NOT ALL ROADS LEAD TO ROM A Response to Michel Boyer’s Paper Entitled “Matching Hypuotic Interventions to Pathology Types” ELGAN L, BAKER Boyer’s paper remines us that different patieats, by nature of their varying degrees of characterolagical maturity and related internal phe= nomenology, will respond differently to various hyp clinical su s, and utilization techniques. He employs Kokut's metaphor slitferentisting structural versus dynamic arenas of psyeho= pathology and neurotic versus preneurotic forms of symptom formation toextend the notion that different therapeutic strategies are required t maximize clinical responsiveness to specific hypnotierapeutic interven tions. He then gives examples of two such differentiated techniques. [could not agree with Boyer's basic thesis more. Although seeming obvious and simplistic and often explicated in the clinical hypnosis and psychotherapy literatures, the notion of specificity of technique end Strategy for treatment remains elusive and aften ignored, As all sea soned clinicians know, even the most elegant technique does not make conceptual or empathic sense for every patient or even for every patient who presents with the same manifest symptom, Issues related to struc tural maturity, personality style, the internal and external functions of a symptom, and Situational factors, such as motivation, level of alliance, andclaborations of the treatment process, all must influence how we taie lor our specific hypnotherapeutic techniques For any specific patient Notoaly do these concerns impact issues of treatment efficacy but atken= tion to these factors is requisite in order to manage the potential unto ward effects of certain techniques for certain types of patients Our current chivical geist has seemed to dritt toward a sort of nat= rowly defined empirical narcissism where clinical extensions of labora tory analogues of clinical and therapeutic processes are elaborated as mannalized treatments,” asf the analogues irom which they derivwere thesame as “the real thing” and therefore applicable in robot-like precie sion to the real work of real psychotherapy. Although the dynamics and. polities of such narcissism arv interesting to clebate for the evolution of periences, pest "acddnosscornespontlence to Egan faker, Ph.D, ABPH, Meridian Psychological Asse ites 441 North Central venue. Indianapolis, Indiana 42ELGAN L, BAKER ‘our professions, the “9s it-ness” of these attempts to standardize inter= ventions cannot be ignored. Like all “asif” phenomena in our lives, th violate the authenticity of onr experience and the attunement of our relatedness, Unfortunately, the legacy of such thought and. practice is eating a new generation of clinicians who do not know that the intrapsychic, interpersonal, and phenomenological contexts of syanp= tom formation must be considered when developing. treatment plan Real patients have not been screened to eliminate the comorbidity of structural pathology, and truly effective psychotherapy is specifically ang uniquely an idhagraphic enterprise For this reason, Boyer’ paper is a useful reminder to each of us that efficacious hypnotherapy—Like all psychotherapy—requires carelul diagnosis ancl conceptualization that considers the person. and his or her internal and relational worlds aswell as the specific presenting symptom, No single induction works maxi= mally for every patient; no suggestion or image or ego-mastery teche nique isindlicated for every presentation of any psychopathology. In par= ticular, the differences in ego functioning for patients arrested at preneurotic levels of character formation require specific alterations in strategy and technique tuenhance and to secure theclinical applications of hypnosis in the psychotherapy of such individuals Further, as Boyer’s paper elaborates, the faci for the utilization of trancevary asa function nt structural maturity and related capacities for selabservation, sel-manayement, self-stability, and seletesdness to ath= ers, Numerous authors have elaborated structural and developmental perspectives for framing and attuning such hypnotherapeutic interven tions, especially with preneurotic patients (Beker, 1YS1; Copeland, 1985; Frederick & McNeal, 1999; Peebles, 1989}, When hy pnotherapentic work. iSnotinformed bysuch conceptualization, techniquesare vtte not help ful anc occasionally harmful as they provoke unmtodulated dissociation and regression or unmetabolized affective intensity As the clichés of our cultural experience remind us, ane size dees not fit al and all that glitters isn’t gol, Thus, it may well be that all readsdo nnoflead ta Rome, The laboratory is nat the clinic, and all patients do not respond in the same way to a Specific technique. Let us hope that our clinical practice is fully informed by our cultural wisdom /REFEREN! Baker, E.L (1981), A hypmotherapeutic approach sw enhance object lations inp chetic patients atetina! 1 Hap 29, 136 Copeland, D8 (1882), The aplication of object ations theory tothe hspnothorapy of ‘ovelopenental arests Theborderline patint atest! 3 Les, ot BlCLINICALFORUM, Frederick, C, & McNeal, $. (199 weary go stengtening Masa mice Erlbaum Peobles, MJ. (198). Theoug postsraumatiestresdis 37,192.26, andra ‘The payeloanalytic use of hypnosis with nad serial gay