Enneagram Work as a Tool to Help Remove Barriers to Recovery · Enneagram Nine Typologies. Enneagram Typologies Myths about the type: ... Enneagram: Nine Faces of the Soul. New York,

Enneagram Work: A

Tool to Help Remove

Barriers to RecoveryGregory Gable, Psy.D.

Kate Appleman, MA, CAADC, CCS, CSAT, CMAT

Enneagram Work

Greg Gable and Kate Appleman

Date of Activity:09/15/20017

Name Commercial

Interests

Relevant

Financial

Relationships:

What Was

Received

Relevant

Financial

Relationships:

For What Role

No Relevant

Financial

Relationships

with Any

Commercial

Interests

Gregory K

Gable

No Salaried by

Caron

No No

Kate Appleman No Salaried by

Caron

No No

Objectives:

Review relevant research on relapse factors

Process the importance of self understanding for long

term recovery

Discuss the history of Enneagram

Increase knowledge of Enneagram Typology

Develop an understanding of enneagram work with

12 step and evidenced based treatment modalities

Increase practical application through case study

review

Relapse Factors

Condition

relapse non-relapse

Abuse * 26 52% 22 45%

Family SUD 30 61% 37 75%

Eating Disorder 10 20% 11 21%

Comp. Behaviors 15 30% 11 21%_________________

* Emotional/Physical/Sexual Abuse

Gable 2002

Relapse Factors

The presence of a personality disorder was

strongly related to relapse

(χ² = 16.071, df = 1, p<.05) (46% of the

relapse group had a personality disorder

diagnosis, compared to eight percent of

the non-relapse group). (p actually

computed as .000)

Gable 2002

Relapse Relevance

Relapse Status f % of group

Relapse 41 82%

No Relapse 17 34%

Note: Co-occurring secondary substance use disorders are not

included

Gable 2002

Relevant Research

308 physician cohort

• 78 physicians with relapse (25%)

• 230 physicians with no relapse (75%)

78 physician relapse population

• 55 physicians reengaged in monitored recovery

• 92% of original cohort in monitored recovery of at

least 5 years

Gable 2002

Relevant Research

Cohort of 292 subjects

107 with co-occurring diagnosis

100 with co-occurring mood or anxiety disorder

diagnosis

5 with co-occurring personality disorder diagnosis

2 with both

Domino, Karen B. MD, MPH; Hornbein, Thomas F. MD; Polissar, Nayak L. PhD; Renner,

Ginger; Johnson, Jilda; Alberti, Scott; Hankes, Lynn MD, 2005

Self-Understanding as

Spiritual Growth

Page 39 in the Big Book: But the actual alcoholic will

be unable to achieve sobriety solely on the basis of

self knowledge

Often misquoted as: Self knowledge is not the answer

12 Step and other spiritual pathways lead us toward

self understanding

In the spiritual traditions, spiritual growth or spiritual

transformation can be described as spiritual

awakening

Carl Jung

Carl Jung

“Knowing your own darkness is the best method for

dealing with the darknesses of other people.”

- Carl Jung

Carl Jung

Personal Growth and

Healing

Transform Personality Traits

DSM language helpful for clinician understanding

Enneagram concepts or 4th Step work may be more

helpful for patient understanding and change

Why Enneagram?

Instrument of Spiritual Formation

Compatible with 12-step Recovery

Non-pejorative

Empowering

Self-engaged process

Why Enneagram?

“Enneagram, instead of putting you into a box, helps

identify the box you live in and helps to point the way

out”

- Riso

Enneagram History

Enneagram Symbol dates back

over 2500 years

Modern development facilitated by Oscar Ichazo

1950s

Jesuit teaching building on Ichazo’s work linking the

attributes with personality types (1970s)

Nine Divine Attributes as they are reflected in human

nature (seven deadly sins)

Enneagram Symbol

Decimal Digits of the Reciprocal

of a Prime Number

1/7 = 0·1 4 2 8 5 7...

2/7 = 0·2 8 5 7 1 4...

3/7 = 0·4 2 8 5 7 1...

4/7 = 0·5 7 1 4 2 8...

