Among the most emotionally charged markings in a genogram are those that document unborn or early lost life. They are methodologically central — and they demand more care than any other notation.
Pregnancy and Birth
An ongoing pregnancy is shown as a small triangle — without a sex indication, since at this stage sex is either not relevant or not yet final. After birth, the triangle is replaced by the standard symbol.
Multiples — twins, triplets, and so on — are drawn as symbols connected upward by a shared line. Identical multiples additionally receive a horizontal connecting line between the symbols; fraternal multiples do not. This distinction is more than a drawing convention: it carries genetic and psychological significance.
Loss
A distinct symbolism has become established for prenatal and early losses:
- Miscarriage: a small triangle with an X — the gestational week can optionally be noted.
- Abortion: a small, solid black triangle — the solid fill distinguishes it from a miscarriage.
- Stillbirth: the standard symbol (square/circle) with an X — like a deceased person, but often with identical birth and death dates.
Infant death after birth is drawn with the age-appropriate standard symbol, crossed out, with the lifespan noted in years. Even with a very short lifespan — days, hours — the child belongs in the genogram if the family regarded it as a family member.
Handling This with Care
These markings should not be added on the spot, but rather in conversation with the client. A grandmother's miscarriage, kept secret for decades and suddenly made visible in the genogram, can upend a session — and sometimes that is necessary, sometimes it is not.
The question "does this belong in the genogram?" is not a drawing question here, but a therapeutic one. When in doubt: ask first, then draw. Losses are rarely incidental.