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Module 9 — Drawing the Family

The drawing session, step by step: a family tree and a line of your life, drawn on paper while you talk and held up to the camera at the end.

Part Three starts with a drawing. Your therapist asks about the family one of you grew up in and draws it on paper while you talk: a family tree, and beside it a line of what happened when. You do not watch it being made. At the end of the hour your therapist holds the paper up to the camera, and there your life is.

The family drawing

Summary: what happens in the session

1 Worksheets go out to both of you. Family of Origin sheets, one set each. No date they are due back.

2 We agree whose family we are doing first. One family per session, and you know in advance whose.

3 Your therapist draws while you talk. On paper, not on the shared screen, and you do not see it till the end.

4 Your therapist asks about every person in it. What they were like, what they were good at and struggled with, and what they did to you.

5 A ring and a word go beside some names. The ring says how sure we are; the word says what it is.

6 A suspicion stays a suspicion. Nobody gets promoted, and nobody diagnoses their partner’s family.

7 The line, and then the paper comes up. Your therapist holds both sheets to the camera. They are yours to keep.

Step 1. Worksheets go out to both of you

After your first session a set of Family of Origin worksheets goes to each of you. They cover the house you grew up in: who was in it, who came before them, what each person was like, what happened and when.

There is no deadline. The sheets go on the roadmap for the weeks ahead, and that is all a roadmap is. If yours is not done, we take the other family first, or we wait. This material is heavy for a lot of people, and taking a month over it is not falling behind.

Why we do this together, not alone. Most therapy about childhood happens one to one. We do it with your partner in the room, on purpose. Your partner gets to understand the wounds you carried into the relationship, and to see, often for the first time, how those wounds shape what happens between the two of you. Then the two of you have a chance to find a healing path together, rather than one of you doing it alone.

That only works if it is safe for your partner to hear it. Making sure that safety is in place is your therapist’s job, not yours. If it does not feel safe yet, say so, and we will work on that first.

Step 2. One family at a time

Both of you fill the sheets in, but a session only ever takes one family. Two in an hour turns into a comparison. Your therapist says whose is first before the session, so nobody arrives braced for the wrong thing. The other partner is there the whole time, and their job is to listen; most people learn more about the person they married in this hour than in the previous five years.

Step 3. Your therapist draws while you talk

Nothing goes on the shared screen. Your therapist has a sheet of paper and draws your family on it as you answer; you do not see it while it is being made. People who can watch themselves being drawn start managing the drawing, and you know your family, so we would rather you just talked.

Opening. I am going to draw your family on paper while we talk, and I will hold it up to the camera at the end so you can both see it. Let us start with you and your brothers and sisters.

Two sheets get made, because a tree cannot show what came first. The tree holds who, with what each person was like beside their name. The line holds when: a divorce, a death, a move from another country, an assessment at thirty-four. It runs down the page rather than across, which is how it holds a life instead of a childhood.

A move from another country is weighted enormously by the people who lived through it, so it always goes on the line.

Why a drawing at all. On paper, a family can be looked at as an object; in your head it has to be defended as an identity. The genogram has almost no outcome research behind it,¹ so the value we claim is the conversation it starts.

Step 4. What your therapist asks about each person

Then your therapist goes round the page person by person, asking the same things about each. Nobody is skipped for being minor.

The questions, asked about every name on the sheet. What were they like? What were they good at, what did they struggle with, and was there anything neurodivergent about them, looking back?

Any mental health difficulty, named or not? Any addiction? Were you close to them or distant? And what did they do to you?

The neurodiversity question comes early rather than last, because it is the one people have been quietly holding. Somebody’s mother could not have music on in the house, went rigid when the plan changed, and was called difficult all her life. Asking early gives her the hour rather than a footnote.

You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable. That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way.

Talking about a parent’s drinking, or what someone did to you, in front of your partner is where most people need this. Saying so does not lose the drawing; it waits.

What she did, not what she was. I am not going to ask whether your grandmother was autistic, because nobody can know that. What could she not stand? What did she do at the same time every day? What did the family call her?

Step 5. A ring and a word go beside some names

Where the answers point at something, a ring goes around that person and the word beside their name. The ring says how sure we are: solid for assessed, with a name and a year; dashed for self-identified; dotted for suspected, untested.

The word is just the word. Autistic. ADHD. Sensory differences, where that is the whole of it. Where nobody ever had a word, the word her own family used goes down in quotation marks. There is no code to learn, which matters, because these sheets are yours and you will read them again in a year.

