Enneagram Work: A Tool to Help Remove Barriers to Recovery. Gregory Gable, Psy.D. Kate Appleman, MA, CAADC, CCS, CSAT, CMAT

Transcription

1 Enneagram Work: A Tool to Help Remove Barriers to Recovery Gregory Gable, Psy.D. Kate Appleman, MA, CAADC, CCS, CSAT, CMAT

2 Enneagram Work Greg Gable and Kate Appleman Date of Activity:09/15/20017 Name Gregory K Gable No Commercial Interests Relevant Financial Relationships: What Was Received Salaried by Caron Kate Appleman No Salaried by Caron Relevant Financial Relationships: For What Role No No No Relevant Financial Relationships with Any Commercial Interests No No

3 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

4 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

5 Relapse Factors The presence of a personality disorder was strongly related to relapse (χ² = , 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

6 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

7 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

8 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

9 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

10 Carl Jung

11 Carl Jung Knowing your own darkness is the best method for dealing with the darknesses of other people. - Carl Jung

12 Carl Jung

13 Personal Growth and Healing Transform Personality Traits DSM language helpful for clinician understanding Enneagram concepts or 4 th Step work may be more helpful for patient understanding and change

14 Why Enneagram? Instrument of Spiritual Formation Compatible with 12-step Recovery Non-pejorative Empowering Self-engaged process

15 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

16 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)

17 Enneagram Symbol

18 Decimal Digits of the Reciprocal of a Prime Number 1/7 = /7 = /7 = /7 = /7 = /7 =

19 Magic Square =

20 Enneagram: Nine Typologies Peacemaker Leader 9 Reformer 8 1 Enthusiast 7 Helper 2 Loyalist 6 3 Achiever 5 Investigator 4 Individualist

21 Enneagram Nine Typologies

22 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:

23 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:

24 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?):

25 Spiritual Journey

26 Spiritual Journey Emphasis on seeking to encourage and embrace, rather than suppress, avoid or change Self Compassion Self Acceptance Acceptance of others

27 Spiritual Journey Turning it over to a higher power leads us to fourth step Exploration of dark side 4 th step process leads to : My part in it Character defects How do I keep these wounds alive today? Enneagram fits with this process

28 Spiritual Journey Self-knowledge is not a route to stopping drinking/using Self-knowledge is essential in progressing on the spiritual journey. 4 th,5 th,6 th steps geared toward increasing selfknowledge Ongoing working of steps as well as ongoing spiritual growth important to continued stable recovery

29 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)

30 Evidenced Based Treatment Compatibility Cognitive Behavioral Therapy (CBT) Dialectic Behavioral Therapy (DBT) Experiential Therapy Intensive Experiential Workshop

31 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.

32 Identifying Distorted Thinking/Response Patterns

33 Self-Exploration Enneagram 4 th Step Group CBT/DBT Intensive Experiential Workshop

34 Enneagram & DBT Similarities Enneagram Inner Coach Awareness of wherever your attention goes, your energy follows Mindful self compassion DBT Wise Mind Observing; just noticing Non-judgmental stance Identify health choices Improve the moment

35 Enneagram & DBT Principle #5, (Daniels & Price) 4 As Awareness Acceptance Action * Adherence

36 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

37 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

38 Case Studies

39 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

40 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 4 th step as change agent

41 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.

42 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

43 Case Study Mark Identified as Enneagram Type 1 Schema identified was one of being defective and ashamed of it (feeling defective) Incident in 4 th 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

44 Identifying Distorted Thinking/Response Patterns Father and teacher shaming Type 1 need to be perfect Introjected negative messages Self-deprecating inner voice Defectiveness and shame I am inadequate

45 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

46 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

47 Identifying Distorted Thinking/Response Patterns Father shaming, feel inadequate, not good enough Type 6 Anxious, fearful, suspicious Identified pattern of I m hiding defective emotions to gain acceptance I am pathetic

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52 Learning Enneagram DO YOUR OWN WORK! Further education Attend workshops, retreats Incorporate into supervision

53 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?

54 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

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

56 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.

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58 Wild Geese a poem by Mary Oliver