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Determining Constitution and Temperament in Homeopathic Treatment Through the use of the Genogram

Last modified on June 19th, 2015

Kenneth Silvestri

Dr. Kenneth Silvestri discusses the use of the genogram in determining constitution and temperament in homeopathic treatment.

genogram-template

“The feeling that we call ‘I’ seems to define our point of view in every moment, and it also provides an anchor for popular beliefs about souls and freedom of will. And yet this feeling, however imperturbable it may appear at present, can be altered, interrupted, or entirely abolished.”

Sam Harris

“I believe that we should do the Genograms of our heroes, our governmental leaders, and the theorists whose teachings we follow to better understand their strengths and limitations, just as we would benefit from examining the Genograms of the authors of the Diagnostic and Statistical Manual of Mental Disorders (DSM), who have described the supposed characteristics of mental illness.”

Monica McGoldrick

 

In homeopathy, as is the case with psychotherapy, we are taught that causation, constitution, and the totality of symptoms are three critical factors. David Little describes how Baron Von Boenninghausen in the early years of homeopathy stressed the importance of understanding the who, what, why, with what and, when modes of a person’s narrative. He also emphasizes the need to understand causation and how imbalance in ones’ make-up opens the door to the need for change (Little, 2001; 2014). He further describes how remedies have a multi-polar nature having been tested on a wide variety of people. Constitution and temperament is what we view first in the patient. This helps contextualize symptoms that are similar and places them in the perspective.

How one feels, radiates and adapts are further clues to the ways of gathering information and handling their evolving contexts. Family legacy and life cycle narration play a part in this determination as well. Learned communication and somatic foundation are the basis upon which to confirm essential patterns that define striking extraordinary, unusual and outstanding symptoms.

Sustaining change deals with a deeper understanding of how our patients construct their world. Reconciling subjective and objective experience is one of the ongoing challenges within our human fallibility. Carl Jung believed that the subjective part gets its information from dreams, symbols of inherent instincts, ancestral connections and universal archetypes. “The collective unconscious communicates from the timeless space that is the source of all religions, myths, visions, dreams, fantasies, altered states, fairy tales and folk stories.” It is a holding place for all the experiences of humanity and a means to wholeness. As ignorance can misguide us, the grasping of one’s potential as well as constraints can enlighten us. “When we confront the mythological core of our experience it offers transcendental meaningfulness of our lives” (Little, 2014; Silvestri, 2002).

The objective psyche is an energetic field of experience lived through these archetypes. Edward Whitmont, who himself was a psychiatrist and homeopath further elaborates that psychological happenings are processed and manifested in the language of symbols. This is a demonstration of the “purposeful direction of movement that expands that which is deficient and balances what is exaggerated.” This natural movement toward wholeness is what Jung called the “self.” If this is the case, “Then all psychosomatic phenomena can be given meaning, intent, and provide information about the state of the unconscious if interpreted symbolically” (Silvestri 2002, 2008). It can also be the source for articulating one’s core grievance story or “tale of woe” which perpetuates the “fight or flight” part of our sympathetic nervous system,

The collective unconsciousness and the self are information sources that go much beyond personal experiences. The blend of the conscious and unconscious dialogue is constant and the symbols that arise in consequent dreams are the language of the unconsciousness, and could be a medium of inspiration and art. It is this process that can also be the driving force behind psychosomatic problems. Being out of “sync” is an indication of imbalance. Although we never see the invisible pure form of the archetypal thing, we can strive to harmonize with its manifested pattern and essence (Storr, 1983). The simultaneous awareness of these connections, the “Ah ha” experiences are the spontaneous automatic reactions that do not follow the rules of the rational mind. Jane Cicchetti (2001), in an interview, said that “Jung felt that symbols were the best possible expression of a reality and wholeness that is greater than the intellect can conceive; that symbols point the way to a greater reality.” She also points out that when we open our minds to this reality, we are able to make connections and see the wholeness of a homeopathic case more readily.” Being aware of how symbols give us understanding of life’s paradoxes and potential creativity is the basis for moving toward wholeness. Homeopathic remedies resonate with natures plan and they can be identified and matched with the emerging articulated “self.”

After practicing systemic psychotherapy (an ecological approach that works with interpersonal relationships) and homeopathy (similarly a holistic healing process) for many years, I have found that the most reliable information for developing a successful therapeutic plan comes from understanding someone’s temperament and how they view themselves and others.

