Dreams: Theory and Clinical Practice- Part 3

In the years that followed with the introduction of the Tripartite Model (Ego, Id and Superego) and the rise of ego psychology, dream life was increasingly ignored. One can speculate why this was so; but I suspect that dream life, which by its very nature is regressive (as outlined in Part Two), was always unconsciously painted and tainted as childish and its “meaning” was somehow disregarded as “mere” infantile wish fulfillment.

It is important to remind ourselves of how much the therapy landscape has shifted and deepened since the early days of Freud and the “alienist.” Early efforts to investigate mental illness naturally stirred deep fears of the irrational, in the patient but, perhaps more acutely, in the doctor as well. As most new therapists come to appreciate, they still do! Positivist scientists, including Freud, managed their anxiety via detachment and devaluation. It was Otto Fenichel who famously truthfully but defensively insisted that psychoanalysis is not irrational; rather it is the data of psychoanalysis that is irrational.

But perhaps inevitably, the psychoanalytic compass was to shift again! Beginning in the ‘50s there was a revolution in psychoanalytic theorizing fueled by child observation and by an increasing focus on the key relationships in early childhood and their enormous later influence on adult attachment. This new movement was initially led by people like John Bowlby, and later by Donald Winnicott, and Margaret Mahler. Their collective work and that of others, has led to a gradual re-estimation and de-estimation of rationality and reality testing, enshrined as the “Secondary Process.” Increasingly, intellectual work and insight has come to be appreciated as more akin to the pleasing fabric covering a chair or sofa.

Symbolism, metaphor and unconscious and preconscious wishing, rather than being “crazy thinking” needed to decode a dream, but happily superseded by calm rationality, is now more centrally understood as THE primary mode of ALL thinking. Psychoanalysts no longer attempt to discover a troubled infantile past to triumph over it; rather, we help the patient discover it, live it in fantasy via the transference and allow for its gradual maturation into its optimal unique adult form. With insight and understanding discovered through our relatedness to the patient, we help him increasingly encompass all his possible wishes, sacred and profane, without excessive condemnation or reproach. We do this with the confidence that they will ultimately commingle; reducing the need to banish unacceptable, “split-off” choices, and allowing for more gratifying compromise solutions to the problems of living and being.

Once we embrace the eternal world of fantasy, the evidence of embedded transference distortions is ever easier to discern; and, in turn, dreams themselves become less mystifying. As a simple example, I recently began an analysis with a young Muslim man who hadn’t spoken with his father for several years after being banished from the family over his divergent sexual orientation. In his third session he had a dream about having diarrhea and soiling “a couch” namely mine. It was enough for me to be tall, old, male, and in his mind, presumably straight for him to begin treatment with an enormous surcharge of aggression and anticipated hurt.

The former clear separation between states of wakefulness and that of sleeping and dreaming is now so blurred that contemporary psychoanalysts speak of the “waking dream thought.” We “dream” while we are awake as much as when asleep but are only less able to access that dream content because of the need to perform a job, drive a car, do mathematics or taxes.

So how are dreams different than the state of wakefulness?

I have picked six of the most central points to review below.

1. A virtual total reliance on hallucination and the visual world; such sense organs as hearing, smell, taste and touch play no significant role. As previously mentioned, the spoken and written word normally play a negligible one.

2. Images are generated that can morph in ways that are largely prohibited in waking life. Some images are literally indescribable and can be an amalgamation of several different objects each of which has a specific dream meaning. This highlights the intense condensation of multiple themes and meanings that is regularly observed in dreams.

3. There is an immediacy about dream images. The dreamer may able to “pull back” and reassure himself with some thought: “this is only a dream” but in the main, dream images are experienced as “real” in a manner totally foreign to the experience of fantasy or day dreaming in an awake state.

4. Whatever the ideational “chain,” the dream has no recourse to punctuation. This means that relationships must be visually represented. If you and I “agree” or are “allied” we can be pictured next to each other. If “opposed” the dreamer might describe a dream character as sitting “across” from him.

In keeping with our deeper understanding of projective identification, often each “character in the dream” may manifest elements of both the dreamer and his subject. To emphasize a particular matter of emotional relevance the dream will frequently use repetition of images, scenes or the entire dream. This is especially true for dreams representing childhood trauma and represents the ceaseless effort to “bind” associated painful affects into a dream representation that could offer solution and comfort.

