Essential Wholeness – A Nine Phase Trans-theoretical Model of Change
by Eric Lyleson, MA
Many clinicians in seeking to be effective with their clients have adopted an eclectic or integrated approach to psychotherapy. What seems to be lacking is a trans-theoretical model that can show us very specifically what methods are best to use with whom, in what phase of treatment. By combining James Prochaska’s five-stage model[i] with Dan Siegel’s River of Integration[ii] and Acceptance and Commitment Therapy’s (ACT) matrix of psychological flexibility[iii] set into a neuropsychological understanding of the Enneagram (mostly know as a system of nine personality types) we have a comprehensive blueprint for effective integrative psychotherapy.
“If your only tool is a hammer then every problem looks like a nail.” Abraham Maslow
I spent much of my twenties working as a carpenter. As I gained experience, expertise and knowledge I was able to take on more varied and complex jobs. New challenges required new tools and methods. High quality tools and sophisticated methods yield better results. There are specific tools and methods needed for each phase of construction: foundations, walls, roofing, plumbing, electrical, etc. We all know that the effectiveness of tools is only as good as the person using them. The quality of the tools and craftsmanship are of no consequence without a good design. Quality therapy, like quality building is determined by the knowledge and skillfulness of the therapist to know what interventions and strategies to use with what sort of problems in achieving quality outcomes that are designed in collaboration with the client’s unique makeup and desires.
From Eclecticism to Integration
Like many people, in order to become the best therapist I could, I studied: books, audios and videos, and sought training and supervision from quality mentors in the best methods I knew of. By the time I started training therapists I had training and experience with Psychodynamic, Gestalt, Solution Oriented, Brief Strategic, CBT, RET, Family Systems, Self Relations, Structural Family, Sexual Crucible, Object Relations, Somatic Psychotherapy, EMDR, Narrative, Ericksonian Hypnosis, NLP and Art Therapy. In addition, I had been working with Buddhist teachings and meditation. In the process of discovering what helped me personally and as a therapist I had accumulated a lot of tools, skills and experience. I had a good sense of the outcomes that were possible from therapy because of the healing and growth I had experienced through my own therapy and the outcomes my mentors helped me achieve with my clients.
I was teaching general psychotherapy courses that grounded students in many of the major theoretical orientations, and felt compelled to find some sort of unifying theory of change that could help organize this eclectic collection of approaches. I also thought that it was important to have a notion of how healthy people grow and develop. I was greatly influenced by Milton Erickson at the time. He often addressed the issue by sharing metaphors of how people and all living things evolve and learn (like learning to walk, talk, read and write), but Erickson was notorious for not making theories explicit. The only trans-theoretical model I found was James Prokaska’s five-stage model—precontemplation, contemplation, preparation, action, and maintenance. Although it has a lot of merit, it didn’t seem to specify how people naturally move through those phases.
Enneagram as a Geometric Model of Change
A few months later during an Enneagram course the teacher was doing a brief review of the core qualities of each personality type, when I realized the qualities of attention and thinking that each type compulsively did too much of, were the qualities needed to move through a second order cycle of change at the respective phase. For example, type NINEs are good at mediating conflict and turning a blind eye to imperfections while appreciating the status quo. These are some of the capacities needed to maintain homeostasis (precontemplation stage), but not so good for moving to contemplation stage which is what type ONEs tend to do too much of—seeing what’s wrong in contrast to how things could ideally be.
It took me a few years of studying neurobiology and other models of change to understand how all living systems progress through the nine phases defined by the Enneagram and even how Joseph Campbell’s Hero’s Journey of transformation mapped onto it.
Dan Siegel came to a similar neurobiological understanding of how living systems function in the region between chaos and order and used the ‘River of Integration’ as way of guiding the therapeutic process.
Acceptance and Commitment Therapy (ACT) provides an integrative matrix of intervention strategies for fostering the development of whole, fully functioning human beings. Its emphasis is on developing psychological flexibility, growth, and meaningful life change. Rather than trying to control symptomatic thoughts, feelings and actions—mindfulness and compassion-based approaches like ACT recognize that it is by overly trying to control natural human responses that pathologies develop. By accepting thoughts, feelings and sensations there is a natural tendency to move through them and learn from the experience. When combined with the experience of transcendent sense of self (self as context) it is possible to reduce the tendency to reify thoughts, images, emotions, and memories. Thereby allowing people to have greater present moment awareness and connect more deeply with what they really value and desire to take action on.
