How to Create a Genogram — Step by Step

Creating a genogram for the first time can feel daunting. You are trying to capture the complexity of a family — biological, emotional, medical, and relational — in a single diagram. This guide breaks the process into manageable steps so you can produce a clear, useful genogram from scratch, whether you are working on paper or using dedicated software.

Step 1: Decide on Your Focus and Scope

Before you draw anything, answer two questions:

• Who is the identified person? The genogram is usually centred on one individual — the client, patient, or person you are assessing. This person is marked with a double border in the final diagram.
• How many generations will you include? Three generations is the standard minimum: the identified person, their parents, and their grandparents. If a specific pattern (e.g., a hereditary illness or a recurring relational dynamic) requires going further back, add a fourth generation. Including siblings and children of the identified person is also standard.

Step 2: Lay Out the Structure

Start with the middle generation — the identified person and their siblings — in the centre of the page. Work upwards to place the parents and grandparents, and downwards to add any children or grandchildren.

Use the standard symbols:

• Squares for male, circles for female.
• Horizontal couple lines connecting partners, with a vertical line dropping to children.
• Siblings share a horizontal sibship line, with individual vertical lines dropping to each child.

At this stage, keep the diagram simple. Focus on getting the structure right before adding any annotations.

Step 3: Add Basic Biographical Information

For each person, add:

• Name (first name is sufficient for most clinical purposes).
• Birth year — placed inside or below the symbol.
• Death year — if deceased, mark the symbol with an X and add the year.
• Current age — optional, but useful for quick visual reference.

For couple lines, note the year of marriage (or union) above the line and, if applicable, the year of separation or divorce with the appropriate slash marks.

Step 4: Add Medical and Psychiatric Information

This is where a genogram diverges significantly from a family tree. For each person, note any significant medical or psychiatric conditions using brief codes or annotations near their symbol. Common abbreviations include:

• HTN — hypertension
• DM — diabetes mellitus
• CA — cancer (with type if known)
• ALC — alcohol use disorder
• DEP — depression
• ANX — anxiety disorder
• MI — myocardial infarction

Use colour coding if you want to visually group related conditions — for example, all cardiovascular conditions in red, all mental health conditions in blue. Add a legend to the diagram so the colour scheme is immediately clear.

Step 5: Document Relationship Quality

Once the structural diagram is complete, draw relationship quality lines between the individuals whose connection quality is relevant to your assessment. These lines run directly between the two symbols, separate from the structural lines. Use the standard line types:

• Two parallel lines for close.
• Three parallel lines or heavy lines for enmeshed.
• Zigzag for conflictual.
• Dashed for distant.
• Crossbar(s) for cut-off.

Focus on the relationships that are most relevant to the clinical question. Drawing every possible relationship quality line will make the diagram unreadable.

Step 6: Add a Legend and Review

Add a small legend in the corner of the diagram that explains any colour coding or non-standard notation you have used. Then review the complete genogram with fresh eyes — or better, with the client. Ask: does this accurately reflect the family as you understand it? Are there missing people or relationships that would change the picture?

Using Software

Creating genograms on paper works well for initial sketches, but digital tools offer significant advantages: easy editing, consistent symbol sizing, automatic alignment, and the ability to save and share files securely. WinGeno runs on Windows, macOS, Linux, Android, iOS, and directly in the browser. It covers Steps 1–3 of this guide: structural layout, partner and child relationships (married, divorced, cohabiting, biological, adopted, and foster connections), names, birth and death dates, and the identified person marker. All files are saved locally — no cloud upload, no registration, fully GDPR-compliant.

Medical annotations (Step 4) and relationship quality lines (Step 5) can be added as free-text notes alongside the diagram, or in a more specialised clinical documentation tool.

For a detailed walkthrough of WinGeno's features, see the WinGeno Manual.

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