Enneagram Work: A Tool to Help Remove Barriers to Recovery Gregory Gable, Psy.D. Kate Appleman, MA, CAADC, CCS, CSAT, CMAT
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
“Knowing your own darkness is the best method for
dealing with the darknesses of other people.”
- 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