and Johnny separately in the family space. She drew strong positive connections between Dad and Johnny, and much conict

Figure 2. Dick and Joannas family map

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elsewhere, especially around herself. She was angry with her older sisters bossiness and her younger brothers chore-free privilege. She told us how deeply she experienced Dads moods and his suffering, and that just like him, she got crabby when things werent going well. The family responded with a discussion of how things might be made better for all. Seven years after these family sessions, Amy (now a college student) sought therapy for depression. When she was shown the family map she had created years before, she did not remember drawing it, but recognized how she had always identied with her father and his moods. This helped her to understand her own depression in the family context. Case 3 (See Figure 3.) Sherry and Donna entered family therapy with their 6-year-old son Aaron and 12-year-old daughter Callie because we have trouble getting along, especially Callie. At rst Callie retreated angrily behind the couch. She agreed to participate only when drawing implements were produced. She issued orders to her brother who seemed very anxious to please her. None the less, there was sufcient genuine agreement in their impressions of the family not to resort to separate maps. To the initial consternation of Mum and Mummy, Sherrys shape took up most of the family space, dwarng Donna and the children equally. Callie and Sherry were depicted at opposite ends of the family map, with Aaron and Donna between them. The sequence of conict was as follows: (1) Sherry comes home tired from work and nds that Donna has not done her share of household chores, nor asked the children to pick up after themselves. (2) She demands a family effort, which Callie angrily resists. (3) Donna criticizes Sherry for being so intense. (4) Callie inserts herself in the ght, and she and Mum blow up at each other. (5) Aaron retreats in fear. (6) The parents do not speak for days. It emerged that the children were often confused as to what was actually expected from them, and by whom. Clarication of family rules foundered as Sherry stated her expectations, and Donna responded with I suppose and a noncommittal shrug. Callie angrily pointed out, it is always like that. The therapist suggested that the parents address their differences in a session without Callie and Aaron. The children happily signed over the problem with their parents to the therapist, and the couple addressed the pattern of
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Figure 3. Sherry and Donnas family map

Donnas passivity and Sherrys frustrated escalation. Tracing the sequence of conict on the family map had shifted the focus from the identied patient to the parent system.