The Essential Wholeness Systemic Change Cycle
The more comprehensive Essential Wholeness[iv] model identifies five interrelated dimensions that serve the self-organizing processes of what it is to be an evolving human being. At each phase on the Systemic Change Cycle the Developmental Task is accomplished with a focus on the corresponding Psychological Domain, while drawing upon the Essential Quality in order to perform the Basic Function needed to successfully address the Primary Concern. Once we adequately attend to our current phase we naturally move into our next phase. Although these are part of both conscious and unconscious processes, when we are most in the flow they are mostly intuitive.
For example, to accomplish the Developmental Task of individuation we focus primarily on the Psychological Domain of what we value while drawing on the Essential Quality of forgiveness. Forgiveness helps us to let go of what we thought was most valuable so we can open to the Basic Function of having the unique experiences needed clarify what is missing or inadequate that needs to be included or attended to in order to individuate more fully from our current systemic patterns/social systems.
Similar to the ACT diagram, but more specific, the internal lines of the Enneagram show us what other aspects of our Essential Wholeness supports change at this phase. For example the connection from FOUR to ONE shows that the primary concern of what is limited or flawed can help clarify what is missing or inadequate. Being able to separate ourselves from aspects of our lives can help with individuation. Being more discerning about our choices will enrich our experience. Being fully conscious of the present can help us forgive the past. And knowing what we would ideally prefer brings what we value more clearly into focus.
Different Interventions for Different Phases
Prochaska, Norcross and Diclemente (2013)[v] doing further research on the 5 stage model formulated therapeutic guidelines for treatment based on a meta-analysis by C. S. Rosen (2000) that found significant evidence for using different therapeutic approaches at different stages. For example, it appears methods associated with experiential, cognitive, and psychoanalytic persuasions are most useful during the precontemplation and contemplation stages, whereas existential and behavioral methods are most useful during action and maintenance stages.
Three in One
The Enneagram of Essential Wholeness’ nine phases provides us with a more comprehensive map than any of these three models alone for specifying what therapeutic interventions are best at any point of the therapeutic process. So metaphorically we are not trying to hang the doors before we have laid the foundation or sealed the roof. The Enneagram diagram can be used to integrate James Prochaska’s five-stage model (six if you include relapse), with Siegel’s River of Integration (2010) and ACT’s matrix of psychological flexibility.
We start with Siegel’s River of Integration, which shows how living systems fluctuate between order and chaos in cycles of destabilization and reorganization. However instead of viewing this as a linear graph we can represent it as a circular process (see diagram). And then overlay Prochaska’s (2012) six-stage Cycle of Change combine it with ACT’s Matrix of Psychological Flexibility (Hayes et al 2006) we end up with a circle/spiral with inner matrix of connecting lines. If we expand it to nine phases we would have something that looks a lot like the Enneagram.
River of Integration and the Enneagram
Looking at the River of Integration in regards to the Enneagram we approach equilibrium at phase NINE, destabilization occurs from phases THREE to FOUR, approach chaos at phases FIVE – SIX and reorganization occurs at phases SEVEN to EIGHT.
ACT and the Enneagram
Looking at the ACT diagram in relation to the Enneagram:
- Self as context is represented by the circle itself.
- Present moment awareness is synonymous the essential quality of ONE – Consciousness.
- Commitment happens most strong at phases THREE (Initiating and promoting ones agenda) and EIGHT (exercising ones will to implement new ideas).
- Defusion techniques like letting go of thoughts, thanking your mind, observing your thoughts and labelling your thoughts and feelings tend to happen at phases FIVE (utilizing the essential quality of Space, identifying beliefs and investigating the nature of subjective experience) and SIX (questioning beliefs and differentiating fact from fiction).
- Acceptance is the Essential Quality of phase SIX.
- Values is the Psychological Domain of phase FOUR
Prokaska’s Change Cycle and the Enneagram
Looking at the Enneagram phases in relation to Prokaska’s model:
- At NINE our emphasis on maintaining homeostasis relates to pre-contemplation and no intention of changing.
- At ONE we become more discerning of the limitations of our patterns especially when contrasted with how we would ideally like things to be, contemplation of change begins.
- At TWO preparation begins as we ask what is needed and make adaptations to problem, but without really changing the pattern.
- At THREE action is initiated as capabilities are pushed towards their limits within the existing system.
- At FOUR there often appears to be a relapse when unaddressed inadequacies are revealed and we clarify what we really want.
- At FIVE a second preparation phase occurs where more thorough investigation of the issues is needed to understand how to address the inadequacies and honor core values.
- At SIX we take action by facing our fears and questioning the beliefs and identifications with old patterns.
- At SEVEN new ideas are explored and experimented with to expand and maintain the change.
- At EIGHT more determined action is implemented that helps reorganize our life around the new ideas and behaviors–giving rise to a new identity inclusive of these changes.
- Returning to NINE these changes can be fully consolidated into and maintained in our lives within a new homeostasis.