To help assess and reperatorize symptoms within the framework of temperament and constitution I use the Genogram (McGoldrick, 2011). The Genogram is a transgenerational and psychological family tree that depicts an individual’s relationships, family patterns and influences (See http://stanfield.pbworks.com/f/explaining_genograms.pdf for images and symbols).Factual information about illnesses etc., help determine miasmatic patterns and legacy. Parental traits and communication (i.e. open, closed, nurturing, controlling, abusive etc.) from one’s own narrative allow for an understanding of how one was raised and reared relevant to developing communication and cultural traits. Constant recording of sensations, modalities, locations, and related ailments will produce an ongoing narrative and openings for uncovering striking and unique symptoms applicable to determining homeopathic remedies and psychotherapy directions.

The Genogram is a tangible and visual means to map large amounts of information in a concise manner and framework. At a glance, one can see the complexity of the family context and its’ connections to past and current emotional issues. It allows a clear introduction and means to explore the patient’s life patterns. It provides a sense of history and psychological attributes relevant for counseling and homeopathic assessments. The Genogram portrays the ongoing evolutionary journey and interconnections to larger contexts of education, employment, race, culture, ethnicity, class, religion, health and many other structures and issues.

Using the Genogram framework, one can construct a preliminary psychological family tree that depicts family legacy. The following questions can prime the narrative that will lead to defining one’s temperament and constitution.

  • How do your family members think about one another? (Look for characteristics that are brought up i.e. the loudmouth, spendthrift, softie, etc.) This provides articulation of joys and pains. Patterns of enmeshment and cut-offs can be the “not-well-since” beginnings of past and present illnesses, aggravations, resentments and grievances, leading to symptoms found relevant to homeopathic treatment.
  • Who was named for whom in your family? (Look for how names reveal roles, hidden meanings, historic connections and psychological patterns.)
  • Were there coincidences between the births of family members and moves or migrations, illnesses or death, changes in family finances, etc.?
  • How much did the family conform to gender stereotypes of their culture and era? Which members did not conform, how were they viewed and how did the family demonstrate flexibility (or inflexibility)?
  • How did the family deal with rituals, stress, rules, leisure, beliefs, and explaining or telling stories of death, money, education, betrayal etc.?
  • What kind of relationships did one’s parents have with their parents? How did you relate to your parents: the good, the bad, any grievances, life cycle and developmental issues, etc.?
  • How did you relate to your siblings? How were siblings expected to behave? What roles did you and your siblings have in the family?
  • What are the patterns of couples’ relationships in your family? Divorce, power struggles, gender roles, employment, attraction, strengths, weaknesses, and how did this effect your development?

When we look at our family legacy and the energy that sustains it, we can gain insights and help patients make positive changes in their lives. We can also identify and learn from the interactive patterns of the family of origin, some of which may have hindered or supported self –development. There is a mystical energy in our family systems. This demonstrates how we are truly baked from our family energies, yet we are in truth all half-baked with room to grow and evolve.

There is an opportunity to differentiate from past hurts and not let our history control us, yet we all have to go home to reaffirm what are our strengths and resources. This can be found in our experiences relevant to our ethnicity, class, race, gender and culture. Here are some questions to stimulate understanding the power of legacy.

In what ways has your legacy taught you to deal with conflict and the paradoxes of life?

What spiritual message do you get from your Genogram?

What emotional and physical sensations did you experience in your different life cycles i.e. childhood, adolescents, early adulthood etc?

How did you and your family deal with trauma?

What unique, unusual and extraordinary sensations do you recall growing up?

Think about the above Genogram questions, and how your answers have supported or held you back in finding yourself.

 

The above suggested questions provide background and support for assessing the presenting problems, coping skills, and stress management. This allows for more concise ways of describing sensations, modalities, location and other related symptoms. The recorded narrative, information and behavioral patterns can then be used for determining a constitutional remedy that represents the gestalt of the presenting symptoms.

After assessing the narrative that the Genogram provides, one can ascertain the temperament traits that appear. The watery Feeling temperament for instance can be rigid, dogmatic, preoccupied and full of hidden fears, especially if they are in an inward mode. If you are more outward and still a Feeling type they can be externally emotional, possibly judgmental, and more egocentric. A Thinking person characterized by the element of air, when in an inward state can be speculative and a theorist while its outward style would be factual, precise, rational and dry.

