What Is a Genogram?

A short definition

A genogram (sometimes written as "family genogram") is a structured family diagram developed for clinical and research use. It builds on the conventions of a genealogical family tree and adds three layers that a tree does not capture: the quality of emotional relationships between family members, the medical and mental health conditions carried in the family, and life events such as divorce, migration, or estrangement that shape family functioning.

Where a written family history can hide patterns inside paragraphs of text, a genogram surfaces them on a single page. A genogram of three generations of substance use disorder, or four generations of breast cancer, makes a pattern obvious that no narrative description ever quite does.

What a genogram looks like

Every genogram uses the same base shapes. A square represents a man, a circle represents a woman, and a diamond represents a person whose gender is unknown or unspecified. A horizontal line connects partners, and children hang from a vertical line under the couple, drawn in birth order from oldest on the left to youngest on the right. An X through a symbol marks a deceased person. Filled colors inside a symbol can indicate medical conditions or other tracked attributes.

Sample three-generation genogramView Only|Made with Genogram Pro

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A simple three-generation genogram. Squares are men, circles are women, horizontal lines connect partners, and vertical lines connect parents to children.

See the full genogram symbol reference for couple types, parent-child relationships, and the 37 emotional bond patterns used in clinical practice.

Genogram vs family tree

A family tree and a genogram share the same starting point - who is descended from whom - but diverge in what they capture beyond that.

• A family tree records names, dates of birth and death, marriages, and biological lineage.
• A genogram records all of the above plus relationship quality (close, distant, conflictual, cutoff), medical and mental health conditions, behavioral patterns like addiction or abuse, and life events such as divorce, adoption, or migration.

Put simply: a family tree tells you who is in the family. A genogram tells you how the family works. For a deeper comparison, see the genogram vs family tree example.

What a genogram captures

A complete clinical genogram records four kinds of information for each person and each relationship:

• Identity and structure. Name, gender, birth and death dates, vital status, generational position. The skeleton of any genogram.
• Medical and mental health. Diagnosed conditions, age of onset, cause of death. Color coding inside the person symbol indicates which conditions apply. A specialized variant called a medical genogram extends this layer.
• Relationship quality. Closeness, conflict, enmeshment, cutoff, abuse. Drawn as additional lines between people, distinct from biological connections.
• Life events. Marriage, divorce, cohabitation, adoption, migration, military service, incarceration, religious conversion. Recorded as notes or specialized symbols on the chart.

Where genograms come from

The genogram emerged from Murray Bowen's family systems theory in the 1960s as a clinical tool for tracking intergenerational patterns. The standardized notation in use today was formalized by Monica McGoldrick and Randy Gerson in their 1985 book Genograms in Family Assessment, which established the symbols, conventions, and three-generation default that most clinicians still follow.

Newer specialized variants - the cultural genogram, the spiritual genogram, the community genogram - extend the core notation to capture cultural identity, faith, and community belonging.

What genograms are used for

Across all the settings genograms appear in, the underlying use is the same: turn implicit family knowledge into a visual that can be examined, shared, and built on. The specific applications include:

• Clinical assessment. Therapists, counselors, and psychiatrists use genograms to identify relational dynamics that influence a presenting concern.
• Hereditary risk mapping. Physicians and genetic counselors use medical genograms to identify inheritance patterns and target screening or testing decisions.
• Case documentation. Social workers and nurses use genograms in case files, court reports, and multidisciplinary handoffs.
• Training and supervision. Graduate programs in family therapy, social work, and counseling use genograms as teaching tools and as required coursework.
• Self-understanding. Individuals sometimes build personal genograms to make sense of their own family history, often during therapy or after a significant family event.

Who uses genograms

Genograms are used by family therapists, marriage and couples counselors, clinical social workers, psychologists, psychiatrists, primary care physicians, nurses, genetic counselors, school counselors, child welfare workers, occupational therapists, and pastoral counselors. The tool is also taught in graduate training programs across these disciplines, which is why genogram literacy is a baseline skill in most clinical roles that work with families.

How to make a genogram

Building a genogram involves five steps: gathering family information, drawing the structural skeleton in birth order, adding life events and dates, layering in medical and mental health information, and finally drawing emotional relationship lines between members. The full process is documented in the how to make a genogram guide.

If you want to build one without learning the symbols by hand, the free genogram maker handles the notation and layout for you. For a deeper conceptual treatment, the full genogram guide covers symbols, clinical use, and theory. Comparing tools first? The best genogram software roundup ranks the options for clinical work.