Clinical Reference

Genogram Template, Symbols and Example for Therapists

Last updated:

Reviewed by the WellNotes Clinical Team

What is a genogram?

A genogram is a family diagram that shows at least three generations: who is in the family, how they are related, and the health, behavior and relationship patterns that repeat. Clinicians build one with the client at intake or early in family therapy, using standard symbols so another clinician can read it.

What is a genogram used for in therapy?

A genogram turns a family history into a picture. Squares and circles show people, lines show how they are related, and notes on each symbol record ages, dates, illness, substance use, losses and relationship quality. McGoldrick, Gerson and Petry’s Genograms: Assessment and Treatment is the standard reference for the format and its symbols.

Clinicians use genograms to gather history efficiently, to see patterns across generations (for example, alcohol use, early loss or cutoffs that repeat), to understand who is in the client’s support system, and to engage the client: many people find drawing the family together easier than answering a list of questions. Rempel, Neufeld and Kushner (2007) describe the genogram as a graphic portrayal of the composition and structure of a family and report that drawing it with participants also built the working relationship.

A genogram is usually gathered during the family and social history part of an intake assessment or a biopsychosocial assessment, and revisited in family therapy as new information comes out. Pair it with an ecomap when you also need the family’s links to school, work, health care and community services.

Genogram symbols key

The symbols below follow the conventions in McGoldrick, Gerson and Petry. Conventions vary somewhat between editions, programs and software, so put a key on every genogram you share.

SymbolMeaning
SquareMale
CircleFemale
Double outline around a square or circleThe index person (the client the genogram is about)
X inside a symbolDeceased; write birth and death years above the symbol and age at death inside
TrianglePregnancy
Small filled circle on a child lineMiscarriage
Small X on a child lineInduced abortion
Small square or circle with an X insideStillbirth
Number inside the symbolCurrent age
Lower half of the symbol shadedAlcohol or drug misuse
Left half of the symbol shadedA physical or mental health condition (label it)
Dotted line drawn around several peopleMembers of the current household

Newer editions add symbols for transgender and nonbinary people, sexual orientation and other identities. Use the client’s own words for identity, write them on the genogram, and do not infer gender from a name.

Family structure lines

LineMeaning
Solid horizontal line joining two partnersMarriage, with the year written on the line (m. 2004)
Dashed horizontal line joining two partnersUnmarried partners or cohabiting couple
One slash across the partner lineSeparation (s. year)
Two slashes across the partner lineDivorce (d. year)
Vertical lines down from the partner lineChildren, oldest on the left
Two child lines meeting at one pointTwins (a short bar between the lines marks identical twins)
Dashed child lineAdopted or foster child (label which)

Emotional relationship lines

LineMeaning
Two parallel linesClose relationship
Three parallel linesFused or enmeshed relationship
Zigzag lineConflict or hostility
Three lines with a zigzagClose but conflictual (fused and hostile)
Dotted lineDistant relationship
Line broken by a gap or two short barsCutoff or estrangement
Arrow along a lineDirection of abuse or of a strong one-way pattern (label it)

Genogram template

Use these prompts to gather what the diagram needs, then draw the genogram by hand or in your record system. Copy the headings into your intake or family history section.

Index person and household

Index person
client initials, age, and the identity terms the client uses
Current household
everyone who lives with the client, with ages and relationship to the client
Reason for the genogram
intake history, family therapy, caregiving, grief, custody context

Three generations

Client’s generation
siblings and half-siblings in birth order, partners, marriages, separations, divorces, with years
Children
biological, adopted, foster and step-children, with ages and where they live
Parents’ generation
parents, step-parents, aunts and uncles, with ages or years of death
Grandparents’ generation
grandparents, years of death and causes if known, migration or major moves

Health, behavior and losses

Mental health
diagnoses or symptoms the client reports for each person, marked as reported, not confirmed
Substance use
who, which substance, current or past, recovery
Medical conditions
conditions relevant to the client or to caregiving
Losses and major events
deaths, suicides, pregnancy losses, incarceration, immigration, job loss, with years

Relationships and patterns

Relationship quality
close, fused, conflictual, distant or cutoff, for each key pair
Repeating patterns
what shows up across generations, in the client’s words where possible
Strengths and supports
people the client can rely on, cultural and spiritual resources
Gaps
information the client does not know or chose not to share

Genogram example

All examples are fictional and de-identified. They show structure and level of detail, not clinical advice for a real client.

Example 1: Three-generation genogram written up in an intake note

Fictional adult client seen for anxiety and drinking concerns. The diagram was drawn with the client in session 2; this is the narrative summary that goes into the intake record.