Now, while the first two temperaments are very rational and can be judgmental, the remaining two are more irrational yet at the same time very perceptional. The fiery Intuitive trait in its outward manifestation can be impressionable, instinctive and full of hunches while its opposing side could be jealous, and have negative projections. The Sensate/Angry outward type which emphasizes the earth element is more of a realist, down to earth yet fearful, angry and helpless; its inward side can have a tendency to misjudge, not complete tasks and can be narcissistic. Together all these traits can help ascertain strengths as well as allow for ways to help with a dysfunction or an injurious symptom (Silvestri 2007, 2012, 2013a, 2014).

In both homeopathy and psychotherapy, you look for the most unique, striking symptom or problem. Carl Jung taught us that a person will present one of the temperaments in a certain habitual, conscious manner. He called this the “persona,” but it is with one’s “shadow,” (the inner opposite part of their temperament or their subconscious makeup) where many answers for helping create a healthy balance in life may be found. Someone, for instance, who usually has an outward temperamental trait, when presenting a problem or grievance, will in most cases gravitate to their opposite inward trait or vice versa (if someone’s characteristic persona is more inward and subdued they will express themselves in a outward extroverted manner). This is where the most pressing symptoms of one’s pain can be found and the consequent barriers to health.

The following is adapted from David Little’s “Constitution and Temperament in Homeopathy,” section of Chapter four, Online Course, 1998) which helps confirm the presenting pattern of responses in differentiating the search for the simillimum.

The positive qualities of the Sensate trait will follow a pattern that includes practicality, adventurousness, dependability, competitiveness, self-reliance, industriousness, balance, strength, decisiveness, persuasiveness, and trustworthiness. Its negative side will be characterized by traits of aversion, anger, irritability, impatience, criticism, pessimism, control, rigidity, argumentativeness, selfishness, brooding, extreme sensitivity to contradiction, and being hyperlogical. It will deal with stress by outward expressiveness, and sudden outbursts or anger.

The positive side of the Feeling temperament demonstrates sensitivity, imagination, sympathy, adaptability, peacefulness, tolerance, gentleness, placidity, and consideration. Its negative side may be exemplified by sadness, attachments, indecisiveness, vulnerability, timidity, envy, hesitantcy, changeability, and submissiveness, that which worsens with strangers. Stress will be dealt with by turning inward and expressing fearfulness.

The Intuitive temperament will have positive patterns of expansiveness, sociability, joy, optimism, spontaneity, enthusiasm, dynamism and compassion, while its more negative traits will include too much desire and passion, indiscriminateness, marked optimism, inconsistency, naivety, manipulation, and a need to be magnetized. They will deal with stress with extroversion and unexplainable over-joyfulness.

With the Thinking temperament you will find positive attributes such as refinement, thoughtfulness, intelligence, eminence, sophistication, orderliness and analytical skills.. The negative traits can be apathy, pensiveness, conceitedness, skepticism, fastidiousness, hypochondria, erratic behavior, alienation, resentfulness, gloom and control. They will encounter stress with introversion and sorrow.

All of the above can be interpreted into the language of our homeopathic reperatory and when combined with presenting sensations and core issues will help in differentiating the most appropriate remedy. Since we all view and construct the world differently, this is why homeopathic remedies work better when they are congruent with the make-up of the specific individual (and psychotherapy is successful when there is a match with how someone perceives and articulates their world view.) What I have found about people looking to attain a balance in their lives is that they are usually working from a shadow temperament rather than their innate temperament. A very introverted Intuitive persona may be out of sorts and communicate from an extroverted Angry Sensate temperament. The everyday outward analytic Thinking person having a bad day can easily revert to an inwardly shy Feeling position. It is this shadow area that gives further information for change and where one’s pain resides. This is the grist for the perceiving psychotherapist to help differentiate from past negative experiences. For the probing homeopath, it is seeing how remedies all have personalities from the many “provings” and will work optimally when similar with the symptoms and temperaments of those needing a remedy (De Schepper 2013; Malerba 2010; Merizalde 2007; Silvestri 2002, 2005; Little 2001) .

 

Case Example:

Susan’s presenting problem was that she felt sad, unconnected to everyone, and craved affection, of which she has little. She is 50 years old and works as a teller in a bank and lives alone. Her narrative began with how sensitive she is; noise aggravates her and she feels stressed all the time. Susan described how interruptions, either by people or with her schedule, easily set off angry feelings. Hiking outdoors brings her some sense of peace.