5/7 = 0·7 1 4 2 8 5...

6/7 = 0·8 5 7 1 4 2...

Magic Square

1 4 2 8 5 7 =27

2 8 5 7 1 4

4 2 8 5 7 1

5 7 1 4 2 8

7 1 4 2 8 5

8 5 7 1 4 2

27

Enneagram: Nine

Typologies

9

1

2

3

45

6

7

8

Peacemaker

Reformer

Helper

Achiever

IndividualistInvestigator

Loyalist

Enthusiast

Leader

Enneagram Nine Typologies

Enneagram Typologies

Myths about the type:

Adjectives describing this type:

The Basic Propositions:

The fundamental principle I lost sight of:

What I came to believe instead:

The adaptive strategy I developed as a result of this

belief:

Enneagram Typology (cont.)

Principle Characteristics:

Because of this strategy, my attention is on:

I put my energy into:

I do everything I can do to avoid:

My strengths:

My communication Style:

Stress, Anger and Defensiveness

What causes me stress:

What makes me angry and defensive:

The nature of my anger and defensiveness:

Enneagram Typology (cont.)

Personal Development:

The ultimate goal of my development:

How I can further my personal development:

What hinders my personal development:

How others can support my development (what do I

need to ask others for?):

Spiritual Journey

Spiritual Journey

Emphasis on seeking to encourage and embrace,

rather than suppress, avoid or change

Self Compassion

Self Acceptance

Acceptance of others

Spiritual Journey

Turning it over to a higher power leads us to fourth step

Exploration of dark side

4th step process leads to :

My part in it

Character defects

How do I keep these wounds alive today?

Enneagram fits with this process

Spiritual Journey

Self-knowledge is not a route to stopping

drinking/using

Self-knowledge is essential in progressing on the

spiritual journey.

4th,5th,6th steps geared toward increasing self-

knowledge

Ongoing working of steps as well as ongoing spiritual

growth important to continued stable recovery

Enneagram Emphasizes

Light vs Dark Aspects of Traits

Traits are not negative or positive.

They have light and dark sides

Healthy, formative ways of expression

Unhealthy, de-formative ways of expression

Movement is from de-formative to formative

Example: Enneagram Type 2 (need to help)

Evidenced Based Treatment

Compatibility

Cognitive Behavioral Therapy (CBT)

Dialectic Behavioral Therapy (DBT)

Experiential Therapy

Intensive Experiential Workshop

Integration of Psychology

with 12-Step Recovery

Best chance of long-term recovery is active 12-step

program utilization

Long-standing fear in 12-step community that

psychology will distract from recovery work

Helpful to find ways of using psychological exploration

in conjunction with step work

When we teach integrated ways of working with

personality traits, we give tools for long-term use.

Identifying Distorted

Thinking/Response Patterns

Intensive

Experiential

Workshop

4th Step

GroupSelf-Exploration

EnneagramCBT/DBT

Enneagram & DBT Similarities

Enneagram DBT

“Inner Coach” “Wise Mind”

Awareness of “wherever

your attention goes, your

energy follows”

Observing; just noticing

Mindful self compassion Non-judgmental stance

Identify health choices Improve the moment

Enneagram & DBT

Principle #5, (Daniels & Price)

4 As

Awareness

Acceptance

Action *

Adherence

Enneagram & DBT

Principle #5, (Daniels & Price)

Action *

1. Pause: Notice your reaction

2. Inquiry: Practice thoughtful and gentle

reflection

3. Conscious Conduct: Utilize “inner

coach” to make healthy choices about

responding

Enneagram and DBT

Action

1. Pause, notice reaction, breathe, center, collect

energy

2. Inquiry: gentle reflection on what is coming up for you,

what might be happening in the other

Conscious Conduct: Use wise “inner coach”

Acceptance or

Moving into compassionate action respectful of self and other

Case Studies

Case Study Sarah

Internist

Treated in long-term residential

Relapsed soon after to meds not covered on HP panel

(after researching this)

Flew under radar for over a year, then relapse

became visible

Returned to long-term residential treatment

Personality issues, cluster B a problem in treatment

Case Study Sarah

Discharged early because of rule violations

Struggled in outpatient, willful, not accepting of

treatment plan

About 8 months after second tx experience, began to

show positive changes

When interviewed, identified sponsor and 4th step as

change agent

Case Study Sarah

Sarah identified a character defect as having been

central to her difficulty in recovery

When asked to name this defect, she did not describe

narcissistic, borderline or antisocial traits.