The neurotype is one layer of four. The depression, the drinking, the strengths and the distance go down in the same plain words.

Without somewhere to put the word a family actually used, the relative who was clearly something falls off the page.

Step 6. A suspicion stays a suspicion

The rings never get collapsed into one another.

Drawing the ring. This one is dotted, and it stays dotted. We are not going to find out, and the pattern is still useful without it.

Among older adults, about ten times as many meet the criteria for ADHD as carry a diagnosis.² So many rings are dotted because of a hole in the record, not a hole in your memory.

The way this goes wrong. One partner diagnoses the other’s family: “her mother is obviously autistic, look at her father”. The page belongs to the person whose family it is. Your therapist redirects to what you watched your mother-in-law do, and that goes down as observation, in her ring.

Their agreement is not needed. If your parents would dispute a dotted ring, that is all right. It is your read of your family, and it diagnoses no one. People ask “so did I get it from her?” within a minute of the second ring. Autism runs strongly in families,³ but a heritability figure describes a population, not a person.⁴

Nobody announces the drift. The rings are there so that months from now you can still tell what you knew from what you guessed.

Step 7. The line, and then the paper comes up

The last thing on the page is your own children, with the same marks. The solid ring is usually the youngest person there, because a child’s assessment is what brought a parent to look up, and a child on the same sheet as a grandparent turns a diagnosis into a pattern.

Then your therapist holds both sheets up to the camera and the two of you look at them together for the first time. Four generations and your own life on a line, at once, is the point of the hour. Some women diagnosed autistic in middle age describe moving from self-critical to self-compassionate.⁵ The woman on your tree who was called difficult may have been one of them, without the last chapter.

The dotted rings above the solid one are not weaker for being dotted. The pattern runs through four generations whether or not anyone over fifty was asked.

Both sheets come to you afterward. Your partner’s family is drawn next, and the drawing comes back out for the wound session, which the next module walks through.

After the session

Family material lands late. The relative you had nothing to say about on Tuesday is the one you have a great deal to say about on Thursday. When it arrives, add it to the sheet in the ring it belongs in. A grandmother suspected in one session has a way of becoming “my autistic grandmother” a few sessions later.

If your partner’s family was drawn first, yours is coming. If you would rather it were not yet, say so; that is information, not a failure.

The one thing, if that is all you have. If the whole tree is too much this week, write down one relative nobody assessed and three things you watched them do. That is one ring, and enough.

Your workbook

Your answers save to this device only - we cannot see a word of what you write. This one is your tree in words, for the week between the drawing and the next session.

The two sheets

Siblings first, then outward. Names and rough ages only, not everyone.

You and your brothers and sisters, oldest to youngest, with rough ages, and the role each of you had, if there were roles

Which parent are you most like? — My mother, My father, Another caregiver, Neither, and I know who I am like instead, I have never been able to answer this

Up to five big events, in order, with your age at each: a divorce, a death, a move, an injury, anything you count as major

The rings

One relative per line. The ring says how sure we are; what goes beside it is what they did, not what they were.

Solid ring, assessed: who, what, by whom, roughly when

Dotted ring, suspected: who, and three things you watched them do

Each of your children, and the ring they would get, if any

A few days later

Fill this in a few days after the session, not the same evening.

What arrived later: a relative you forgot, an event missing from the line, a pattern you never had a place for, and which ring it goes in

If your partner's family was drawn first: — I want mine drawn next, I am not sure I want mine drawn, I would rather not, and I will say so, Mine was drawn first

Where this comes from

Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson.

Research discussion

The family drawing, or genogram, is standard practice in family therapy. It has a large descriptive literature and almost no outcome research. The review the lesson cites searched five databases across all study designs and found the literature to be mostly about settings and adaptations, with minimal studies of effectiveness.¹ It does not report a count of included studies, and it does not say there are none, so the lesson says minimal rather than none.

Nobody has tested whether drawing a family this way helps a couple, and we do not claim it does. Our claim is narrower: the value is in the conversation, and the drawing is how the conversation gets started.

The three rings and the questions about what a relative did are the practice’s own way of working. Nothing official exists. Their value is that they are consistent: the same marks on every family, so that months later everyone can still tell what was known from what was guessed. Like the rest of this program, the session rests on what thousands of neurodiverse couples have told us, not on a trial.