5. The most striking of differences is of course, that the body is paralyzed. Ignoring somnambulism, the dreamer is safely in bed. If a dream is too distressing, the patient will wake up from a surfeit of anxiety. But otherwise, death, intercourse, birth, murder, every possible mental experience can be represented in a dream with nothing more than rapid eye movement taking place in the physical body of the dreamer. One might assume that the motor paralysis is precisely what allows for the representation of activities that would engender too much danger if access to the motor apparatus was possible.

6. The raison d’etre of dreams is the reestablishment of emotional homeostasis. Research in sleep laboratories has demonstrated an inverse relationship between dreaming and a need to seek “pleasure” or satisfaction. When contented, subjects demonstrate a reduction in the need for sleep and REM activity whereas … when individuals are sleep and dream deprived, the need for “pleasurable” experiences increases. Such findings support the notion that dreams serve a key soothing function, restoring homeostasis by dealing with core issues critical to emotional survival. What that means for us is that dreams are never trivial.

Even if your patient dreams of an evening bowling; do not be misled by the indifferent content. He may well be worried about being “bowled over.” As an aside, note the concreteness in the dream word-link which we would never utilize in waking adult life but which a child might well seize upon when first hearing those words and visualizing the pins as they go flying. Every “trivial” dream exists because of some link between that which is of no consequence that that which is. Frequently matters that are too distressing to dream of are often dealt with in this way. For example, a man with a recurrence of his cancer might dream of getting a cold, or a 24-hour intestinal disturbance, in other words, illnesses from which one can anticipate a full recovery. A guilty woman who is considering infidelity might dream of a being stopped for a speeding ticket. Matters are magnified or trivialized as needed to titrate the internal anxiety to a level that allows a dream to be created and dreamt.

This is perhaps the primary reason for so-called distortion in dreams; too little disguise renders a nightmare or an absence of dreaming or sleeping altogether. Yet another reason for the distortion in dreams is that, as I have previously remarked, they are immensely concentrated and can contain a remarkable number of issues that are dealt with as if as one. It has been said that often the first dream in an analysis, if one could fully analyze all its content, would encompass all the pertinent themes of the entire analysis.

So, then what are such core themes and how are they represented in dream material?

Again, you will see an arbitrary list of 6 themes. Whereas I could in truth say “anything and everything” such a statement would be exceedingly unhelpful; so, I will parse out some areas that they may “light up” in your mind as you hear a dream in your practice.

1. Early Bodily Desires. Freud focused on sexual desire and the associated issues of guilt and incest particularly as manifested through the child’s experiences with the parental figures. But drive representatives of aggression, as well as body experiences of pain, sexual desire, hunger, thirst, and fatigue, can and do all find representation in dream material.

2. Self-image and Ego Strength. Dreams almost invariably reveal the patient’s own sense of who he is and what his capabilities are at any one time. A dream of a capsizing boat or airplane/car crash should trigger concerns about your patient feeling overwhelmed by life events, possibly even the treatment itself. A dream of a Conquistador or sports champion who “wins out” or “does ok” in competition is certainly representative of narcissistic worries but in general, a “decent” outcome in a dream struggle speaks to an internal sense of flexibility and capacity. [I will give you an example of such a dream a bit later]

3. Guilt and Moral Turpitude. Dreams virtually always contain some reference to issues of conscience. Frequently they are dreamt to represent or confess to internal attitudes and behaviors that in an awake state, are denied or sweep away. Often dreams of this sort can utilize images of dirt or dirty laundry. Lady Macbeth’s “spot” comes to mind. I had one patient whose debilitating rage at her parents and the world was represented for years by malfunctioning toilets overflowing with feces. Note here the combination of rage (the pouring out of all this feces) and self-punishment (she can’t get rid of it and it ends up soiling her). Almost invariably, overtly masochistic outcomes in dreams signal a need for punishment for internally experienced sins and crimes.

4. Mood and affect. These are often the most puzzling and, on the surface, least in sync with underlying material. Normally affects are muted in dreams other than in nightmares and painful, or arousing feelings embedded in the dream images are unavailable until the dream is unpacked with the therapist. This is yet another reason to work with dreams that is: to liberate important frequently obscure and problematic embedded feeling tone.

5. Core Relationships. People normally dream of their relation to others because the people they hate and love and those that hate and love them are of primary concern. It is the rare dreamer who is not concerned with another in his or her world. I had a very traumatized patient whose mother was emotionally unavailable and whose father was an explosive and very disturbed man. One of her earliest dreams in analysis was of her putting red shaded spheres or “eggs” in their proper slots on a grid. You might not be surprised to hear that she grew up on a farm, is now a scientist and prefers to isolate herself in a lab. The point is that the absence of another might suggest some relevant and important emotional difficulty interacting with others.

