Intergenerational Family Counselling and Therapy: Concepts, Methods, Family Patterns, and Scientific Evidence

Abstract

The report presents a critical review of intergenerational family counselling and therapy, that is, counselling and therapeutic work in which family history across generations is the central subject, and of the wider range of intergenerational family approaches. In Bulgaria, they are commonly offered under the term rodova terapiya. The field does not form a single method. It includes family and systemic therapy, genogram work, psychogenealogy, family constellations and narrative work with family stories, which differ in theoretical foundations, professional applications and levels of evidence. The review is a structured narrative review with critical appraisal, not a systematic review. Evidence for the effectiveness of specific interventions was assessed separately for each approach. Systemic therapy has demonstrated effects in adults with a range of mental disorders and relationship problems, but the effect of its intergenerational elements has not been isolated. Family constellations show improvement after a workshop in people from the general population. The 2021 systematic review rates the quality of the included studies as low. The 2026 preprint rates the certainty of the evidence as very low. The specific effect of the method has not been established. The searches conducted identified no studies of psychogenealogy as an intervention. The genogram has been studied in a randomised trial in family medicine as an instrument for collecting information, with no effect on the clinical encounter; the searches conducted identified no studies of its independent therapeutic effect. Adverse effects are poorly studied for all approaches. Evidence for intergenerational psychological mechanisms is of a different kind. Intergenerational links have been documented for attachment, parenting practices, maltreatment and socio-economic conditions. They are moderate in strength and not deterministic, and the interruption of adverse patterns is common. Explanations in terms of "ancestral memory", a "field" or the epigenetic transmission of specific experiences have no established mechanism. Conceptual models and hypotheses form a third category. The author's framework, the Internal Autobiographical Map (IAM), describes repetition in family history through the conclusions, rules, roles and scenarios of the specific person. It translates the concepts of practice into psychological constructs and formulates testable hypotheses, which still require independent empirical testing. The published studies concern measurement, not the effect of an intervention. According to the sources verified, there is no specific law in Bulgaria regulating these practices; this conclusion is preliminary pending verification against official state sources. The report proposes minimum ethical rules and competences and directions for future research.