Genogram Questions to Ask in a Family Assessment

The genogram questions worth asking fall into seven groups — structure and membership, couple history, emotional closeness, health and substance use, roles and rules, culture and migration, and the hard questions around loss and secrets. A genogram is only as good as the interview behind it. The symbols are easy; the skill is knowing what to ask, in what order, and how to listen for the thing the family is not saying.

Most people new to genograms make the same mistake. They treat the session like a form to complete — names, dates, boxes ticked — and they leave with a tidy family tree that tells them almost nothing clinically. The chart looks finished. It is empty. What turns a diagram into an assessment is the conversation: the follow-up question, the pause you let sit, the moment someone changes the subject. This guide organizes the questions the way a clinician actually uses them, category by category, with prompts you can take straight into an intake, a home visit, or a class assignment.

If you have not built one before, start with how to make a genogram for the mechanics, then come back here for the interview. The two halves are separate skills. You can know every symbol on the reading side and still run a flat interview if you only ask for facts.

1. Structure and membership

Everything else hangs off this. You cannot draw a relationship line, a marriage, or a cutoff until you know who the people are and how they connect. Start here every time, and go wide before you go deep — get the full cast on the page across three generations before you ask about any one person in detail. Watch for who gets left out. The half- sibling nobody mentioned, the aunt who is “not really family,” the child who died young — omissions are data.

• Who is in your immediate family? Let's start with you, then your parents, then your siblings.
• Are your parents living? If not, when did each die, and of what?
• How many brothers and sisters do you have? Where do you fall — oldest, youngest, in the middle?
• Have your parents been married before? Are there children from those relationships?
• Are there any children I haven't heard about — from any relationship, including any who died?
• Who raised you, day to day? Was it always the same household?
• Going back a generation: tell me about your grandparents on each side.
• Is there anyone you think of as family who isn't a blood relative?

2. Couple and marriage history

The line between two partners carries a lot. Marriages, separations, divorces, remarriages, and the children attached to each one form the backbone of the chart. Get dates where you can — the year a marriage ended often lines up with a birth, a death, or a move on another part of the genogram, and those coincidences are where patterns live. Ask about the relationships that did not become marriages too, especially any that produced children or left a long shadow.

• When did you and your partner meet, and when did you marry or move in together?
• Have either of you been married or partnered before? What happened to those relationships?
• If there was a divorce or separation, when was it, and how did it go — amicable, bitter, somewhere between?
• Who has primary care of the children from earlier relationships?
• How did your parents' marriage work? Would you call it close, distant, conflicted?
• Did anyone in the family marry someone the rest of the family disapproved of?
• Are there relationships that never became official but mattered — a long partnership, a child outside a marriage?

3. Relationships and emotional closeness

This is the layer that makes a genogram clinical rather than genealogical. Two people can be biologically connected and emotionally cut off; a stepparent can be closer than a birth parent. You are mapping the felt quality of each tie — close, distant, conflicted, fused, estranged — and this is where circular questions earn their keep. Asking someone to describe the relationship between two other people surfaces alliances and triangles they would never volunteer about themselves.

• Who in the family are you closest to? Who do you call when something good or bad happens?
• Who is hardest for you to be around? What makes it hard?
• When your parents disagreed, who did each of you children side with?
• Is there anyone in the family you don't speak to at all? How long has that been?
• Who tends to get pulled in to settle conflicts between two other people?
• If your mother and your sister fell out, who would each of them call first?
• Are there two people who are so close it's hard to tell where one ends and the other begins?
• Who do you worry about most right now?

4. Health, mental health, and substance use

Physical illness, psychiatric history, and substance use repeat across generations in ways that matter for both risk and meaning. You are looking for the medical thread — heart disease, cancer, diabetes, the conditions that cluster — and for the patterns around mental health and addiction that the family may never have named out loud. Ask about cause of death specifically; “he passed” can hide a suicide, an overdose, or a long depression nobody discussed.

• What runs in the family medically? Heart trouble, cancer, diabetes, anything that shows up again and again?
• For the relatives who have died — what did each one die of, and roughly how old were they?
• Has anyone been treated for depression, anxiety, bipolar disorder, or another mental health condition?
• Has anyone struggled with alcohol or drugs? How did the family talk about it — or not talk about it?
• Did that drinking or drug use change the household? Who covered for it, who confronted it?
• Has anyone been hospitalized for their mental health, or attempted suicide?
• Whose health does the family organize itself around right now?

When the assessment is mainly about health, this category can become the whole genogram. Social work and nursing intakes often lead with it, because the family's medical and behavioral history is the care plan. The page on genograms in social work covers how this fits a biopsychosocial assessment.

