Published September 6, 2026
Genograms in Practice on the NCMHCE: Notation, Patterns, and How to Use Them
By David Zimmerman · 7 min read · Domain deep-dives
The genogram is on NBCC’s list of the tools counselors use most, and multigenerational (Bowenian) family therapy is on its list of frameworks[3]. The exam tests what a genogram is for, the standard notation, what patterns to look for, and how the information is used and protected. The reference is McGoldrick, Gerson, and Petry[1], working from Bowen’s theory[2]. Seven scenarios follow.
What it is for
- Assessment: a graphic family history across at least three generations, gathered in the first sessions as part of the biopsychosocial assessment (Domain 2B).
- Pattern recognition: repeated illnesses, substance use, suicide, violence, cutoffs, triangles, and role patterns across generations; life events and their timing.
- Engagement: clients often see their situation differently when it is drawn; the process is collaborative and non-blaming.
- Treatment planning: patterns feed the case conceptualization; in Bowenian work, the genogram is also an intervention (coaching differentiation, detriangulation).
- Cultural genograms add ethnicity, migration, religion, and identity; ecomaps add the surrounding systems.
Standard notation
| Element | Symbol |
|---|---|
| Male / female | Square / circle |
| Index person (client) | Double outline |
| Deceased | X through the symbol; dates inside or beside |
| Marriage / partnership | Horizontal line connecting the two; date; man on the left by convention |
| Separation / divorce | One slash / two slashes through the connecting line |
| Children | Vertical lines from the couple line, oldest to youngest left to right |
| Pregnancy, miscarriage, abortion, stillbirth | Triangle, small filled circle, small X, small X with symbol |
| Adopted / foster child | Dashed vertical line |
| Twins | Lines converging to one point |
| Household | Dotted line encircling current members |
| Relationship: close / fused / conflictual / fused-and-conflictual / cutoff / distant | Two lines / three lines / jagged line / three jagged lines / broken line / dashed line |
| Abuse | Arrow from abuser to abused (zigzag in some systems) |
| Substance use, mental or physical illness | Symbol half-filled or marked with a code; note diagnoses and dates |
Patterns the exam asks about
- Multigenerational transmission: a problem recurring across generations, often with the same relational position.
- Triangles: a third person drawn into a two-person tension (a child between parents, an in-law, an affair).
- Emotional cutoff: distance used to manage unresolved fusion.
- Sibling position and birth order as they shape roles.
- Anniversary reactions: symptoms clustering around dates of loss.
- Structural patterns: enmeshed or disengaged subsystems, parentified children, coalitions.
Using it well
Family and intake reasoning runs through the free cases
5 free full cases and 18 free drills with rationales for every option.
Scenarios
Interactive
Genograms in practice on the NCMHCE
A counselor draws a three-generation genogram with a new client during the second session. The primary purposes are:
Related
Sources
- McGoldrick, M., Gerson, R., & Petry, S. (2020). Genograms: Assessment and Treatment (4th ed.). W. W. Norton.
- Bowen, M. (1978). Family Therapy in Clinical Practice. Jason Aronson.
- NBCC — NCMHCE Examination Specifications, effective July 1, 2027 (domain weighting, format, scaled scoring)
Frequently asked questions
What is a genogram used for?
A graphic three-generation family history used in assessment to map structure, relationships, and multigenerational patterns (illness, substance use, conflict, cutoffs, triangles), to engage the client in seeing patterns, and, in Bowenian work, as an intervention.
What are the basic genogram symbols?
Squares for males, circles for females, a double outline for the index person, an X for death; couple lines with slashes for separation and divorce; children below from oldest to youngest; relationship lines: two for close, three for fused, jagged for conflict, broken for cutoff, dashed for distant.
How is a genogram different from an ecomap?
A genogram maps the family across generations; an ecomap places the person or family at the center and maps connections to outside systems (work, school, faith community, agencies, friends) with lines showing the strength and quality of each.
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