Representing Gender-Diverse Family Members in a Genogram

The square and the circle were never the whole story

Genograms encode gender in shape. Since Murray Bowen's family diagrams and the standardization by McGoldrick and Gerson, a square has meant male and a circle female, and generations of clinicians have learned to read family structure through those two forms. But the families in our consulting rooms include transgender and non-binary members, and a notation that cannot represent them forces an unhappy choice: misgender a person on paper, or leave part of the family unreadable. Neither belongs in an instrument whose whole purpose is to depict a family faithfully.

What the current standard says

The fourth edition of Genograms: Assessment and Treatment (McGoldrick, Gerson & Petry, 2020) brought the notation up to date:

• Non-binary person: a dome. The book introduces "a new modified gender symbol": a square base with a circular top, literally a fusion of the two binary shapes. (In the same edition, the diamond denotes a pet.)
• Transgender person: shape-in-shape, and direction matters. In the book's own words, "a square outside a circle indicates a transgender man and a circle outside a square indicates a transgender woman." The outer shape always shows lived gender.
• Sexual orientation: an inverted triangle inside the symbol marks gay, lesbian, bisexual, queer, intersex, or asexual orientation.
• Unknown sex: the book defines no symbol at all. The question mark inside a shape is a convention inherited from GenoPro-family charts, and it remains the least ambiguous choice.

The outer-shape rule is the load-bearing convention. Whoever scans the genogram reads the person's gender first, and their history only if it has been recorded.

Practical guidance for the therapy room

• Draw lived gender. The person's symbol shows who they are; the inner shape is available when their gender history is clinically relevant.
• Ask, don't infer. Never derive gender identity from a name, an appearance, or a relative's account.
• Use the client's own words where a symbol falls short. A free-text label such as "genderfluid" or "agender" often says more than geometry can.
• Treat it like the rest of the record. Gender identity is part of the client's history like anything else on the genogram, covered by the same confidentiality that governs the whole therapeutic relationship.

How WebGeno implements this

As of July 2026, WebGeno draws these symbols exactly as the 4th edition specifies:

• Non-binary is a first-class gender. Choose it in the gender selector and the person is drawn with McGoldrick's dome. Unknown gender is a diamond with a "?" inside, and the legend explains every symbol automatically.
• Gender history draws the standard inner shape. Set the person's gender to their lived identity; record their gender history under "Identity (optional)" in the edit dialog when it is clinically relevant, and the shape-in-shape symbol appears.
• Identity labels in the client's own words. A free-text label appears in italics under the person's name.
• Accuracy extends to the AI. The AI builder never infers anyone's gender identity from a name; it records non-binary only when your text says so.

The full notation is documented in our symbol reference chart, and the one-page printable cheat sheet includes the new symbols too.

Conclusion

Represent people as they live, use their words where symbols fall short, and treat the result like any other part of the clinical record. A genogram drawn that way is not just more inclusive; it is more accurate, and accuracy is what the instrument was always for.