Genograms for Occupational Therapy
Understand how family context shapes occupational performance, caregiver dynamics, and rehabilitation outcomes.
Family Context in Occupational Therapy Assessment
Occupational therapy is fundamentally concerned with enabling people to participate in the activities that give their lives meaning. But meaningful occupation does not happen in isolation. It occurs within families, communities, and cultures that shape what activities a person values, how they perform daily routines, and who supports them when function is compromised.
The genogram gives OT practitioners a structured tool for understanding this family context. Drawing on the Model of Human Occupation (MOHO) developed by Gary Kielhofner, the genogram maps the environmental factors, particularly the social environment, that influence a client's volition, habituation, and performance capacity. It reveals occupational patterns transmitted across generations, caregiver dynamics that will shape rehabilitation, and family attitudes toward disability and independence.
The Occupational Genogram
First described in occupational science literature, the occupational genogram specifically maps how work, leisure, and self-care patterns flow through families. It asks questions traditional genograms miss: What did your grandparents do for work? Were hobbies passed down? Who in your family was the caregiver? What happens when family members become unable to do the activities that define them? These questions connect the client's current occupational challenges to their family's occupational narrative.
Why Occupational Therapists Use Genograms
Clinical scenarios where family mapping improves OT assessment and intervention
Stroke Rehabilitation
After a stroke, family dynamics determine rehabilitation success. The genogram reveals who will be the primary caregiver, whether the family tends to over-assist (reducing client independence) or under-support, and family history of cardiovascular disease that may affect prognosis.
Pediatric Occupational Therapy
Children's occupational performance is inseparable from their family context. The genogram maps family routines, parenting styles, sibling dynamics, and whether parents have realistic expectations informed by their own developmental histories.
Mental Health Recovery
In mental health OT, the genogram uncovers family attitudes toward work, productivity, and meaningful activity. A client who cannot maintain employment may come from a family where mental illness led to generations of unemployment, creating both a pattern and a lack of role models.
Aging and Caregiver Assessment
When assessing older adults, the genogram identifies the entire caregiver network: who provides physical care, who manages finances, who is experiencing caregiver burnout, and whether the caregiving pattern repeats across generations.
Disability and Adaptive Living
For clients with congenital or acquired disabilities, the genogram reveals family attitudes toward disability, use of adaptive equipment across generations, and whether the family promotes independence or learned helplessness.
Workplace Injury and Return to Work
When planning return-to-work programs, the genogram reveals family occupational values, financial pressures, family history of workplace injuries, and attitudes toward pain and disability that may affect the client's motivation and recovery timeline.
What OT Practitioners Map in Genograms
Key elements for an occupation-focused family assessment
Functional Abilities and Disabilities
Physical and cognitive abilities across family members: mobility limitations, sensory impairments, chronic conditions, and how these have affected daily occupations across generations.
Caregiver Roles and Patterns
Who provides care in the family, whether caregiving is shared or falls on one person, history of caregiver burnout, and whether the current client has been a caregiver themselves before becoming a care recipient.
Occupational Patterns (Work, Leisure, Self-Care)
Multigenerational patterns in work roles, career choices, leisure activities, and self-care routines. Does the family value physical labor or intellectual work? Are hobbies shared across generations? How do self-care habits get transmitted?
Disability History
Family members with disabilities (physical, cognitive, developmental), the age of onset, how the family adapted, and whether disability led to isolation or community engagement.
Adaptive Equipment and Modifications
Family experience with assistive technology, home modifications, wheelchairs, orthotics, or other adaptive equipment. Prior experience affects acceptance and utilization of recommended adaptations.
Environmental Context
Home environment, accessibility features, neighborhood resources, transportation access, and how the physical environment supports or hinders occupational engagement for family members.
Health Behaviors and Routines
Family patterns around exercise, nutrition, sleep, medication adherence, and health-seeking behavior that affect the client's rehabilitation participation and carryover at home.
Occupational Values and Identity
How the family defines productivity, success, and meaningful activity. A retired carpenter whose family values physical work may experience more identity disruption after a hand injury than someone from an academic family.
How GenogramAI Helps OT Practitioners
Quick Family Mapping
Describe the client's family in natural language and GenogramAI generates the visual diagram. Add occupational details, caregiver roles, and health history in minutes rather than hours of manual drawing.
Medical History View
Use GenogramAI's Medical View to highlight health conditions, disabilities, and causes of death across generations. Identify hereditary conditions that affect occupational performance and rehabilitation prognosis.
