Genograms in family therapy

Family therapists usually draw the genogram with the client rather than for them. While they draw it together, the therapist can notice things a client rarely writes on a questionnaire, such as a pause before a relative's name, tears when a deceased parent is added, or a quiet "we don't talk about him".

Once the people and the dates are drawn, a therapist can ask questions like these to hear how the family relates:

• What was the relationship like between your parents?
• Who in your family are you most like, and who are you least like?
• Are there family secrets or rules nobody says out loud?
• Which patterns do you see repeating across generations?
• Which relationships in your family are most like your own relationships today?

The questions about the household, parents, grandparents and health are on the genogram questions page, each with the symbol or line drawn from its answer.

Family therapists often look for these patterns across three generations:

• Triangles. Two people in conflict with a child or another relative drawn in on one side, as in the triangulation genogram example.
• Cutoffs. A relative nobody speaks to, often in the same position in more than one generation, as in the emotional cutoff genogram example.
• Role reversal. A child who looks after a parent or younger siblings, as in the parentification genogram example.
• Substance use across generations. Drinking or drug use in a grandparent, a parent and a child, and the relatives who cover for it, as in the substance abuse and recovery genogram example.
• Repeating roles. An oldest daughter who becomes the caretaker in each generation, or men who keep their distance while the women carry the family's emotional work.
• Losses and secrets. An early death, a suicide or a miscarriage that nobody talks about, and the silence around it in the generations that follow.

In Bowen family systems therapy, the therapist reads the genogram for triangles, cutoffs, fusion and the family projection process across at least three generations, and the guide to Bowen family systems theory has each of Bowen's eight concepts and what it looks like on a genogram.

In structural family therapy, developed by Salvador Minuchin, the therapist looks at who is in charge, who is allied with whom and where the boundaries between generations are. Minuchin drew these on a family map, and a therapist can draw the same alliances on a genogram with relationship lines, as with a 12-year-old who looks after her younger siblings while her parents are disengaged.

Social workers, nurses and counselors draw genograms too, and there are separate pages on genograms for social work students, nursing students and marriage and family therapy students. A nurse's genogram is usually a family health history, drawn as a medical genogram, and social workers often draw an ecomap next to the genogram for the schools, services and other supports around a family.