Psychotherapy What Is a Genogram? By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is a clinical psychologist who works with children and adolescents. She is certified in TF-CBT and telemental health. Learn about our editorial process Published on February 14, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print SDI Productions / Getty Images Table of Contents View All Table of Contents What Is a Genogram? History of Genograms How Genograms Are Constructed Genogram Uses Tips for Using a Genogram When to Use a Genogram What Is a Genogram? Genograms are a visual representation of a person’s family, relationships between members, and medical and mental health histories. It is more in-depth than a family tree because it provides more extensive information about the family and each member. The genogram uses different symbols to represent gender, diagnoses, and connections between various family members. A therapist might use a genogram to help their client see transgenerational patterns or make connections about interactions between their relatives. If multiple family members are attending family therapy together, the therapist might use the genogram to gather more information about the family as a whole as well as each individual member. Clients attending couples therapy might use the genogram to identify how various patterns in their families of origin impact their relationship. An individual might also use a genogram to explore their own relationship patterns or to observe how intergenerational trauma might be affecting them. History of Genograms The genogram was initially developed as a therapeutic tool by Murray Bowen, the psychiatrist who created Bowenian Family Therapy. Genograms have been used in both medical and mental health settings to map family history and gain information about a client or patient’s presenting problems and needs. Original genogram structure relied on heteronormative and cisnormative assumptions about users, such as the assumption that couples consist of one man and one woman. Additionally, genogram symbols included binary transgender individuals but did not offer nonbinary options. In recent years, researchers have addressed these limitations and expanded genogram symbols to include various nonbinary identities. Genograms have also begun including options for ethically non-monogamous relationships. These changes have allowed providers to construct genograms for many different types of families. How Genograms Are Constructed The genogram has symbols that represent gender, and individuals are marked with the corresponding symbol, with lines drawn to represent the family relationships between them. For example, a married couple’s symbols are positioned next to each other, with a black line connecting them. If the couple is divorced, the connecting line is red with two lines through it indicating the legal and emotional separation. Older generations are at the top of the page, with children positioned below parents and lines connecting children to parents to indicate whether the child is biological or adopted. Each person’s symbol can include marks to represent various diagnoses. These symbols help medical providers identify genetic predispositions to various diseases. Any deceased people on the genogram are marked with an X and their age at the time of their death. In addition to family relationships and medical histories, the genogram often includes lines representing the emotional relationships between family members, including positive, loving connections as well as tensions, estrangement, and physical, emotional, or sexual abuse. Although a therapist might craft a genogram as part of an intake session to gather background information about their client, genograms often need to be updated over the course of treatment. A client might not feel ready to share certain information at the start of therapy. They might remember relevant details about relationships that they disclose later on. A client may also not identify behavior as abusive until they have processed the memory in therapy, which would alter the relationship lines in their genogram. Genogram Uses The genogram is used in many types of family therapy. In family systems therapy, a therapist views the family as a whole unit, and the genogram maps this unit to provide insight into how the various members relate to and affect each other. In structural family therapy, the therapist can use a genogram to observe the various structural relationships among family members and identify dysfunctional patterns. Individual therapists practicing psychodynamic therapy might use a genogram to gain insight into the client’s emotional patterns by seeing how these patterns have played out across generations and within the client’s family. Genograms are not limited to a specific therapeutic orientation, however; many different types of therapists use them, and they can help conceptualize a case from multiple clinical perspectives. Some people also craft genograms on their own as a part of exploring their genealogy and family history. Although a family tree is often sufficient for this project, you might choose to map your genogram in order to gather more information about the emotional connections as well as the physical and mental health of your relatives and ancestors. Tips for Using a Genogram The purpose of the genogram is to gather information and insight about a client’s family history and the relationships and emotional bonds between these family members. Relationships evolve, and people’s perception of relationships can change as they gain new insight into past interactions. As such, a genogram can be seen as a living document to be updated regularly. As you and your therapist create your genogram, you might become aware of patterns that you had not previously noticed. You might re-conceptualize things in different ways. This process can be emotional, so it can help to have strong self-care practices around your therapy sessions to manage these emotions. You might also benefit from mindfulness practices to ensure that you are addressing these emotions rather than ignoring or pushing them down. If you and your therapist are creating a genogram as part of your first session or very early in treatment, remember that you can disclose information at your own pace. You only have to share information that you feel safe and comfortable sharing, and you can always ask to return to a topic at a later date when you feel ready. When to Use a Genogram A genogram is a great tool for anyone who wants to further explore the emotional connections and health history of their family. If you are in therapy, the genogram can help your therapist understand your relationships to various family members and see the larger picture of your family unit. If you are seeking a deeper understanding of your past and how your family relationships might be impacting your emotions and other relationships in your life, a genogram might be a helpful tool for you on this journey. 2 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Barsky, A. E. (2020). Sexuality- and gender-inclusive genograms: Avoiding heteronormativity and cisnormativity. Journal of Social Work Education, 1–11. Browning, S., & Hull, R. (2019). Treating multidimensional presenting problems with a mutually integrative approach using the genogram. Family Process, 58(3), 656–668. https://doi.org/10.1111/famp.12470 By Amy Marschall, PsyD Dr. Amy Marschall is a clinical psychologist who works with children and adolescents. She is certified in TF-CBT and telemental health. 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