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Module 9 — Drawing the Family
The drawing that opens your family-of-origin session, and the marks that put an undiagnosed relative on the page without diagnosing anyone.
Part Three goes somewhere most couples do not expect: the house each of you grew up in. Not to find someone to blame. The way you were loved and hurt as a child is still running in your marriage, and we look at it so it stops running you. The first thing we do is draw your family.
What this is about
Every child finds a way to cope with what was missing. That way of coping is still in the room when the two of you fight. Over the next few sessions we find it, name it to your partner, and give them one thing to do about it this week. The next module, Your Childhood Wound, walks through that part.
It starts with a drawing. Your therapist shares a screen and draws your family while you talk, one family at a time, with your partner watching. It is not a whole family tree. We draw the part of your family that is still operating inside your marriage.
Somebody’s mother could not have music on in the house. She went rigid when the plan changed, she knew an implausible amount about birds, and all her life the family called her difficult. Every family drawing marks addictions, mental illness and abuse. Ours adds a layer no textbook has a symbol for, so that she gets onto the page.
The drawing shows the pattern that runs through your family, and it does that without diagnosing anybody.
What happens in the session
Your therapist says what the drawing is for, then starts with names and ages. People who think they are about to be analyzed manage their answers, so the analysis waits.
You will see the page. Everything typed appears on the screen as it goes, including the hard words. Watching “addiction” appear next to your father’s name is not the same as not seeing the page, so you are told it is coming.
There are two sheets, because a tree cannot show what happened first. So the big events go on a separate line, in order: a parents’ divorce, a death, a move from another country, an injury, and whatever else you name as major.
A move from another country tends to be underweighted by therapists and weighted enormously by the people who lived through it, so it always goes on the line.
The Drawing
1 Siblings first, then outward. You and your brothers and sisters, then your parents, then your grandparents. Names and rough ages only. Then two optional questions: which parent are you most like, and did you and your siblings have roles?
2 The second sheet. The big events, in order, on a line. Beside the tree, in words, go your parents’ strengths and weaknesses and how their marriage worked: affection, communication, conflict and decision making.
3 The colored pen, then the rings. Addictions, mental illness diagnosed or undiagnosed, abuse. Then a ring around each person that says how sure we are: solid for assessed, dashed for self-identified, dotted for suspected. A letter says what kind: A for autistic, D for ADHD, S for sensory differences with no other label, and a question mark for the relative who was clearly something.
4 Your children, and the file. Your own children go on the sheet with the same marks. A child on the same page as a grandparent turns a diagnosis into a family pattern. Then both sheets go to you, tonight.
If you are the partner watching, your job is to witness, not to check. Later you will be asked what you saw, and that is when it is yours.
The question mark gets used more than you would expect; without it, the relative nobody ever had a word for falls off the page.
Three rings, three kinds of knowing. Suspected: you or the family think it, and nobody has tested it.
Self-identified: the person says so about themselves.
Assessed: someone tested them, with a name and a year attached.
The rings never get collapsed into one another, in either direction. For a dotted ring, the questions are about what the relative did, never what they were. Someone who was a child at the time can answer those.
Opening. I want to draw your family. We will start with you and your brothers and sisters and work outward, and I am only after names and rough ages, not the whole tree. Then a second sheet for the big events and when they happened. You keep both.
What she did, not what she was. I am not going to ask whether your grandmother was autistic, because you cannot know. What could she not stand? What did she do at the same time every day? What did the family call her?
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.
Every question asks what somebody did, and every mark records how sure we are.
The way this goes wrong. One partner diagnoses the other’s family. Watching it go onto the screen, they start filling in the rings: “her mother is obviously autistic, look at her father”. The layer belongs to the person whose family it is. Your therapist redirects to what you watched your mother-in-law do, and that goes on the page as observation, in her ring.
You do not need their agreement. If your parents are alive and would dispute a dotted ring, that is all right. It is your read of your family, and it diagnoses no one.
If there is almost nothing to draw, because you were adopted, estranged or raised in care, a half-empty sheet is not a deficit. We draw what exists, write where there is nobody, and work on the generation you do know about: yours.
Why we do it this way
A family drawing has one job. It moves a family out of one person’s head and onto a surface that two people and a therapist can look at together.
On the page, a family can be discussed as an object.
In the head, it has to be defended as an identity.
What kind of tool this is. The family drawing (the genogram) is standard practice in family therapy, and it has almost no outcome research behind it. A review that looked for every study of any design found minimal studies of whether it helps.1 We hold our claims at that size. The value is in the conversation the drawing starts, not in the sheet.
The rings ask for a permission the standard drawing already grants. Nobody finds it strange to mark an undiagnosed depression on a family tree on the strength of a family’s description. The neurodiversity layer asks for the same thing and nothing more.
The reason so many rings are dotted is a hole in the record, not a hole in your memory.
Among older adults, about ten times as many meet the criteria for ADHD as carry a diagnosis.2 Later in this part, The Family You Grew Up In Was Neurodiverse Too puts the same kind of number on autism. The dotted ring exists so that a relative nobody assessed still gets onto the page.
People ask “so did I get it from her?” within a minute of the second ring going on. Autism and ADHD run strongly in families, and that is not in dispute.3 But a heritability figure describes a population, not a person.4
What the figure can and cannot say. It supports: this runs in families.
It does not support: you got it from your grandmother.
Character, not condition. That is how these relatives usually survive in family language: difficult, highly strung, private. A pattern we notice, not a finding. What is documented is what a label can do: women diagnosed autistic in middle age describe moving from self-critical to self-compassionate.5 The woman on your tree who was called difficult all her life may have been one of them, without the last chapter.
The solid ring is usually the youngest person on the page, because a child’s assessment is what brought a parent to look up.
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, open the sheet and add it, in the right ring. Do not promote anyone. A grandmother who was suspected in one session has a way of becoming “my autistic grandmother” a few sessions later.
The three rings exist so that long after the session the two of you can still tell what you knew from what you guessed.
If your partner’s family was drawn first, yours is coming. If you would rather it were not, say so. That is information, not a failure. The workbook below is your tree in words, for the week between this session and the next.
The one thing, if that is all you have. If the whole tree is too much this week, write down one relative nobody ever assessed and three things you watched them do. That is one ring, and it is 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, the four letters and the questions about what a relative did are the practice’s own notation. 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.
Up next
Module 10 — Your Childhood Wound