She talked about becoming aware of her intolerance,

lack of acceptance

This construct was, for her, something to build change

upon.

Case Study Mark

60 year old Internist, married with adult children

Diagnoses:

Alcohol Use Disorder, Moderate

History of Opioid Use Disorder

Obsessive-Compulsive Disorder

Other specified Depressive Disorder

Entered treatment with the intention to not re-enter

medicine

Grew up as the middle child of 7 children

Case Study Mark

Identified as Enneagram Type 1

Schema identified was one of being defective and

ashamed of it (feeling defective)

Incident in 4th grade, shamed by teacher

Had done some cognitive work in the past to manage

OCD symptoms

Identified Enneagram Type in Schema group because

of the similar information he was finding

Identifying Distorted

Thinking/Response Patterns

Defectiveness and shame

Type 1 need to be perfect

Introjected

negative

messages

Self-deprecating

inner voice

I am inadequate

Father and

teacher

shaming

Case Study

Jeff S

Second Year Medical Student

Preparing to take Step 1 and move into third year

Opioid use disorder, severe

Previously treated, hx of 120 mg/day oxycontin

Relapsed to use of Kratom, attempting to conceal this

use

Benzodiazepine use to manage anxiety

Hx of MJ use, not current

Using some synthetic MJ preparations

Case Study

Jeff S

Diagnoses

Opioid use disorder, severe

Sedative, Hypnotic or Anxiolytic use disorder, severe

Persistent Depressive Disorder (Dysthymia)

Social anxiety disorder (social phobia)

Identifies with Enneagram type 6

Schema work around self message of “pathetic”

CBT work around distorted thinking/projection

Identifying Distorted

Thinking/Response Patterns

Type 6Anxious, fearful, suspicious

Identified pattern of hiding emotions to gain acceptance

“I’m defective”

“I am pathetic”

Father shaming, feel inadequate, “not good enough”

Learning Enneagram

DO YOUR OWN WORK!

Further education

Attend workshops, retreats

Incorporate into supervision

Application in Clinical

Supervision

8 week clinical supervision group with Enneagram

focus

Self-Identification of Enneagram Type

What tendencies work and don’t

In the past week, how have you seen your behaviors

present as it relates to your typology

How does this correlate with countertransference?

Application in Clinical

Supervision

After the 8 week supervision group, the cohort reported

the following:

Increased self awareness

Reduction of countertransference

Better team cohesion due to understand team

members better

Better communication with the use of a “common”

language with patients and staff

References

Daniels, David, and Virginia Price. (2009) The Essential Enneagram: The Definitive Personality Test and Self-Discovery Guide. Revised and Updated. New York, NY: Harper Collins Books.

Enneagram Institute (www.enneagraminstitute.com)

Palmer, Helen. (1995) The Enneagram in Love and Work. San Francisco, CA: Harper Collins Books, 1995.

Riso, Don, and Virginia Price. (1999). The Wisdom of the Enneagram. New York, NY: Bantam Books.

Rohr, R. and Ebert, A. (2004) The Enneagram: A Christian Perspective. Revised and Expanded New York, NY: Crossroad Publishing Company.

References

Maitri, S. (2000). The Spiritual Dimension of the

Enneagram: Nine Faces of the Soul. New York, NY:

Penguin Putman, Inc.

Empereur, J. (2007). The Enneagram and Spiritual

Direction: Nine Paths to Spiritual Guidance. New York,

NY: Continuum International Publishing Group, Inc.

Linehan, M. M., (1993). Skills Training Manual for Treating

Borderline Personality Disorder. New York, NY: Guilford

Press.

“Wild Geese”

a poem by

Mary Oliver