The standard clinical genogram covers three generations. Explore the Johnson family genogram to see how therapists map multigenerational patterns, emotional dynamics, and the identified patient.
A three-generation genogram is the minimum standard for clinical family assessment. It was established by Monica McGoldrick and Randy Gerson in their foundational work on genograms as a clinical tool. By mapping at least three generations, clinicians can identify repeating patterns in relationships, behavioral tendencies, health conditions, and coping mechanisms that would not be visible in a simpler two-generation family tree.
This example follows the Johnson family, where 14-year-old Emily has been referred for therapy due to anxiety and school refusal. By constructing a three-generation genogram, her therapist uncovers critical multigenerational patterns including anxiety transmission through the maternal line, emotional cutoffs, and parentification following the death of a grandparent.
Three generations of the Johnson family, showing how patterns of anxiety, emotional cutoffs, and caretaking roles repeat across the family system.
Robert and Martha married in 1970. Harold and Dorothy married in 1972. Robert died of a heart attack in 2020. Martha has remained a widow and lives independently.
Michael married Susan in 2005. James and Karen divorced in 2018 after 12 years of marriage. Lisa has been emotionally cut off from the family since 2015 following a conflict with Martha over family finances.
Emily is the identified patient presenting with anxiety and school refusal. She is particularly close with grandmother Martha and has taken on a caretaking role since grandfather Robert's death.
Emily is marked with a double-lined circle as the index person. She is the focus of the clinical assessment and the reason the genogram was constructed.
Grandfather Robert is shown with an X through his square symbol. His death from heart disease at 72 triggered significant family system changes.
Michael and Susan's marriage is shown with a solid horizontal line. James and Karen's divorce is shown with two slashes through the marriage line, with the year 2018 noted.
Lisa's estrangement from the family is shown with a broken line with perpendicular dashes, indicating an emotional cutoff since 2015.
Emily and Martha share a fused relationship (triple line), reflecting Emily's enmeshed caretaking role toward her grandmother following Robert's death.
Health conditions (heart disease, diabetes, hypertension) and behavioral patterns (alcohol use, anxiety) are noted next to each individual's symbol.
Anxiety appears across all three generations in the maternal line. Dorothy (Generation 1) has a history of depression, her daughter Susan (Generation 2) presents with anxiety, and granddaughter Emily (Generation 3) is the identified patient with anxiety and school refusal. This multigenerational pattern suggests both genetic predisposition and learned coping behaviors being transmitted through the family system.
Lisa's cutoff from the family mirrors a pattern visible in earlier generations. When family conflict arises around finances or loyalty, members tend to withdraw rather than engage. This avoidant pattern increases anxiety in the remaining system, as unresolved conflict creates triangulation. Emily may be absorbing the systemic anxiety generated by these unresolved cutoffs.
Following Robert's death, Emily took on a caretaking role with her grandmother Martha. This parentification mirrors Sophie's role in James and Karen's household, where she has become a parentified child managing the emotional needs of her younger brother Tyler. These role reversals place developmentally inappropriate burdens on children and are a common presenting factor in adolescent anxiety.
Robert's death in 2020 was a pivotal event for the family system. It intensified Martha's dependence on the family, triggered Emily's anxiety and fused relationship with Martha, and exacerbated James's alcohol use. The genogram reveals how a single loss event can ripple through an entire multigenerational system, activating latent vulnerabilities in multiple family members simultaneously.
Begin by placing Emily (the identified patient) and build outward to parents and grandparents.
Map grandparents at top, parents in the middle, and children at the bottom with proper symbols.
Add marriage, divorce, cutoff, and emotional relationship lines between family members.
Note medical conditions, behavioral patterns, dates, and ages for clinical analysis.
Free to use. No account required.
Use GenogramAI to create a professional three-generation genogram for clinical work, coursework, or personal family exploration.