INTEGRAL RECOVERY: A CASE STUDY OF AN AQAL [ALL-QUADRANTS, ALL-LEVELS, ALL-LINES, ALL-STATES, ALL-TYPES] APPROACH TO ADDICTION TREATMENT A Dissertation Presented to the Faculty of John F. Kennedy University Psy. D Program In Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology by Adam M. Gorman, MA MAY 2013 © 2013 by Adam M. Gorman All Rights Reserved ii INTEGRAL RECOVERY: A CASE STUDY OF AN AQAL [ALL-QUADRANTS, ALL-LEVELS, ALL-LINES, ALL-STATES, ALL-TYPES] APPROACH TO ADDICTION TREATMENT This dissertation by Adam M. Gorman has been approved by the committee members, who recommend that it be accepted by the faculty of John F. Kennedy University, Pleasant Hill, California, in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY _____________________________________________________ Mark D. Forman, Ph.D., Chair _____________________________________________________ Alette, Coble-Temple, Psy.D., Reader ____________________________________ Date iii ABSTRACT INTEGRAL RECOVERY: A CASE STUDY OF AN AQAL [ALL-QUADRANTS, ALL-LEVELS, ALL-LINES, ALL-STATES, ALL-TYPES] APPROACH TO ADDICTION TREATMENT ADAM M. GORMAN John F. Kennedy University College of Graduate and Professional Studies Pleasant Hill, CA KEYWORDS: Integral Recovery, AQAL, Ken Wilber, Integral Psychotherapy, Addiction Treatment, Addiction Recovery Addiction to drugs and alcohol is at an all time high. Billions are being spent annually on this epidemic with minimal success (Califano, 2007). Research indicates that drug and alcohol abuse/addiction is one of the major contributing causes to mental health problems (Fletcher, 2013; Sheff, 2013). The purpose of this inquiry is to understand the experience of one client in Integral Recovery (IR). Using a phenomenological design, the researcher interviewed one client of IR, his mother, and one staff member who regularly worked with the client over the course of three months. After careful analysis of these interviews five key themes related to the IR treatment model emerged: 1) Practices and Structure 2) Obstacles to Recovery 3) Values Integral Recovery 4) Relatedness 5) Optimism. Interview results provided an additional perspective on the experience of an IR client in primary treatment. Future research might consider a longitudinal study with more participants to better understand the success rates of individuals who use IR interventions as their primary means of drug and alcohol treatment. iv Dedication To my Wife Jackie & Son Liam. Thank you for opening me up to a level of Love I never knew existed. To my incredible parents. Without your endless Love and Support this dissertation would never of been possible. I Love You v Acknowledgments First and foremost I want to thank John Dupuy for taking a chance on an 18 year old aspiring field guide with one year of sobriety. My time at Passages to Recovery set me on a course that is culminating in the completion of this doctorate. It has been a joy working with you these past few years. Your huge heart and endless compassion for those who are in the grips of addiction is an inspiration. A deep bow to Gregory Martin whose brilliance inspired me to be a therapist. Thank you for being such an amazing model of what a healer is. To my wife Jackie who helped settle my anxiety, and reassured me countless times that this project would get done. To my son Liam thank you for always reminding me of what’s important in life. I pray that “your heart never stops speaking to you.” Thank you Mom and Dad for encouraging me to dream big, and to always follow my heart. To my Brother Brian for being the best friend and confidant I could ask for. “Allow me to say it plainly sir I cannot afford to lose you.” To Evelyn and Robert Birnbaum. I will always count you both as my most cherished guides and mentors. You enriched the last five years more than words can say. To Alec Peterson you left us to soon my brother. Your passing has motivated me to do a better job for all those wrestling with addiction. To Padre Frank Buckley for helping me push this project over the finish line. Thank you for all your pep talks; they helped more than I ever let on. To Charlie Hopper for being a amazing presence and positive force in my life for almost fifteen years. I deeply value our friendship and your unique perspective on the world and look forward to many shared endeavors in the future. To Mark Forman and Alette Coble-Temple for agreeing to take on this project, and for riding this three year roller coaster with me. To everyone at Casa Belicosa for the many nights shared together smoking cigars. I will always count those evenings as the best of times. vi Table of Contents Abstract .......................................................................................................................................... iv Dedication ....................................................................................................................................... v Acknowledgments .......................................................................................................................... vi List of Figures .............................................................................................................................. xiv Chapter 1 ......................................................................................................................................... 1 Introduction ..................................................................................................................................... 1 Chapter 2 ......................................................................................................................................... 3 Review of the Literature ................................................................................................................. 3 Current State of Alcohol and Drug Treatment ............................................................................ 3 Medical Model ............................................................................................................................ 4 Alcoholics Anonymous ............................................................................................................... 4 Four-Quadrant Assessment of AA .............................................................................................. 8 Harm Reduction ........................................................................................................................ 10 Cognitive Behavioral Therapy .................................................................................................. 12 Review of Current Integral Recovery Research ....................................................................... 13 John Dupuy’s Integral Recovery .............................................................................................. 15 A Five-Elements Assessment of Dupuy’s Integral Recovery ................................................... 16 Quadrants. ............................................................................................................................. 17 Lines. ..................................................................................................................................... 20 Cognitive line. ................................................................................................................... 20 Physical line. ..................................................................................................................... 21 Spiritual line. ..................................................................................................................... 23 vii States. .................................................................................................................................... 23 Types. .................................................................................................................................... 25 Levels. ................................................................................................................................... 27 Stage-appropriate interventions. ........................................................................................... 28 Regression. ............................................................................................................................ 