Table of Contents
How to Make a Genogram
This guide walks you through creating a genogram from start to finish. You can follow the process on paper or build the same structure in Genogram Pro as you go.
Last updated March 2026 · Based on McGoldrick et al., Genograms: Assessment and Treatment (4th ed., 2020)
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create a genogram online freeHow to Create a Genogram Step by Step
Identify the Index Person
Every genogram starts with an index person - the individual at the center of the diagram. In a clinical setting, this is typically the client or patient. In a personal or academic genogram, it's usually yourself. The index person's generation forms the middle horizontal row, with their parents above and children below.
Gather Family Information
Collect information about at least three generations. For each family member, try to gather:
- Full name and date of birth (and death, if applicable)
- Marriage, divorce, and cohabitation history
- Medical conditions and causes of death for deceased members
- Emotional relationship quality (close, distant, conflictual)
- Significant life events, occupations, and locations
Draw Person Symbols
Place person symbols in generational rows. Use squares for males, circles for females, and diamonds when gender is unknown or unspecified (the diamond is also used for pets). Mark deceased individuals with an X through the symbol. A small triangle drawn inside any person symbol indicates LGBTQ+ orientation. The index person (the person at the center of the genogram) is traditionally shown as a double-lined symbol or drawn larger than siblings; in Genogram Pro, they are highlighted with a yellow outline. See the genogram symbols reference for the complete set of person symbols.
Add Family Structure
Connect partners with horizontal couple relationship lines. Different line styles indicate marriage (solid black), divorce (solid red with two slashes), cohabitation (dashed blue with house marker), and other partnership types. Draw a family bar (horizontal line) between the couple, then extend vertical parent-child lines downward to their children.
Add Emotional Relationships
Draw emotional bond lines between individuals to show the quality of their relationship. Green lines represent positive bonds (close or harmonious), red lines represent negative bonds (conflict, hostility, or fusion), blue lines indicate abuse, and gray lines mark neutral or focused relationships. The most common mistake at this stage is using "close" (double green) when "fused" (triple red) is the more accurate choice: a close relationship describes two people who enjoy each other while still living their own lives, whereas fusion means one person becomes destabilized when the other is upset. See the relationship lines guide for all 39 emotional bond types.
Add Details and Annotations
Annotate the genogram with dates, medical conditions, occupations, and other relevant information. Add color-coded fills to person symbols to indicate medical conditions. Always include a legend explaining any symbols, colors, or abbreviations used in the genogram.
Worked Example in Genogram Pro
Start with the index person, add parents and grandparents, then layer in marriages, children, and the few emotional or medical details that matter to the case. That keeps the genogram readable and prevents the common mistake of encoding every family fact at once.
In Genogram Pro, build in the same order you would draw by hand: people first, then family structure, then emotional lines and annotations. Getting the structure stable before adding detail prevents the most common source of cluttered, hard-to-read genograms. Try the sequence on a blank canvas with our free online genogram maker, no account required. If you are still deciding on a tool, the best genogram software comparison scores each option on clinical accuracy and exports.
Rivera family genogram: Thomas (deceased, cardiovascular disease) and Helen as grandparents, their son Daniel (index person) divorced Patricia and remarried Catherine, children Michael and Sofia from each marriage, close bond between Daniel and his mother Helen.
How to Show Specific Situations
Divorce and Remarriage
Divorce is shown with two forward slash markers on the couple line, and the line turns red. When a divorced individual remarries, a new marriage line connects them to their new partner while the original couple line with divorce markers remains visible. Always preserve the first marriage on the genogram, because removing it erases timing information that can be clinically significant.
Divorce & Remarriage Genogram ExampleAdoption
Adoptive parent-child relationships use a dashed blue line instead of the solid line for biological children. When biological parents are known, show both connections: the biological line carries hereditary risk information, while the adoptive line reflects the family the person grew up in.
Adoption in GenogramsTwins
Twins are shown by parent-child lines that converge to a shared point before branching to each twin. Identical twins have a horizontal connecting bar; fraternal twins share only the convergence point. The distinction matters for medical genograms because identical twins share all their genes.
Twins in GenogramsHalf-Siblings
Half-siblings share one biological parent but not both. In a genogram, they are connected through their shared parent. Each half-sibling has a biological parent-child line to the common parent, but their other parent-child lines lead to different partners. A common mistake is drawing half-siblings as if they were full siblings under a single couple line, which hides important information: if a father had two children with his first wife and one with his second, those children share different mothers, and the genogram should make that visible because it affects both family dynamics and medical history.
Sarah and James are half-siblings who share the same father, Mark. Sarah's mother is Linda (divorced from Mark), while James's mother is Karen (married to Mark).
Deceased Members
Deceased individuals are marked with an X through their person symbol. The person's birth year and death year are typically noted near the symbol (e.g., 1945-2018). A widowed couple relationship is shown with an X marker on the marriage line near the deceased partner. Always include the death year alongside the X, because without it a reader cannot tell whether multiple deaths happened decades apart or within three years of each other, and that difference is often the key to understanding a family's emotional history, including, for instance, why a parent who lost three close relatives in rapid succession might find it difficult to speak about his childhood.
John (1945-2018) is marked deceased with an X through his symbol. The widowed couple relationship with Mary shows the marriage ended by death. Birth years and ages are displayed on each symbol.
The 3-Generation Genogram
A standard genogram includes at least three generations, and the reason is straightforward: two generations show you what happened, but three generations reveal what keeps happening across time.
- Generation 1 (Grandparents): This is where patterns originate. If the grandfather dealt with stress through alcohol and the grandmother responded by withdrawing emotionally, those coping strategies set the template for the next generation.
- Generation 2 (Parents): This generation reveals what was inherited and what changed. The father may drink the same way his father did, while the mother broke from her own mother's pattern and is openly affectionate. This is typically the generation that reveals the most about current family dynamics.
- Generation 3 (Index person / Children): This generation shows which patterns survived and which ones broke. If the index person avoids conflict the same way the grandmother did, that is a pattern visible only when all three generations are on the page together.
Chen family across three generations: divorced grandparents George (deceased) and Ruth, their children David and Laura with an emotional cutoff between them, David's wife Maria with a close bond to their daughter Amy, and a distant bond between David and his son Brian.
What Are the Rules for Building a Genogram?
Males Left, Females Right
In a couple pair, males are placed on the left and females on the right. This convention helps readers quickly identify gender without examining each symbol closely.
Oldest Left, Youngest Right
Siblings are arranged from left to right in birth order, with the oldest on the left and the youngest on the right. Birth order shapes family roles, and scrambling the order loses that context for any reader.
First Spouse Closest
When a person has had multiple partners, the first spouse is placed closest to the individual. Subsequent partners are positioned outward, creating a visual timeline.
Clarity Over Convention
Complex situations such as multiple marriages or crossed lines may require rearranging the layout. A person may even appear twice with a note indicating the duplication. Readability always takes priority.
Always Include a Legend
Every genogram needs a legend explaining symbols, colors, and line patterns. This is essential for medical genograms and any genogram shared with others.
Common Mistakes When Making a Genogram
The most common sources of confusion in a genogram are structural errors and uncertain information recorded as established fact.
Genogram Pro is designed to support this workflow, encouraging you to build the structure first and layer in detail across subsequent passes.
Frequently Asked Questions
How do you make a genogram step by step?
How many generations should a genogram include?
What is an index person in a genogram?
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