Index person and household
Client (double outline), 34, lives with partner (m. 2019, solid partner line) and their daughter, 4. Dotted household line around the three of them.
Client’s generation
Client is the second of three children. Older brother, 37, lower half shaded for alcohol misuse per client report; cutoff line between client and brother since 2021. Younger sister, 30, close relationship (two parallel lines).
Parents’ generation
Parents divorced in 2001 (two slashes on the partner line). Father, 63, lower half shaded for alcohol use, described as in recovery for 10 years; distant relationship with client (dotted line). Mother, 61, left half shaded for depression per client report; close but conflictual relationship with client.
Grandparents’ generation
Paternal grandfather deceased 1998 at 58 (X in symbol), cause reported as liver disease linked to alcohol use. Maternal grandmother, 84, close to client and a stated support. Other grandparents deceased, details unknown to client.
Patterns noted
Alcohol misuse across three generations on the paternal side; client identifies this as a reason for seeking help now. Cutoffs follow conflict over drinking in two generations. Strengths: close ties to sister and maternal grandmother.
Use in the treatment plan
Client asked to keep the genogram in the record and revisit it when discussing alcohol goals. Information marked "per client report" because no other family members were present.

How do you create a genogram with a client?

  1. Explain why. Tell the client what a genogram is and that they can skip anything they prefer not to share.
  2. Start with the household. Draw the client and the people they live with, then partners and children.
  3. Add generations. Work up to parents and grandparents, and across to siblings in birth order, oldest on the left.
  4. Add dates and events. Births, deaths, marriages, separations, moves and other major events, with years.
  5. Add health and behavior. Mental health, substance use and medical conditions, labeled as reported by the client.
  6. Add relationship lines. Ask about the closest and the most difficult relationships rather than rating every pair.
  7. Ask about patterns. "What do you notice when you look at this?" often brings out the most useful material.

Most clinicians build the core diagram in one session and add to it over time. Date the genogram and update it when new information comes out.

How do you document a genogram in therapy notes?

The diagram itself is usually stored as an attachment or drawing in the record. The note should still carry a short narrative, because a reader may not open the attachment and because the narrative records your clinical observations:

  • In the intake or biopsychosocial assessment, summarize household, three-generation structure, significant losses, health and substance use history, and the patterns you and the client identified.
  • In a progress note, record that the genogram was completed or updated, what the client noticed, and how it connects to the treatment goals. For example: "Completed genogram with client; client identified a pattern of cutoffs after conflict in two generations and linked it to current distance from brother. Will continue to explore in relation to goal 2."
  • In family therapy notes or child and family therapy notes, record who contributed, where accounts differed and any reactions in the room.

Label information about other people as reported by the client, avoid diagnosing family members who are not your clients, and follow your organization’s rules on recording third-party information.

Common genogram mistakes

  • No key, so readers interpret shading or lines differently.
  • Writing a family member’s diagnosis as fact when it is the client’s report.
  • Stopping at two generations, which hides the patterns a genogram is meant to show.
  • Guessing gender, relationships or identity from names instead of asking the client.
  • Drawing every relationship line, so the important ones get lost.
  • Never dating or updating the genogram after the first session.

Frequently Asked Questions

What are the basic genogram symbols?

A square is male and a circle is female, a double outline marks the client, an X inside a symbol means the person has died and a triangle is a pregnancy. Solid lines join married partners, dashed lines join unmarried partners, one slash is a separation and two slashes are a divorce. Always include a key.

How many generations should a genogram include?

At least three: the client’s generation, their parents’ and their grandparents’. Add the client’s children when there are any. Three generations is what lets repeating patterns show.

What is the difference between a genogram and an ecomap?

A genogram maps the family across generations: who is related to whom and what patterns repeat. An ecomap maps the household’s links to outside systems such as school, work, health care, faith community and services, and whether each link is supportive or stressful.

Can I make a genogram with a child or a family together?

Yes. With families, have members add to the drawing together and note where their accounts differ. With children, keep it simple and concrete, focus on the people the child lives with and sees, and involve caregivers for the history.

Do I need software to make a genogram?

No. A hand-drawn genogram with a clear key works, and many clinicians draw it on paper in session and scan it into the record. Software can make large or changing genograms easier to read and update.

Sources

This page is educational reference material for clinicians. It does not replace clinical judgment, supervision, or the requirements of your licensing board, payer and organization.

Related templates

Spend less time on the session note

WellNotes drafts progress notes in SOAP, DAP, BIRP and other formats from brief session details you type. You review and edit every note before you use it.

Try the free Therapy Progress note generator

3-day free trial · Cancel anytime

All note templates