A NINE-STEP METHOD FOR USING THE ENNEAGRAM IN PSYCHOTHERAPY
© Belinda Gore, Ph.D., 2005

Karen is a high-level manager in a large corporation, very bright and very responsible. At 40, she has never been married and has a significant weight problem. She knows that she has to make some changes in her life and has read hundreds of books and made dozens of plans but she cannot seem to take action.

In taking the RHETI, Karen scored 27 on Type Nine, her highest score. Reading through the description of the type behavior on the back cover of the RHETI, she recognized herself immediately. Type Two was the next highest score and while she could relate to many of the statements about Two, she identified these are more descriptive of her mother and therefore of the family culture.

As a Nine, Karen learned very early in her life how to check out and go numb rather than have to feel anxiety or do anything that might disturb her inner peace. At an early age she learned to deal with these conflicts by withdrawing from the pain while appearing to still be involved. When Karen could stay focused in her body, she realized that her body was in pain. After a few sessions with a massage therapist, to help her learn to identify the pain and how to relieve it, the emotion that had been lying dormant beneath her numbness began to surface. Fear of those feelings had been blocking her from taking action about her life situation.

Karen could track her tendency to become overly anxious about potential mistakes at work. Rather than bother her team members (because she did not want to stir up problems or have her staff dislike her), she would work late and on weekends to fix possible mistakes. Compulsive overeating was her way of soothing her feelings of isolation and burnout. Understanding this cycle helped Karen identify the pattern when it was starting and she was better able to take more positive action.

Karen recognized that smoothing over problems and trying at all costs to not make waves was not the answer to having the close relationships she wanted. She wanted to be able to have more friends rather than to retreat into loneliness and compulsive eating.

How would we approach psychotherapy with Karen?

In working with psychotherapy clients from the perspective of the Enneagram for the past fourteen years I have developed this nine-part intervention checklist. It is based on language and concepts taught by the Riso-Hudson Enneagram Institute.

1. Assess with the RHETI: review 2-3 types with highest scores and determine primary type
2. Consider presenting problem in view of Type, Level, and Stress Point
3. What is the Object Relations structure and how does it relate to the presenting problem?
4. What is the primary issue identified by the Triad (underlying feeling of Rage, Shame, Fear)?
5. Identify and Balance: process style (Horneyvian subgroup)
6. Identify and Balance: coping style (Harmonic subgroup)
7. Identify and Balance: instinctual style
8. Work with Levels of Development
9. Teach the Practice of Presence

As a Nine with a One wing, with a primary Social instinct, we find Karen feeling lonely and wanting companionship but getting bogged down in the anxiety of her stress point, Type Six. To sooth her anxiety and recover from the stress of the work day, she withdraws and eats in front of the television. In terms of the object relations structure of her type, she is following a lifelong pattern of numbing out to her own needs rather than risk not belonging (and therefore not receiving the support of the primary holding environment). This has left her with a deeply buried anger that she is afraid to explore lest it be too overwhelming.

I began therapy with helping Karen recognize her pattern of withdrawing to manage her feelings, as Nine, Five, and Four are in the Withdrawn group of the process styles. She is healthy enough to be able to recognize being Assertive or Complying with a given structure as other alternatives; those alternative behaviors did not come easily but she could name them and develop behavioral experiments to try out new strategies. We know that the Withdrawn group most needs to take action, even though it will have to be with small steps. Going to a massage therapist was an important action for Karen because it was one that she was willing to do. Later, another action was to agree to go to find out where Overeaters Anonymous met, and then to agree to attend just one meeting.

Similarly, Nines are in the Positive Outlook group, indicating that when their preferred strategies don’t work, they want to look on the bright side and see the cup as half full. Along with Seven’s and Two’s, they are reluctant to focus on the problems. While sometimes having a positive attitude is a genuine benefit, it can also be a way to avoid negative feelings. Karen explored how to be more expressive of her feelings and opinions like the Reactive group. While she is certainly concerned with Competency at work, her drive to perform ends when she goes home. Some of that energy could be expended on herself, lending motivation to improve her nutrition and exercise. She already reads lots of books so bibliotherapy is not indicated.

Karen’s Social instinct is well-developed, almost to a fault as she concerns herself with how others are responding to her and with neglecting her own self development and personal needs. Her Sexual instinct is the least developed and she is exploring how to invest herself deeply in relationships, taking risks to reveal her thoughts and feelings.

Next month we will look at the Levels of Development to understand how best to address Karen’s issues from that perspective.