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Genogram symbols

The symbols of genograms, the family diagrams of family therapy, medicine and social work: people, partnerships, children and the lines for emotional relationships.

Test yourself: Genogram symbols quiz

People 6 symbols

Partners and children 7 symbols

Emotional relationships 4 symbols

About genogram symbols

A genogram is a diagram of a family across at least three generations. Like a family tree, it shows who is related to whom; it also records marriages, separations and divorces, births and deaths, illnesses, and how people in the family get on with one another. Family therapists, social workers and doctors draw genograms, using symbols that Monica McGoldrick and Randy Gerson published in Genograms in Family Assessment in 1985. Each symbol has its own page.

Genogram or family tree

McGoldrick’s Multicultural Family Institute calls a genogram a family therapist’s version of a family tree. Both draw the generations of a family. A genogram adds the relationships: SAMHSA’s guide to family therapy describes it as a map of a family’s health, communication and relationship patterns across three or more generations, including emotional closeness, conflict and cutoffs. A family tree can show that two people are married; a genogram can also show that they are Close relationship, in Conflict or cut off from each other.

Reading a genogram

Each person is a shape: a square for a male and a circle for a female, with the age inside and an X through it after a death. A couple are joined by a line beneath them, solid for a Marriage and dashed for a couple living together, with one slash for a Separation and two for a Divorce. Children hang from the couple’s line, oldest on the left; a Pregnancy is a triangle in the same row. Lines drawn straight between two people record the relationship itself: two parallel lines for Close relationship, a zigzag for Conflict, a dotted line for Distant relationship and a line broken by two bars for a Cutoff. The person the genogram is drawn around, the index person, has a double outline.

Where the symbols come from

The psychiatrist Murray Bowen developed the genogram in the 1970s as part of his family systems theory. In 1980, when three researchers in family medicine at Stony Brook tested a genogram form with family medicine residents, they wrote that no standard method of recording had yet been developed, and that wide use would need standard symbols. The North American Primary Care Research Group agreed a standard with family therapists, and McGoldrick and Gerson published it in 1985. McGoldrick has called the genogram a tool in progress whose symbols have changed since that first edition. The book’s second edition was titled Genograms: Assessment and Intervention, and the fourth, written with Sueli Petry, appeared in 2020 as Genograms: Assessment and Treatment.

Why two genograms can look different

There is no single fixed key. SAMHSA’s guide reprints two genograms whose keys differ on how they show addiction, illness, closeness, conflict and cutoffs. The 2021 Research in Practice guide for social workers adds colours for themes such as substance use or mental health, and asks that every genogram carry a key that grows with it. The Multicultural Family Institute’s sheet and the Research in Practice guide also have symbols for sexual orientation and for transgender people. A genogram’s own key decides what its marks mean.

Lines for abuse and violence

The standard notation includes lines for abuse. On the Multicultural Family Institute’s chart of interactional patterns they are zigzags ending in an arrowhead, in separate forms for physical, emotional and sexual abuse. The Practice Supervisor Development Programme’s guide, funded by the Department for Education, has lines for violence from one person and violence to each other, and the Research in Practice guide’s example genogram has one for domestic abuse. Like the other relationship lines, they record what was known when the genogram was drawn: the Research in Practice guide notes that what a genogram records is often not objective fact but sensitive, relational information, and that any genogram represents a moment in time.

Genograms and medical pedigrees

Doctors and genetic counselors draw a related diagram, the pedigree, to trace inherited conditions. The American Academy of Family Physicians describes family history work as ranging from asking whether relatives have the same illness to drawing a full family genogram. The pedigree has its own standard, first published by the National Society of Genetic Counselors in 1995 and revised in 2008 and 2022. It agrees with the genogram on squares, circles, couple lines and children in birth order, and differs on several marks: a death is a diagonal line through the symbol, not an X; a pregnancy is a diamond with a P, not a triangle; a Miscarriage is a small triangle; an adopted child is drawn in brackets; and the proband, the affected family member whose condition raises the question for relatives, has an arrow where a genogram’s index person has a double outline.

Sources

  1. Drawing a genogram, PSDP Resources and Tools, November 2019, Practice Supervisor Development Programme, funded by the Department for Education (copy hosted by Tri.x procedures online), What is a genogram?; Figure 1
  2. Substance Use Disorder Treatment and Family Therapy (Treatment Improvement Protocol 39), SAMHSA Publication No. PEP20-02-02-012, updated 2020, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (govinfo.gov), Chapter 4, Genograms
  3. Using genograms in practice, Practice Tool, Hannah Scott, February 2021, Research in Practice (The Dartington Hall Trust), Pages 2, 4 and 12
  4. Genograms (Vivienne Kennedy, MAI Review, 2010), Vivienne Kennedy, MAI Review 2010, 3, MAI Review (Ngā Pae o te Māramatanga), Pages 1–2
  5. What's a Genogram?, Monica McGoldrick, Introduction to Genograms, 2003, The Multicultural Family Institute (Internet Archive), What's a Genogram?; About Genograms
  6. Standard Symbols for Genograms, The Multicultural Family Institute (copy on a PBworks course wiki), Pages 1 and 2
  7. The Genogram, Winifred Jolly, Jack Froom and Melville G. Rosen, The Journal of Family Practice 10, no. 2 (1980): 251–255, The Journal of Family Practice (MDedge archive), Abstract and page 252
  8. Family History: The Three-Generation Pedigree, Daniel J. Wattendorf and Donald W. Hadley, American Family Physician 72, no. 3 (2005): 441–448, American Academy of Family Physicians, Introduction
  9. Practice resource-focused revision: Standardized pedigree nomenclature update centered on sex and gender inclusivity: A practice resource of the National Society of Genetic Counselors, Robin L. Bennett, Kathryn Steinhaus French, Robert G. Resta and Jehannine Austin, Journal of Genetic Counseling 31 (2022): 1238–1248, National Society of Genetic Counselors (Wiley), Introduction; Figures 2–4

Researched, edited and approved by Rory Hansen before publishing. Last reviewed October 9, 2026. How we research