Caregiver Network Mapping
Visualize the entire support network around your client. Identify primary and secondary caregivers, assess caregiver burden distribution, and plan interventions that leverage the full support system.
Case Example: Robert, Stroke Rehabilitation
Fictional composite case for educational purposes
Presenting situation: Robert, 62, was referred to outpatient OT following a left-hemisphere stroke that caused right hemiparesis and mild aphasia. He was a retired electrician who spent his retirement woodworking in his garage shop. His initial OT goals focused on upper extremity function and returning to woodworking.
Family context from the genogram: Robert's wife, Linda, immediately took over all household tasks and began accompanying him everywhere. The genogram revealed that Linda's mother had suffered a stroke at age 58 and became fully dependent. Linda had been her mother's primary caregiver for 12 years, during which her mother never regained independence. Linda was unconsciously applying the same caregiving pattern to Robert, expecting full dependency. The genogram also showed Robert's father had died of a heart attack at 65, creating anxiety about Robert's cardiovascular health.
OT intervention informed by the genogram: The OT recognized that Linda's over-assistance was rooted in her lived experience with her mother, not resistance to therapy. Intervention included caregiver education that distinguished Robert's prognosis from her mother's, graded independence training with Linda present to build her confidence in Robert's abilities, and a home program that gave Linda a supportive role (setting up the workshop, organizing tools) without doing tasks for Robert. The genogram also prompted a referral to cardiology to address Robert's family cardiovascular risk, supporting both his rehabilitation and long-term health.
How to Get Started
Integrate with the Occupational Profile
During your initial occupational profile, add genogram questions: Who lives with you? Who helps with daily activities? What did your parents and grandparents do for work? Has anyone in your family had a similar condition? Enter the responses into GenogramAI to build the family map alongside your standard assessment.
Map Occupational Roles and Caregiver Dynamics
Annotate the genogram with occupational information: work history, caregiving roles, disability status, and functional abilities. Use GenogramAI's Medical View for health conditions and the Emotional View for relationship dynamics that affect caregiving and support.
Apply Insights to Intervention Planning
Use the genogram to inform your treatment plan. Identify caregiver patterns that may help or hinder progress. Understand the client's occupational identity within their family context. Plan family education that addresses specific dynamics the genogram revealed. Export the genogram for interdisciplinary team meetings.
Frequently Asked Questions
What is an occupational genogram?
An occupational genogram adapts the traditional family genogram to focus specifically on occupational roles, patterns, and engagement across generations. Developed from occupational science principles, it maps work history, leisure patterns, self-care routines, and caregiving roles within the family. It helps OT practitioners understand how a client's occupational identity has been shaped by family patterns and expectations.
How is the MOHO framework connected to genograms?
The Model of Human Occupation (MOHO) emphasizes that occupational behavior is shaped by volition (motivation), habituation (patterns), and performance capacity within an environment. A genogram helps OT practitioners understand the environmental context, particularly the family environment, that has shaped a client's occupational habits, roles, and values across generations. It adds a systemic layer to the MOHO assessment.
When should OT practitioners use genograms?
Genograms are particularly useful in OT when working with clients whose family dynamics significantly impact their rehabilitation or daily function. This includes stroke or brain injury rehabilitation (where family caregivers are central), pediatric OT (understanding family routines), geriatric OT (mapping caregiver networks), and mental health OT (exploring how family patterns affect occupational engagement).
Do OT students need to learn genograms?
Yes. Many accredited OT programs now include genogram training as part of family-centered care and psychosocial assessment curricula. The American Occupational Therapy Association (AOTA) emphasizes the importance of understanding family context in occupation-based practice. Genograms help OT students develop systems thinking skills essential for holistic client care.
How does a genogram differ from an occupational profile?
An occupational profile (as defined in AOTA's Occupational Therapy Practice Framework) focuses on the individual client's current occupational needs, interests, and performance. A genogram adds the multigenerational family context: how occupational patterns, values, and roles have been transmitted through the family. Together, they provide a comprehensive picture of who the client is and why they engage in occupations the way they do.
Can genograms be used in community-based OT practice?
Absolutely. In community OT settings, genograms help practitioners understand the family and social networks that support (or hinder) occupational participation. For community-dwelling older adults, the genogram reveals the caregiver network. For community mental health clients, it maps family attitudes toward occupation and employment. For pediatric community programs, it shows the home environment and family routines.
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