The figures in the lesson frame the drawing; they do not test it. The ADHD prevalence figures are pooled from twenty studies and about twenty-one million people; the paper defines older adults as fifty and over in its methods rather than its abstract, and heterogeneity across studies was significant.² The heritability estimate comes from two million people in a family design using siblings and cousins rather than twins.³

The primer is cited for its argument that heritability is a population average with no meaning for an individual.⁴ The lesson’s point about a single family line is our extension of that argument, not the paper’s words.

The late-diagnosis study is eleven women, interviewed and analyzed for themes, and it is quoted for what late diagnosis can be like rather than for how common any of it is.⁵ The observation that undiagnosed relatives survive in family language as character rather than condition has no study behind it, and the lesson presents it as a pattern we notice.

Who this research was done with. The studies behind this module drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you.

Peer-reviewed research

1. Joseph B, Dickenson S, McCall A, Roga E (2023) Exploring the therapeutic effectiveness of genograms in family therapy: A literature review. The Family Journal, 31(1), 21-30. https://doi.org/10.1177/10664807221104133 Literature review searching MEDLINE, EMBASE, CINAHL, SCOPUS and PsycINFO, including all studies irrespective of methodology. The literature was found to be predominantly about the use of genograms in various settings and adaptations, with minimal studies on the effectiveness of genograms as a therapeutic tool in family therapy. Limitation: the abstract gives no count of included studies and no limitations statement; it says minimal, not none.

2. Dobrosavljevic M, Solares C, Cortese S, Andershed H, Larsson H (2020) Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 118, 282-289. https://doi.org/10.1016/j.neubiorev.2020.07.042 Systematic review and meta-analysis of 20 studies (32 datasets, 20,999,871 individuals). Pooled prevalence of ADHD in older adults differed by method: 2.18 percent (95 percent CI 1.51-3.16) by research diagnosis on validated scales, 0.23 percent (0.12-0.43) by clinical diagnosis, and 0.09 percent (0.06-0.15) by treatment. Older adults are defined as 50 and over in the methods. Limitation: heterogeneity across studies was significant for every method, and the age threshold is stated in the full text rather than the abstract.

3. Bai D, Yip BHK, Windham GC, Sourander A, Francis R, Yoffe R, Glasson E, Mahjani B, Suominen A, Leonard H, Gissler M, Buxbaum JD, Wong K, Schendel D, Kodesh A, Breshnahan M, Levine SZ, Parner ET, Hansen SN, Hultman C, Reichenberg A, Sandin S (2019) Association of genetic and environmental factors with autism in a 5-country cohort. JAMA Psychiatry, 76(10), 1035-1043. https://doi.org/10.1001/jamapsychiatry.2019.1411 Population-based multinational cohort of 2,001,631 children born in Denmark, Finland, Sweden, Israel and Western Australia between 1998 and 2011, followed to age 16; 22,156 were diagnosed autistic. Median heritability 80.8 percent (95 percent CI 73.2-85.5), with country estimates from 50.9 percent (Finland) to 86.8 percent (Israel); maternal effect 0.4 to 1.6 percent. Limitation: a family design using siblings and cousins rather than twins; shared-environment estimates, reported in the full text, ranged from 0 to 14.5 percent by country; a heritability figure describes a population, not a person.

4. Moore DS, Shenk D (2017) The heritability fallacy. WIREs Cognitive Science, 8(1-2), e1400. https://doi.org/10.1002/wcs.1400 A primer arguing that heritability, as used in human behavioral genetics, is one of the most misleading terms in science: the measurable heritability of a trait does not say how genetically inheritable it is, what causes it, or the relative influence of genes or environment in its development, and the statistic is a population average with no meaning for any individual. Limitation: a conceptual review rather than a study, and the lesson's phrase about a single family line is an extension of its argument rather than its words.

5. Leedham A, Thompson AR, Smith R, Freeth M (2020) 'I was exhausted trying to figure it out': The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135-146. https://doi.org/10.1177/1362361319853442 Eleven autistic women diagnosed over the age of 40, semi-structured interviews analyzed by Interpretative Phenomenological Analysis. Four superordinate themes: a hidden condition (pretending to be normal and fitting in; mental health and mislabeling), the process of acceptance, the impact of others post-diagnosis, and a new identity on the autism spectrum. Several participants experienced diagnosis as a transition from self-critical to self-compassionate, with an increased sense of agency, though the adjustment was painful at such a late stage. Limitation: eleven people, so it describes what late diagnosis can be like and cannot say how common any of it is.

A family you can look at together, instead of defend

The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD. Your family-of-origin session opens with a drawing you keep: two sheets, drawn live, with the neurodiversity layer marked in three states that never get promoted. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing.

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