Learn how to create, interpret, and use genograms effectively in clinical practice.
Encourage clients to practice new relational habits between sessions with HabitForge so their goals stay aligned with the insights you chart in each genogram.
A genogram is a pictorial diagram of a person's family relationships and medical history. It goes beyond a traditional family tree by allowing the user to visualize hereditary patterns and psychological factors that punctuate relationships. Genograms display family information in a way that provides a quick overview of complex family patterns.
Genograms were popularized by Monica McGoldrick and Randy Gerson through their book "Genograms in Family Assessment" (1985). The approach builds on Murray Bowen's family systems theory and has become a standard tool in family therapy training programs worldwide.
Begin by collecting basic demographic information about at least three generations:
Start with the index person (identified patient) and work outward:
Use different line styles to show relationship quality:
Add clinical indicators near each person's symbol to show medical and mental health conditions, substance use patterns, and other relevant clinical information.
Create genograms collaboratively with clients. This process often reveals insights and helps clients see their family system from a new perspective. The act of creating the genogram can be therapeutic in itself.
Use questions like:
Genograms are living documents. Update them as new information emerges in therapy or as family circumstances change. Compare versions over time to track family evolution.
Be mindful that discussing family history can be emotionally triggering. Watch for signs of distress and provide appropriate support. Pace the genogram construction over multiple sessions if needed.
Look for patterns that repeat across generations, such as substance abuse, mental health conditions, relationship patterns, or occupational choices.
Identify three-person systems where tension between two people involves a third person as a way to stabilize the relationship.
Notice patterns of distancing or complete severance of relationships, often as a way of managing unresolved emotional issues.
Pay attention to significant dates and how family events (births, deaths, marriages) may cluster around certain times of year.
Cultural context is essential when creating and interpreting genograms. Different cultures have varying norms around family structure, relationship boundaries, and the sharing of family information.
Document migration patterns, noting which generation immigrated and from where. Pay attention to acculturation stress and generational conflicts around cultural values.
Approach each family with curiosity rather than assumptions. Ask clients to educate you about their cultural norms and family values. Avoid imposing Western family therapy concepts universally.
Clients should understand the purpose of the genogram, how it will be used in treatment, and that they can decline to answer any questions. Make it clear that the genogram is a collaborative tool, not an interrogation.
Record information as reported by the client, but note when information is uncertain or disputed. Multiple family members may have different versions of family history.