This article sets out to provide a conceptual framework for appreciating the range of psychosocial issues faced by families with genetic conditions. The framework is based on three components: a psychosocial typology of chronic illness; a consideration of the time phases of an illness / condition; and a systems view of the family life cycle as outlined by Rolland (1994) in relation to chronic illness. The particular nature of genetic conditions in relation to these components is outlined and discussed. Specifically, the quality of “uncertainty” associated with genetic disease is elaborated and a “pre-illness” phase is identified and outlined. Clinical examples of the framework as applied to Huntingtoris Disease and Duchenne Muscular Dystrophy are described. Implications for practice are discussed.