6. Treatment and the transference. As you are perhaps doubtless aware, psychoanalysis and dynamic psychotherapy almost exclusively utilize the element of transference to effect insight and change. However, as I have been at pains to make clear, no matter your clinical approach, transference is universal, readily discernible in any relationship and is of potential importance to every therapist. Childhood experience and unconscious anticipation of the behavior of parental figures enter into the treatment field willy-nilly and that is especially true in dream life. Every CURRENT dream a patient recounts to you is, in some measure about the past, present concerns and also about the two of you. This is particularly the case with increasing contact and therapy sessions. Knowledge of that unconscious or partly conscious relationship is of immeasurable value in refining your role and the work you intend to pursue with your patient.

For instance, a patient of mine at the onset of treatment was intensely hyperemotional, subject to bouts of self-cutting, depression and severe alcoholism. She had hinted at serious sexual trauma perpetrated by someone in the immediate family. Later you will hear a dream from the termination phase of this very successful analysis but night after night, this patient dreamt of her escape: escape from prison camps in North Korea, Burma and, of course, Nazi Germany. You might ask why “of course” but my last name should give you a strong clue, given the similarity between Dutch and German language. Such a dream underscored the level of mistrust and the anticipated danger she felt in working with me. Its content helped me see how much preliminary work on elaborating her fears was needed and alerted me to her propensity to be unintentionally dishonest, affecting compliance while secretly planning her escape.

Another patient of mine dreamed in the initial sessions of being in an out-of-control vehicle careening wildly. Association to the dream led to his idea of being imprisoned in a white van. Again, my last name should suggest his concern. In addition, the white van contained references to radical Islamic activity but was not a workable focus at the time.

This example underscores that a fully elaborated and analyzed dream occurs rarely in a psychotherapy or psychoanalysis and a variety of themes may remain mysterious and unexplored for a long period of time; but that does not diminish what the dream can teach you in the “now” about your patient’s current life and his experience of working with you.

At the risk of being tendentious, I would reiterate that dreams are almost always triggered by and constructed to visually represent some current situation or critical life problem. This underscores the importance of asking when a dream occurred, the so-called “day residue” a simple intervention that is nevertheless frequently overlooked even by experienced clinicians. The night before an exam, the night after sex, the day after a promotion, the night after a break-up or the day after a stormy therapy session will frequently find representation in the dream creation and offer clues to its latent meaning.

We human beings live in ambivalence; to explain why this is so would take us too far afield. But the need to suppress one set of feelings in favor of another is often the cause of significant neurotic misery. Dream analysis frequently demonstrates meanings that contradict so called “official version,” for those of you old enough to remember, the old Soviet “Tass” version. Exploration of dream images often can challenge the prevailing narrative and offer a chance to explore eschewed areas of mentation. To grasp the hidden meaning of a dream, one must be alert to every kind of potential reversal or substitution. Small can be big; high can mean low on multiple levels, action can be reversed between characters, aggression can represent love and the reverse. What this means for you as the listener is that you must resist moral judgment and be comfortable with uncertainty. Any attempt to definitively state THE meaning of any dream should be avoided. As I have said the dream is most closely aligned with childish thinking. To work successfully with dreams is partially surrender to your “child” mind to consider and allow for anything and everything. Popeye is small (as are children); threatened by bully Bluto, he eats the right vegetable that makes him the strongest man in the world. Roadrunner is not eaten by the wolf but gets his eternal revenge by dropping a safe on the plotting evil wolf etc.

I was recently told a dream of a depressed woman who was entering analysis. She dreamt: I was on a submarine and one end was low and the other high and I was on the high side and offered my hand to N [a friend of the patient] who was on the low side.

Here reversals play a large role; the patient felt, in fact, “under water” and, to feel in control, reverses the action, having her help N (or her analyst) rather than the other way around. Note that issues of bravery and interest to explore new subterranean worlds coexist with her fear as she considers a budding trust in the analyst; all are represented in this dream.

Douglas J. Van der Heide, M.D. is a training and supervising psychoanalyst at the Psychoanalytic Association of New York affiliated with New York University Medical Center and a member of the New York Psychoanalytic Institute

Navigation Menu

Part One: Why dreams?

Part Two: A brief history of dreams in EARLY psychoanalytic thinking.

Part Three: Important shifts in the psychoanalytic understanding of the nature of dreams and “dream-thoughts.”

Part Four: How a composite understanding of dreams can be used by therapists in their daily work.

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