5. Roles, rules, and family beliefs

Every family runs on rules nobody wrote down. Someone is the responsible one, someone is the scapegoat, someone holds everyone together, someone is never quite forgiven. There are rules about what you can feel, what you can say, and what stays inside the house. These roles get assigned early and tend to follow people for life, so naming them out loud is often the most useful thing the interview does.

• Growing up, what was your job in the family? The responsible one, the peacemaker, the troublemaker?
• Who was seen as the strong one? Who was treated as fragile?
• When something went wrong, who tended to get blamed?
• What were the unspoken rules — about money, about anger, about what you don't discuss outside the family?
• How did your family handle emotions? Were feelings talked about, or kept private?
• What does your family believe it takes to be a good son, daughter, mother, father?
• Is there a story your family tells about itself — “we're survivors,” “we don't need anyone”?

6. Culture, faith, and migration

A family does not exist outside its context. Ethnicity, religion, language, immigration, and class shape who holds authority, how grief is expressed, what counts as loyalty, and which subjects are off the table. Two families with identical structures can run on entirely different rules because of where they come from and what they believe. Ask about movement across borders and generations — migration stories almost always carry a loss and a shift in roles.

• Where did your family come from, and how would you describe its cultural background?
• Who in the family immigrated? When, from where, and what was left behind?
• What languages are spoken across the generations? Has that changed?
• What role does religion or faith play? Has anyone converted, left the faith, or married outside it?
• How does your culture expect families to care for aging parents, and does your family follow that?
• Are there cultural expectations about gender roles that shaped how you were raised?
• When there's a death or a crisis, how does your family's background say it should be handled?

When culture is central to the work, it can anchor the whole map. A cultural genogram puts ethnicity, faith, and migration at the center rather than the margin, and the questions above are its starting point.

7. Loss, secrets, and the hard questions

The most clinically loaded material is the material families protect: deaths that were never grieved, the suicide nobody names, the child given up, the abuse that gets called something else. You do not pry, and you do not save the hard questions for when you have run out of easy ones. You ask them on purpose, with a steady voice, and you give the person an easy way out. The technique matters as much as the question.

A few principles. Name the topic directly rather than circling it — vagueness signals that you, too, find it unspeakable. Normalize the question by telling the person you ask everyone. Offer permission to decline. Then stop talking and let the silence do its work; the urge to rescue the moment with another question is usually your discomfort, not theirs.

• I ask every family this: has anyone died by suicide, or attempted it?
• Are there deaths in the family that were especially hard, or that people still don't talk about?
• Is there anyone the family lost touch with on purpose — someone who was cut off?
• Some families have a secret everyone half-knows but nobody says out loud. Is there anything like that here?
• Has anyone in the family experienced abuse or violence? You can tell me as much or as little as you want.
• Was there ever a child placed for adoption, or raised by someone other than the parents?
• When you think about the losses in your family, which one still feels unfinished?

Building the genogram while you interview keeps the conversation moving and shows the person you are listening. Sketch it live in a free genogram maker as you go — drop in each person, draw the relationship lines as they describe them, and let the emerging shape prompt your next question.

Interview technique: how to ask

The categories give you content. How you ask determines what you get. Four habits separate an interview that opens a family up from one that files it away.

Stay open-ended. “Tell me about your father” gives you a person; “Is your father alive?” gives you a fact. Lead with questions that cannot be answered yes or no, and save the closed ones for confirming dates and spellings. The open frame lets the person decide what matters, and what they choose to say first is itself information.

Use circular questions. Asking one person to describe the relationship between two others is the single most useful move in a family interview. It surfaces triangles, alliances, and roles that direct questions miss, and it lowers defensiveness because the person is observing rather than disclosing. “Who does your brother turn to when he and your dad clash?” tells you about three people at once.

Go three generations. Patterns are invisible in a single layer and obvious across three. A man's distance from his son means more once you know his own father was absent the same way. Push the questions back to grandparents even when the presenting problem sits in the present — the repetition is usually the point, and it is the thing the family has never seen laid out.

Listen for what is not said. The branch that gets skipped, the name said quickly and moved past, the “we don't really talk about him” — these are not gaps in the data, they are the data. When someone changes the subject, note where. When a whole category comes back flat — “everyone got along fine” — that smoothness is worth a gentle second pass. The genogram you end up with should have a few question marks on it. The empty-looking ones are the families you did not really interview.

Putting it together

You will not march through these seven categories in rigid order, and you should not try to. A good interview wanders — a question about a grandmother's death opens onto a migration story, then onto a family rule about grief. Let it. The categories are a map of what to cover by the end, not a script to read top to bottom. Keep one eye on what is still blank, and circle back before you close.

Aim to leave the session with three things: an accurate structure, an emotional layer that reflects how the family actually feels to the person in front of you, and at least one pattern you can name across generations. If you have those, the chart will do real work. Get the questions right and the genogram fills itself in — and the reading, the part where you make sense of what you drew, becomes the easy half.