The sexual genogram (Hof & Berman 1986, updated by Belous et al. 2012) focuses on intergenerational scripts around intimacy, sexuality, and gender roles — topics that often play a peripheral role in general couples therapy, but are here brought systematically to the fore.

Why a Distinct Methodology?

In standard couples therapy, sexuality appears as one topic among many — alongside communication, conflict behaviour, daily routines, and parenting issues. There is good reason for this: most couple conflicts are not primarily sexual conflicts. However, there is a downside: when sexuality is in fact a core issue, the standard methodology often lacks the depth to reveal its intergenerational roots.

In 1986, Larry Hof and Ellen Berman proposed the sexual genogram as a distinct method in the Journal of Marital and Family Therapy — a structured extension of the classic genogram, focusing exclusively on sexual and intimate-relational themes. Their basic premise: sexuality is always also an intergenerational script. How grandparents and parents spoke or remained silent about intimacy, which taboos were handed down, which formative experiences of sexual education occurred — all of this shapes current couple dynamics.

The Guiding Questions of Hof and Berman

Hof and Berman structured their method around a list of guiding questions, which are worked through with the couple over two sessions. The questions are initially answered separately — each partner on their own — and only in the second step shared with the other. Key areas of enquiry include:

  • Sexual education: From whom and when did you first learn about sexuality? What words were used in your family of origin for sexual topics — or was there silence?
  • First experiences: Which early sexual experiences shape your current perspective — both positive and negative?
  • Family patterns: Which couples in your extended family were considered "sexually happy", and which were not? What did you know as a child, even if it was never spoken?
  • Taboo and permission: Which sexual topics were taboo in your family? Which were addressed openly, cynically, or vulgarly?
  • Gender roles: What expectations existed in your family regarding men and women, initiative and receptivity, desire and duty?

These questions are visualised in the genogram by assigning the answers to the respective family members and making them visible through markings — for example, by colour-coding generations, using taboo markers (closed symbols), or lines connecting recurring scripts across generations.

Belous (2012): Modernisation to Include Sexual Diversity

In 2012, Cassandra R. Belous and colleagues published a substantial update to the Hof/Berman methodology in the American Journal of Family Therapy under the title Revisiting the Sexual Genogram. The key extensions were:

  • Sexual orientations beyond heteronormative assumptions: The original methodology implicitly assumed heterosexual couples. Belous formulated guiding questions neutrally, making them applicable to queer, bisexual, and asexual identities as well.
  • Gender diversity: Trans* and non-binary identities are integrated into the methodology. Questions such as "Which gender roles were assigned to you?" expand the Hof/Berman focus to include the possibility that assigned gender itself can be a topic.
  • Plurality of relationship forms: Polyamorous, open, and co-parenting relationships are methodologically recognised — not as pathology, but as legitimate constellations.
  • Sexual experiences of violence are addressed more explicitly, with clear guidance on preventing re-traumatisation.

Belous emphasises that the original methodology was not wrong, but incomplete — it now encompasses more realities without abandoning its methodological core.

Sexual Violence in the Genogram — Marking Without Re-Traumatisation

When sexual violence has occurred in the family context — as an experience of current clients or as a story handed down from the grandparents' generation — the question arises of how to mark this appropriately. The methodology recognises various conventions: a lightning arrow between perpetrator and victim, a colour-coded marker, or a specific notation ("SV" with date). Which convention is chosen should be discussed with the clients — visibility is not helpful at every stage of the process, and sometimes a concealed notation ("*", explained only in the legend) is more appropriate.

The order is crucial: stabilisation before exploration. If the sexual genogram activates experiences of violence that have not yet been therapeutically processed, the method can re-traumatise. David Schnarch's work (Intimacy and Desire, 2009 German edition) has methodically elaborated how differentiation work must be established as a prerequisite for sexual genogram work — without this preparation, the method is not indicated.

Gender Roles, Erotic Scripts, and Cultural Overlay

Sexuality is never "just" individual — it is always shaped by culture, religion, and social milieu. The sexual genogram thus regularly becomes a site where religious upbringing, migration experiences, and class codes become visible. A woman raised Catholic in the 1960s brings different scripts than a man socialised in the secular milieu of the 1990s; a third-generation client of Turkish descent is embedded in a different web than her grandmother in 1950s Anatolia.

For practice, this means: the sexual genogram is methodologically closely intertwined with the cultural genogram (Lesson 1) and the spiritual genogram (Lesson 4). Those who separate these layers often overlook the central sources of current scripts.

Setting: When, With Whom, and in What Sequence?

The methodological literature agrees that the sexual genogram is not indicated in the first sessions of a couples therapy process. Prerequisites are: a stable working alliance, clients' capacity for differentiation, and sufficient time for follow-up. Hof and Berman recommend introducing the method only after three to five joint sessions — and then with a clear framework: two consecutive sessions, adequate preparation and follow-up, and the option for individual sessions in between.

An open methodological question is the choice between couple and individual settings. Some experiences cannot be voiced first in the couple setting — experiences of abuse, previous relationships, sexual identities not yet disclosed. Belous therefore recommends a flexible alternation between settings, with clear agreements about what may be brought from the individual to the couple setting.

Practice Vignette

A heterosexual couple in their mid-40s, together for twelve years, comes to couples therapy. The conflict: sexual frequency — she wishes he would take more initiative, he experiences her wishes as pressure. After five preparatory sessions, the therapist introduces the sexual genogram. It emerges: in her family of origin, sexuality was taboo — her mother never spoke about it, sexual education came from biology lessons. In his family, sexuality was addressed openly and vulgarly — his father told jokes, his grandmother made derogatory remarks about women. The scripts collide: she learned that initiative is dangerous; he learned that women are unreliable in their desire. This is the work — not the frequency.

State of Research & Discussion

Hof and Berman are regarded as classics of systemic sex therapy; their methodology is established in the clinical curriculum of the German Society for Sex Research (DGfS) and comparable associations. Belous (2012) is recognised as a necessary modernisation, but has not yet been systematically integrated into training curricula in German-speaking countries — a gap currently discussed in DACH sex therapy.

Empirical efficacy studies on the method itself are scarce — which is not unusual for structuring assessment tools in psychotherapy. What is well supported empirically is the effectiveness of the underlying sex therapy (Masters & Johnson, Schnarch, Brotto). The sexual genogram stands in this tradition as a diagnostic tool, not as an independent intervention method. There is ongoing debate as to whether the method focuses too much on deficit scripts and underrepresents positive sexual family experiences — a resource-oriented sexual genogram is yet to be developed methodologically.

Cross-References

  • Module 4 "LGBTQIA+/Rainbow Genogram" — closely linked, especially following Belous (2012)
  • Module 4 "The Spiritual/Religious Genogram" — religious scripts as a central source of sexual taboos
  • Module 3 "Couples Therapy" — methodological framework in which the sexual genogram is embedded

Further Links