Her family of origin Genogram narrative described her family ethnicity as being Italian. She shared that they grew up in a working class neighborhood in Brooklyn, N.Y. Susan was the oldest of four with a younger sister that is emotionally distant from her and two brothers who are estranged. When asked how her family siblings thought about her, she answered that they saw her as a pseudo-parent, with much resentment from them. She had the role and responsibility to be a caretaker of her siblings, which is when she started feeling disconnected from others (around 12 years old). Susan’s father, who passed away when she was twenty-five, worked in a factory and was a “bully.” He had a severe drinking problem and was always critical of her and verbally abusive to she and her mother.  Her mother (who recently died) was passive, bipolar and not affectionate verbally or physically. There were little coping skills, flexibility or support within the dynamics of her family of origin. She did not know her grandparents, but was told that they were abusive and not nurturing. Her parents weren’t social and seldom did much together.

She left the house at 20 and got married a year later. Her husband cheated on her and they split up a year later. She felt abused and lonely. She became a recluse and although she dated, she could not be intimate in any way. She is a conscientious worker and gets good reviews in her bank position of twenty-five years. She has few friends and has had a series of superficial relations with unavailable men, mostly married.

At this time her behavioral pattern is to have sex, yet cannot feel any intimacy with those she dates. She takes care of herself and hikes regularly, but feels weak much of the time due to being “hyper-tense, “ yet has trouble sleeping at night. She has battled with psoriasis for many years and describes herself as having a high tolerance for people who take advantage of her. This causes her to “dissociate” and shuts down her feelings, especially during sex. Her emotions are described with much anger, yet she can be “sweet and empathic” but only up to a point. She says that “her style is to eventually become impatient and walk away.” She describes her confidence being high with regard to her intellect, despite not having gone to college, but with a low self-image. Susan mentions how she used to be intuitive yet, with all the present grief and anger in her life, it is no longer the case.
She is very organized and punctual. Her dreams are often about being alone and struggling to stay on top of things, as well as being chased and ending up in sexual encounters. When angry, she will violently throw out things of importance and seldom cries.

Conclusion

The framework of the Genogram creates an almost hypnotic, trance-like induction. Going over a transgenerational map is the catalyst for in-depth narratives that bring out the developmental stages and character development of an individual. Not all individuals will respond to the silence of the unprejudiced observer method taught in many Homeopathic Schools. The gentle guiding of how, why, what, where and with, within the framework of the family context, elicits multiple emotions and events that are part of everyone’s development. Having the Genogram map as a visual guide also reinforces recall and connects with the unconscious reservoir of information that eventually describes the whole person.

About the author

Kenneth Silvestri

Kenneth Silvestri

Dr. Kenneth Silvestri has been in private practice as psychotherapist and Homeopath since 1980. He holds a doctoral degree from Columbia University in anthropology and psychology. In addition, he has been the recipient of national fellowships in the social sciences at the University of Chicago and University of Pennsylvania. Dr. Silvestri has participated in post-doctoral training at the Ackerman Institute for Family Therapy in New York City and the Multi-Cultural Family Institute in New Jersey. He is also a Certified Classical Homeopath (CCH), having completed intensive certification programs with renowned homeopaths Dr. Luc De Schepper and David Little. Dr. Silvestri has been an adjunct professor at the graduate schools of Montclair State University and the College of Saint Elizabeth over a twenty-year period. He has published more than sixty professional articles and monographs, as well as several chapters for books on mental health/homeopathy. He has conducted numerous workshops on family therapy, alternative education, communication skills, forgiveness and homeopathy. He is an American Association of Marriage and Family Therapy (AAMFT) clinical member, AAMFT certified clinical supervisor, and an active black belt student of Aikido. www.Drkennethsilvestri.com

2 Comments

  • DEAR DR
    IT IS TRUE THAT GENOGRAM IS AN IMPORTANT FACTOR IN TOTALITY OF SYMPTOMS BUT NOW A DAYS DUE LIFE STYLE OF YOUNG PEOPLE WE FIND BLOOD PRESSURE,HEART TROUBLE, RHEUMATIC PAIN IN KNEE AND BACK, SPONDOLESES, ASTHMA, OBESITY, VISION PROBLEM, SKIN DISEASES IN CHILDREN WITHOUT ANY TRACE OF GENOGRAM

  • Dear Dr. Gupta, Thank you for reading my article. Everyone has a background and legacy. The Genogram is a trans generational map that collects and contextualizes all the factors that you mentioned. in order to find the matching remedy.
    Be well
    Ken

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