Magazine "Research" · Reading time approx. 9 min
Few tools in family work are as widespread — and as little studied on their own. An honest look at a research gap, and what it means in practice.
An Uncomfortable Starting Point
The genogram has been part of the craft for decades. It appears in textbooks, training curricula, and documentation requirements. Anyone working in counseling or therapy has drawn one.
The state of research is all the more surprising. There is no Cochrane review in which the genogram is the intervention under study. There is no large controlled trial comparing two groups — one using a genogram, one without — and deriving an effect from that comparison.
This is not an oversight by individual researchers. It has to do with the nature of the thing itself.
Why This Is Hard to Measure
A medication can be isolated. You give it to one group and a placebo to the other. A genogram cannot be treated that way.
It is rarely the intervention itself. It is usually the framework within which an intervention takes place. Drawing a genogram means having a conversation. The practitioner asks questions, listens, organizes, and marvels together with the client. Which part of that has the effect — the drawing, the questions, the shared time?
On top of that, a genogram looks different in every practice. Some practitioners sketch three generations in ten minutes. Others work across several sessions and color-code relationship lines. Both are called a genogram. A study would first have to define exactly what it is investigating.
What Actually Exists
A literature review by Joseph, Dickenson, McCall, and Roga appeared in 2023 in The Family Journal. It surveys the existing work on the therapeutic effectiveness of genograms in family therapy. Its finding matches what practitioners suspect: high clinical acceptance, a thin empirical base.
One level up, the picture is considerably better. In 2014, Alan Carr compiled the evidence for family-therapy and systemic approaches in the Journal of Family Therapy — in two extensive reviews, one on child-focused problems and one on adult-focused problems. For systemic therapy as a whole, solid effectiveness evidence exists.
The usual inference follows: the genogram is a component of effective approaches. The conclusion is plausible. It is not direct proof.
The Difference Between "Ineffective" and "Unproven"
This distinction is the most important one in the whole topic.
"Unproven" means: it has not been properly studied. "Ineffective" means: it was studied and nothing was found. The genogram is unproven, not disproven.
The distinction has consequences for the language used in everyday professional life. Writing in a funding application that the genogram is "evidence-based" overstates the case. Writing that it is "established in systemic practice and part of evidence-based approaches" stays accurate.
Hypothetical case: A counseling center submits a funding application. The funder asks about the evidence base for the methods used. The director is tempted to describe the genogram as evidence-based — after all, it appears in every textbook. Instead, she writes that the center works systemically, that good effectiveness evidence exists for that approach, and that the genogram is an established structuring tool within it. The application is stronger for it, not weaker — if questions come up, the careful wording holds.
What the Genogram Demonstrably Does
Even without an effectiveness study, a fair amount can be said with confidence.
It makes patterns visible that get lost in a spoken narrative. Three generations laid out side by side reveal repetitions that nobody notices when hearing about just one generation at a time.
It structures the intake. Drawing a genogram means asking systematically — about siblings, deaths, moves. Without that structure, questions go unasked.
It creates a shared point of view. Client and counselor look at the same sheet of paper instead of sitting across from each other. That changes the dynamic of the conversation, and many practitioners describe this as the real benefit.
It documents in a way that is easy to follow. Anyone taking over a case understands the system faster than from ten pages of narrative notes.
These four points are not a claim of effectiveness. They describe what the tool does.
Where Research Could Start
What would be interesting are questions smaller than "does the genogram work."
Does creating a genogram together measurably change the working relationship? Does a structured genogram interview yield more complete information than an open-ended conversation? Does information gathered via a genogram stay more readily available later in the process?
Questions like these are testable. They don't capture the whole picture, but they capture something.
What This Means for Practice
Nothing that calls for restraint. The genogram is a tool, not a method that promises effectiveness. A stethoscope isn't tested for effectiveness either — it makes something audible, and what follows from that is decided by the person using it.
What changes is the language. Knowing the state of the research leads to more precise wording. That protects against follow-up questions that would otherwise be hard to answer. And it keeps one's own attention sharp: a tool whose effect you never examine yourself easily turns into routine.
Sources
- Joseph, Dickenson, McCall & Roga (2023): Exploring the Therapeutic Effectiveness of Genograms in Family Therapy: A Literature Review. The Family Journal.
- Carr, A. (2014): The evidence-base for family therapy and systemic interventions for child-focused problems. Journal of Family Therapy 36(2), 107–157.
- Carr, A. (2014): The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy.
- McGoldrick, M., Gerson, R. & Petry, S. (2020): Genograms — Assessment and Intervention. 4. Auflage, W. W. Norton.