30 Limitations ................................................................................................................................ 31 Research Question .................................................................................................................... 32 Chapter 3 ....................................................................................................................................... 33 Methods......................................................................................................................................... 33 Choice of Method ..................................................................................................................... 33 Participants ................................................................................................................................ 34 Recruitment ............................................................................................................................... 34 Data Collection ......................................................................................................................... 35 Data Analysis ............................................................................................................................ 36 Limitations ................................................................................................................................ 36 Assumptions .............................................................................................................................. 36 Clinical Case History ................................................................................................................ 37 Chapter 4 ....................................................................................................................................... 39 Results ........................................................................................................................................... 39 Interview Summaries ................................................................................................................ 40 Karl interview 1: First day of treatment. ............................................................................... 40 Karl interview 2: One week into treatment. .......................................................................... 41 Karl interview 3: Three weeks into treatment. ...................................................................... 42 viii Karl interview 4: Final week of inpatient treatment. ............................................................ 43 Karl post-treatment interview 1: One month following discharge. ...................................... 44 Karl’s post-treatment interview 2: Two months following his discharge. ............................ 45 Nadia interview 1: One week into treatment. ....................................................................... 45 Nadia interview 2: Two weeks into treatment. ..................................................................... 47 Nadia interview 3: One month after discharge. .................................................................... 47 John Dupuy interview 1: First day of treatment. .................................................................. 48 Dupuy interview 2: Two weeks into treatment. .................................................................... 50 Dupuy interview 3: One month following discharge. ........................................................... 51 Progression of the Four Quadrants Through Therapy .............................................................. 54 Upper Left (UL). ................................................................................................................... 54 Upper Right (UR). ................................................................................................................ 54 Lower Left (LL). ................................................................................................................... 55 Lower Right (LR). ................................................................................................................ 55 Stages. ................................................................................................................................... 55 States. .................................................................................................................................... 56 Lines. ..................................................................................................................................... 57 Spiritual. ............................................................................................................................ 57 Emotional. ......................................................................................................................... 57 Cognitive. .......................................................................................................................... 58 Physical. ............................................................................................................................ 58 Observations of Interviews ....................................................................................................... 58 Qualitative Analysis .................................................................................................................. 59 ix Themes. ................................................................................................................................. 59 Theme 1: Daily practice is essential to sobriety. .................................................................. 59 First third: Daily practice is essential to sobriety. ............................................................. 59 Karl. .............................................................................................................................. 59 John. .............................................................................................................................. 60 Nadia. ............................................................................................................................ 60 Second third: Daily practice is essential to sobriety. ........................................................ 60 Karl. .............................................................................................................................. 60 John. .............................................................................................................................. 60 Nadia. ............................................................................................................................ 61 Final third: Daily practice is essential to sobriety. ............................................................ 61 Karl. .............................................................................................................................. 61 John. .............................................................................................................................. 61 Nadia. ............................................................................................................................ 61 Theme 2: Obstacles to Recovery. ......................................................................................... 61 First third: Obstacles to recovery. ..................................................................................... 62 Karl. .............................................................................................................................. 62 Nadia. ............................................................................................................................ 62 Second third: Obstacles to recovery. ................................................................................ 62 Karl. .............................................................................................................................. 62 John. .............................................................................................................................. 62 Nadia. ............................................................................................................................ 62 Final third: Obstacles to recovery. .................................................................................... 63 x