Genogram symbols: complete reference guide with clinical context

Patterns to look for

Person symbols: the foundation layer

Person symbols form the structural backbone of every genogram. A square represents a male. A circle represents a female. A diamond represents other, non-binary, or unknown gender. A triangle represents a pregnancy, miscarriage, stillbirth, or abortion. These conventions, established by McGoldrick and Gerson in the foundational genogram literature, are used universally across clinical settings.

Several modifications convey status information. An X drawn through any shape indicates a deceased person. A yellow outline around a shape identifies the focus individual, the person around whom the genogram is constructed, typically the patient or identified client. Adopted or foster children connect to parents with dashed vertical lines, distinguishing biological from legal family membership.

Size is not meaningful on a standard genogram. A grandparent's symbol should be the same size as a grandchild's. Placement follows generational convention: the oldest generation at the top, the youngest at the bottom. Siblings are ordered left to right from oldest to youngest.

Questions to explore:

• Is every person represented with the correct symbol for their gender identity and vital status?
• Is the focus individual clearly identified with a yellow outline?
• Are adopted, foster, or step-family members distinguished with appropriate dashed-line notation?
• Which family members have avoided the hereditary pattern, and what differs about their situation?

Couple and relationship symbols: mapping structure

Horizontal lines between two person symbols encode the type and status of a couple relationship. Genogram Pro supports 25 couple relationship types, including marriage, divorce, cohabitation, engagement, dating, affair, separation, widowed, and committed-relationship. Each type has a distinct visual representation.

These structural symbols are factual, not evaluative. A divorce line does not imply failure. A marriage line does not imply harmony. The structural layer records what exists legally and socially. The emotional layer (covered below) records how those relationships actually function. This distinction between structural and emotional notation is one of the most important concepts in genogram literacy. The same couple might have a marriage line (structural) and a discord bond (emotional).

Multiple relationships are recorded chronologically from left to right. If a person has married, divorced, and remarried, the first spouse appears to their left and the second to their right. This convention breaks down with multiple marriages. McGoldrick notes that partners are then arranged chronologically, with the current partner closest.

Questions to explore:

• Are all current and former couple relationships recorded with the correct structural symbol?
• For individuals with multiple partnerships, is the chronological order (left to right) maintained?
• Are legally distinct relationship types (marriage vs. cohabitation) appropriately differentiated?

Parent-child symbols: connecting generations

Vertical lines drop from a couple's horizontal line to connect children below. A standard solid vertical line represents a biological parent-child relationship. A dashed vertical line indicates an adopted child. A dotted vertical line represents a foster child. These distinctions encode the nature of the biological and legal connection, which is clinically relevant for hereditary health assessment.

Twins share a single vertical drop from the parent couple line, then branch at the child level. Identical (monozygotic) twins are connected by a horizontal bar between their symbols. Fraternal (dizygotic) twins branch from the same point but without a horizontal bar.

Sibling order is recorded left to right, from oldest to youngest. Miscarriages, stillbirths, and terminated pregnancies are recorded using triangle symbols, positioned chronologically among the siblings. These reproductive events are clinically significant. They may indicate genetic conditions, Rh incompatibility, or recurrent pregnancy loss.

Questions to explore:

• Are biological, adopted, and foster children appropriately differentiated?
• Are siblings ordered from oldest (left) to youngest (right)?
• Are pregnancy losses documented in their chronological position among siblings?

Emotional relationship lines: the relational layer

Emotional bonds are drawn between any two individuals on the genogram. This layer is distinct from the structural layer and is what turns a genogram from a family tree into a clinical tool. Emotional bonds can connect parent and child, two siblings, grandparent and grandchild, or a client and a non-family member.

To create an emotional bond, select a person, click "Emotional Bond" in the selection toolbar, then click the target person. A bond type picker appears with Genogram Pro's 39 bond types, including:

• Close: A warm, mutually supportive relationship.
• Fused: An overly close relationship with poor boundaries.
• Distant: Minimal emotional connection or avoidance.
• Cutoff: A severed relationship with no contact, shown as a segmented line (broken into pieces with gaps, in red).
• Cutoff-repaired: A previously severed relationship that has been restored.
• Discord: An active hostile or contentious relationship.
• Hostile: Hostility between two individuals.
• Fused-hostile: Enmeshment combined with hostility, an intense boundary-poor relationship marked by frequent conflict.
• Focused-on: One person organized around the other (common in caregiving and codependency).
• Abuse, violence, neglect, controlling, manipulative: Specific harmful dynamics.
• Love, harmony, friendship: Positive bond types.

Emotional bond lines are approximations. McGoldrick notes they are "the least reliable lines on a genogram" because they oversimplify complex dynamics. Use them as starting points for conversation, not as definitive assessments.

The same pair of individuals can have different emotional bonds at different points in time. Some clinicians use date annotations on emotional lines to track relational changes.

Questions to explore:

• Are emotional bonds documented between all clinically relevant pairs, not just couples?
• Does the emotional layer tell a different story than the structural layer? (For example, a married couple with a discord bond.)
• Are there clusters of similar bond types that reveal a systemic pattern (e.g., multiple cutoffs on one lineage)?
• Which relationships provide stability during health crises?

Medical condition and clinical markers: the health layer

Medical conditions are recorded as color-coded fills on the person's symbol. The colors are customizable per condition. When multiple conditions are tracked, each condition gets a distinct color fill on the symbol.

For complex medical genograms, the Genogram Key panel shows all conditions and their assigned colors. Click a condition row in the Genogram Key to highlight everyone who has it. Every medical genogram should include a readable legend.

Mental health conditions, substance use disorders, and behavioral health conditions follow the same notation. They are medical conditions and belong in the same layer. Genogram Pro includes default conditions: Cardiovascular, Cancer, Diabetes, Autoimmune, Neurological, Respiratory, Genetic, Reproductive, Autism, ADHD, Depression, Anxiety, Bipolar, Schizophrenia, PTSD, and Other. Custom conditions can be added.

Entity conditions (red fill patterns on the symbol itself) indicate: illness, addiction, suspected-addiction, illness-remission, recovery, recovery-with-illness, illness-and-addiction, and more.

A family cluster of a condition does not automatically indicate genetic inheritance. Shared environment, lifestyle, and exposure can produce similar patterns. Kaakinen advises nurses not to "assume that a condition is genetic merely because more than one family member has it."

Questions to explore:

• Does the genogram include a condition legend that explains every colored fill?
• Are mental health and substance use conditions recorded with the same rigor as physical health conditions?
• Is age of onset recorded alongside each medical condition to enable pattern analysis?
• What screening or prevention steps has the family already taken?

How to build this in Genogram Pro

Clinical context

Genogram symbol conventions are rooted in the standardized system developed by Monica McGoldrick and Randy Gerson, first published in 1985 and updated in subsequent editions of Genograms: Assessment and Intervention. This system has been adopted across family therapy, genetic counseling, social work, nursing, and medical education as the common visual language for family assessment. While minor variations exist between fields, the core symbol set is broadly consistent.

The distinction between structural symbols (who is in the family and how they are connected) and emotional symbols (how they relate to each other) is what separates a genogram from a family tree. A family tree records structure. A genogram records structure and function, letting clinicians see where formal relationships and actual relational patterns diverge.

A genogram generates hypotheses for further exploration. Hereditary clustering on a genogram suggests risk, not certainty. McGoldrick writes that the genogram "cannot be used in a cookbook fashion to make clinical predictions."

McGoldrick emphasizes assessing resilience alongside problems. Which family members have coped well? What resources has the family drawn on during crises?