Discussion
Small children have limited facility with abstract language. In family therapy this impacts on their ability to describe their experience of
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family life, view of relationships, or contributions to possible solutions. Several authors have claimed that therapists who are familiar with tools appropriate to younger children are more likely to modify the format of therapy than to exclude children from the therapy room. In treating families with children, early structural family therapists and some strategic therapists relied upon enactment of the presenting problem within the session. Experiential techniques included a variety of sculpting or enacting methods. Play naturally engages children, and drawings are often used by play therapists and art therapists alike. Nevertheless, the literature describes few methods which will work well with young children in conjunction with more verbal adolescents and adults in family sessions. This paper offers a simple technique for engaging younger children, and accessing their intuitive perceptions of the family. The method, developed from aspects of various existing techniques, requires no complicated set-up and no specialized tools or toys. Importantly, the technique involves the entire family in a shared exploration, in spite of widely differing verbal skills. The family map technique was inuenced by family sculpting, developed by Duhl et al. (1973) as a means of eliciting active spatial learning about family relationships, in order to free up the familys capacity for transformation. Sculpting is akin to psychodrama (Blatner, 1994) although it captures a tableau vivant (Simon, 1972), rather than an entire action. Like sculpting, the family map accesses non-verbal learning, and concerns itself with personal space and distance. It visualizes affection and anger, and traces the sequence of events in the family sphere. It makes clear at the onset whose views of the family are being represented as distinct from an objective reality, and others are given roles as actors and/or audience. Absent players are represented. Despite these similarities, the method of the map is different from sculpting. The experience is created on paper rather than by staging family members positions, expressions and body language. Whereas many families are reluctant to get up and act, most are immediately comfortable with paper and coloured markers, and engage in genuine expression and transformation. The children produce a lasting record to refer to later on, which can benet the review of progress in treatment, and even many years later in follow-up. Other sculpture techniques, such as the Kvebaek Family Sculpture Technique and the FAST or Family Systems Test (Gehring and Wyler, 1986; Gehring and Marti, 1993b), depict the architecture of family structures with gures to be arranged on a board, and apply scoring procedures to determine cohesion and hierarchy within the family.
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These tools have proven useful in research as well as clinically (Gehring and Marti, 1993a). The family map however is not intended as a diagnostic tool. Rather, it assists children in communicating their experience of the family directly to their parents. As in structural family therapy (Minuchin, 1974), a simple map of the family system is created. Symbols for enmeshed, distant or appropriate boundaries drawn by the therapist are replaced by the childs intuitive representation of relative distance, affection and conict. Whereas structural and strategic therapists have used enactment of the family problem in session, the map allows for enactment on paper, when it traces the sequence of conict through the family system. The symbolic drawing of the family (Geddes and Medway, 1977) and the family circles (Asen et al., 2004) invite all family members to place circles within or outside a large family space to represent immediate family as well as extended family, important others and any relevant institutions. Each person rates her communication with the people and institutions on the drawing as good, so-so or bad, and a lively discussion of the different views of proximity and relative size of the circles is encouraged. As Asen suggests, even children as young as 3 can place circles, but the family map invites only the childrens perceptions, to ensure that they are not overshadowed by more verbal family members. In addition, it usually focuses only on immediate family, and it depicts affection and conict explicitly, albeit in a playful way. These differences make the map accessible to even very young children. Keith and Whitaker (1981) argue that play is a powerful, perhaps essential tool in any successful family therapy, as do proponents of family play therapy (Anderson, 1993; Busby and Lufkin, 1992; Kaslow and Racusin, 1990; Scharff, 1989), but play therapy has more often been used in individual therapy, or in child-centred lial play. Miller (1994) pointed out that the disciplines of play therapy and of family therapy have diverged more than cross-fertilized. Larner (1996) uses a combination of play and narrative techniques in individual child sessions, and then incorporates what is learned into separate family sessions. The family map shares the as if quality of play therapy. The activity of drawing, like play, makes the communication feel less direct and less threatening. This helps children to share material which might otherwise be more defended and less accessible. The technique also borrows from the narrative tradition in supporting children, in a safe setting, to comment on others position in the family and to entertain alternative outcomes in a mood of playfulness. However, it does so with spacial representation on paper,
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rather than with stories and verbal approaches like circular questioning (Benson, 1991; Larner, 1996). The method differs from art therapy in that it does not rely on creative self-expression (Retzlaff, 2005). In the familiar draw a family picture, kinetic family drawing and the drawing up of boundaries (Burns and Kaufman, 1971; Wilkinson, 1985) objects and gures are represented and interpreted. While naive observers can successfully distinguish important elements in childrens drawings (Stein, 2001), interpretation of such complex material requires caution. Restricting the assessment to specic elements of childrens drawings has proven useful, both clinically and in research: Roe et al. (2006) demonstrated that a young childs exclusion of family members from a family drawing, as well as placement of the parents together or apart, are stable features over time which predict adjustment. Similarly, the family map restricts its elements to symbolic, more abstract representation, and helps the children verbalize these. The mixing of verbal and non-verbal modalities facilitates the process of engaging children and adolescents of different developmental levels simultaneously and the exercise validates the personal reality of even the youngest child. The activity is directed and structured by the therapist. Parents are helped to receive communications from the child about the family, with the goal of making things as good as they can be for everyone. Cooklin (2001) pointed out that the exclusive use of play and non-verbal communication with young children risks underutilizing their capacity to think; the family map aims to stimulate their critical thinking and create a common language with older family members. Before choosing to set up this activity, the therapist must decide whether it is safe to do so. If there is abuse in the family system, encouraging free expression can endanger the children or other family members. Most parents will readily agree that there should be no punishment at home for anything the children may express here, and Chasin (1994) suggests that nobody needs to answer any questions if they dont want to. Yet however careful one may be, there are times when a well-kept family secret may be revealed or uncovered by a child. It is wise to remember that children often self-protect by becoming withdrawn or disruptive in such circumstances and it may be a mistake to dismantle a necessary self-protection. Non-verbal cues to danger areas are vital information for the therapist, but it may be wiser to explore their meaning at a later time. In summary, drawing a family map is offered as a technique for family therapists to engage young children, adolescents and adults at
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widely different levels of development and verbal skill into a shared process. This offers important information, which is intuitively accessible to younger children and to the entire family through the use of a simple colour map, and provides a lasting visual record to refer to as the therapy proceeds.

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