Case Study

The Enneagram as a clinical tool

We all have a categorizing brain, a virtual pattern-recognition machine, which enables us to recognize doorknobs regardless of their particular shape or a friend from the back, even if we can’t see the whole person. Recognizing patterns allows our brains, with their 100 billion neurons and thousands of connections from one neuron to another, to help us adapt and survive.

Therefore, it’s unsurprising that the field of psychotherapy has countless typologies, including the DSM and the Myers-Briggs 16 Types, intended to assist us in recognizing distinctive patterns of human personality. As a clinician, the typology that I’ve found most helpful in organizing my own work and understanding the most enduring lifelong patterns in my clients’ lives is the Enneagram, a system of personality types.

The Enneagram has its roots in the world’s great spiritual traditions and in Pythagorean mathematics—which suggests to me that this system fits our basic human characteristics and evolutionary requirements. We need the perspectives and talents of different types of people to help our highly intelligent and social species survive.

What gives the Enneagram its distinctive clinical utility in the consulting room is its focus on the largely unconscious core beliefs that shape people’s view of how to lead a satisfying life. According to Enneagram understandings, our underlying core beliefs shape our focus of attention (in Enneagram terms “habit of mind”) and how we direct our energy (“the driving emotion of type”). Each of the nine Enneagram types has a distinct adaptive pattern based upon and supporting a specific core belief, yet no type is deemed more or less healthy than any other type. Here are brief descriptions of the nine basic types:

Type One: The Perfectionist believes you must be good and right to assure a satisfying life in a world that demands good behavior and punishes bad behavior. Consequently, Perfectionists are conscientious, responsible, improvement-oriented, and self-controlled, but can be critical, resentful, and self-judging.

Type Two: The Giver believes you must give fully to others to assure a satisfying life in a give-to-get world. Consequently, Givers are caring, helpful, supportive, and relationship-oriented, but can be prideful, overly intrusive, and demanding.

Type Three: The Performer believes you must accomplish and succeed to assure a satisfying life in a world that rewards doing, rather than being. Consequently, Performers are industrious, fast-paced, goal-focused, and efficiency-oriented, but can be inattentive to feelings, impatient, and image-driven.

Type Four: The Romantic believes you must obtain the longed-for complete and highly idealized relationship or situation to assure a satisfying life in a world that otherwise would abandon you. Consequently, Romantics are idealistic, deeply feeling, empathetic, authentic to self, but can be dramatic, moody, and sometimes self-absorbed.

Type Five: The Observer believes you must protect yourself from intrusion to insure a satisfying life in a world that demands too much and gives too little. Consequently, Observers are self-sufficiency-seeking, nondemanding, analytic/thoughtful, and unobtrusive, but can be withholding, detached, and overly private.

Type Six: The Loyal Skeptic believes you must gain certainty and security to assure a satisfying life in a hazardous and unpredictable world you can’t trust. Consequently, Loyal Skeptics are themselves trustworthy, inquisitive, good friends, and questioning, but can be overly doubtful, accusatory and fearful.

Type Seven: The Epicure believes you must keep things positive and open to assure a satisfying life and escape from a world that causes pain and imposes limitation. Consequently, Epicures are optimistic, upbeat, pleasure and possibility seeking, and adventurous, but can be pain-avoidant, uncommitted, and self-serving.

Type Eight: The Protector believes you must be strong and powerful to assure a satisfying life in a tough and unjust world in which the powerful will take advantage of you. Consequently, Protectors are justice-seeking, direct, strong, and action-oriented, but can be overly impactful, excessive, and impulsive.

Type Nine: The Mediator believes you must blend in with others and “go along to get along” to assure a satisfying life in a world that makes you unimportant or requires you to blend in. Consequently, Mediators are harmony-seeking, comfortable, and steady, but can be self-forgetting, conflict-avoidant, and stubborn.

In addition to focusing on the nine types of core belief patterns, the Enneagram system works with all three centers of intelligence—head, heart, and body—and the three basic aversive emotions associated with these centers of intelligence—fear, distress, and anger. We all have some of each type in us, but it’s important to determine a client’s core type because, as the following case illustrates, it gives us leverage with which to support the work of personal transformation.

Finding a Voice

In her first session with me, Marie, a 38-year-old attorney who’d recently gotten divorced, explained the reason she’d come to see me. “Through my entire life, I haven’t felt like I have a voice,” she said, trying to explain the sense of intense anxiety and worry that had brought her to treatment. “I’ve completely surrendered to what other people expected of me, or I’ve gone over to the other side with reactivity and anger. I don’t want to live like that anymore.” Marie was particularly concerned that her lifelong pattern of oscillating between a willingness to please and anger was occurring again in a new love relationship.

She’d grown up with a dominating but caring father, a law-enforcement investigator, who constantly worried about her safety. “I struggled to keep him calm and didn’t want to stick out,” she recalled. “If I opposed him, he’d be hurt, wounded, angry, and see me as betraying him. To keep him from yelling—raging—I couldn’t have a voice. My mother was like an angel, taking care of him and everybody else, never saying anything about her needs. I felt I had to protect her by not speaking up and causing conflict.”

Marie had first discovered the Enneagram through a friend. She’d come to see me because she knew I practiced this method of therapy. She’d determined that the Enneagram Type Nine, The Mediator or Peacemaker, best fit the way she functioned in the world. This is an observation that I confirmed through an initial inquiry process about her behavior patterns and energy, key themes, and focus of attention. Mediators believe that the best way to gain love from others is to forget their own priorities and desires, choosing instead “to go along to get along.” They can become so outer-referenced that they bend over backward to accommodate the claims that others make upon them.

What typically happens with this type is that, beneath the veneer of adaptability, anger festers inside when they don’t feel honored or treated as important. Over time, their core dilemma of wanting to have a voice, yet suppressing it to avoid rejection, can manifest as stubbornness, resistance, passive-aggressiveness, and not speaking up until unwanted anger erupts. The specific development keys for Type Nines include learning to pay attention to their own self and needs, determining their own priorities and taking action on them, and especially discovering not only what they’re against, but what they’re for.