Dreams: Theory and Clinical Practice- Part 4
So how do dreams help the treatment? Nobody talks about “corrective emotional experience” a la Franz Alexander but almost all analysts value as Freud stated, that you cannot kill (or embrace) anyone in effigy. Change requires a new “here and now” experience; exploration of the past by itself remains anthropologic and fundamentally unhelpful.
We know that the bad outcomes and fears of such, that our patients experienced in their initial encounters with the world are automatically triggered and then superimposed on every ostensibly new life event. But if we can all agree that change results from a new experience; given what we know of the mind and the incessant reverberation of transference, how do we actually have one?
Think of the dreams I have just related. Your awareness and exploration of the newest renditions of imagined danger in the treatment situation: prison camp, careening autos, drowning or claustrophobia, helps to reassure your patient and constitutes, via the privileging his emotional life, the beginning of the establishment of what many have called “basic trust.”
Contemporary analysts highlight a renewed and revitalized faith in the benign and loving interest of the therapist as the core fruit of analytic or dynamic work and credit the exploration of early fantasies of danger or psychic pain in this new trusting setting as key to restarting one’s emotional life.
How to work with dreams
1. Ask for dreams.
2. Consider the day residue and current life situation.
3. Ask the patient for his thoughts.
4. Consider your emotional reaction to the retold dream.
5. Focus on one or two striking dream elements. Have some notion of what you want to determine.
7. Admit when you are flummoxed.
The preceding parts of this series have already indirectly offered you some methods to use when hearing a dream. In this fourth and last part I do not intend to provide a cook book set of instructions to you all but there are a few “do’s and don’ts” that can be helpful, and I will review them here.
The first and perhaps most important suggestion is to find a way to ask about your patient’s dreams. One way I start is to say something like: you are here to change “x” or” y.” We are using “a” and “b” techniques to accomplish these goals. However, we know that these symptoms, habits, repeated relationships have deep roots and efforts to change or alter them, can stir up powerful feelings. While undergoing this treatment, it is possible you may have a dream related to the work we are doing. I would be interested if you have any and would encourage you to recount them to me. Dreams are important and can often shed light on matters that may affect the course of your treatment here.
Such a statement is often enough for the patient to remember a dream immediately or perhaps have one occur before the next meeting.
So, let’s say the patient reports a dream. Let us take the scenario of a dream of an indifferent character, no particular storyline and little feeling tone to guide the way. In such a case, after asking the patient for his or her ideas about the dream, it is especially important to consider asking a few general questions which might cast light on the images: 1. What day or night did the dream occur? 2. On that day did anything happen that might be related to the dream images? 3. Is there something weighing on your mind right now or anticipated in the immediate future? 4. Can you think of any reason why you might have had this dream at this time?
One other question you can ask yourself is how the dream images might be representative of you and your patient in your work together.
Once a patient recounts a dream, you might consider asking if that was the whole dream. Often patients may wake and break off one dream to begin another; as you might by now expect via psychic determinism, the second dream is most often a furtherance of the first dream thought. In my experience, patients may offer only the dream which seems most coherent, keeping the more confused but more revealing “second dream” to themselves unless asked.
While listening to a dream, it is important to allow yourself to be immersed in it. What do the images provoke in you? Do you have an emotional reaction to the dream? When you do have a strong reaction to the manifest content of the dream, that would be the most important thing to comment on AFTER asking for the patient’s feelings and ideas, and BEFORE exploring other interesting aspects or dream images.
For instance: one of my patients reported in her first dream that she was being penetrated genitally with knives and scissors.
Contrast that to another patient of mine who dreamt that she was at some beach and various people were around. She wasn’t sure what was happening, but she noticed a “beautiful blue beach ball.”
You probably didn’t have much of a reaction to the second dream; probably a great deal to the first.
When a dream causes you to feel suffused with feeling, it is important to reflect your experience even when it is entirely unclear if the emotion manifest in the dream is the “real” feeling tone or is even shared by your patient. I said to the first patient: “That seems like one scary dream! How does this come to mind?” I would ignore for the moment but not forget the possibility that what is presented as horrific, might also represent an activity of desire.
As a further aside, pay attention to the words used in the reporting of a dream. Note the phrase “knives and scissors” which at least strikes my ear as “odd” even “quaint.” Scissors are prominent in fairy tales like Snow White and vaguely hint at a genetic or historical significance … in other words, perhaps the phrase is an allusion to a fantasy or distorted memory generated early in life.
In the second instance of the “beach dream,” I would ask my generic questions and then, if nothing of substance is found, I would attempt to break down the dream into its component elements.
Remember the dreaming mind does not deal in the generic. You can be certain that an unadorned “beach” has been scrubbed clean by defense. So, we need to ask about it.
To borrow an example from Ella Freeman Sharpe, who authored one of the suggested books: Dream Analysis, her patient said: “I dreamt of a pirate.” The needed query is “Which pirate?” If the answer is Captain Hook, then all sorts of allusions to little boys with spectacular erotic capacities: meaning ones who can fly, who fight with older men and who worry about bodily injury and castration come immediately to mind.
The beach dream contains an object that is clearly overdetermined. I am referring to the “beautiful blue beach ball” which is striking for its alliteration, its stark color and shape. This form of dream emphasis should offer certainty that there is something of moment about it. Questions about why beautiful, why that color, why a beach ball and the elucidated memories and associations would likely be illuminating.
Do not be uneasy if the ensuing discussion seems to veer away from the dream itself; the related, unearthed issues will continue to be elaborated in your patient’s mind and may emerge at some later juncture overtly or perhaps in another dream.
I cannot provide an encyclopedia on dream interpretation, but I would emphasize in these closing statements that the dream is almost always useful as a self-image.
As you may know, in the termination phase of any analysis there is a temporary but often disturbing and unsettling upsurge of the original symptoms. This has a great deal to do with leaving you and can be understood as a repetition of leaving the original loved objects. Patients who have improved vastly as a result of treatment have a tendency, on the one hand, to present themselves as super healthy in order to feel adult and ready to take charge of their lives or on the other, to exaggerate their difficulties in order to demand further care and to postpone indefinitely the pain of saying good-bye. As a result, it can be difficult to know when to terminate. To return to my self-cutting depressed patient who did so well, I will now relate a dream she had in the closing days of her ten-year analysis.
“I had another dream last night. I was with my cousin C. He’s my Scandinavian cousin. We were going to take a hang glider trip and we were on the top of the mountain. And we jump off! And the assumption is that it’s just going to know where it needs to go sort of automatically and suddenly I realize that that wasn’t true, and I didn’t know how to fly it. So, I said to C: “Okay you fly it.” And he said, “I don’t know anything about this.” I looked to see that we were headed for a forest and we needed to do something. I mean if we landed in a forest you know maybe we would be injured or anyway, somewhere far away and would be lost. Somehow, I maneuver it to land in a safe unforested area.
These are the patient’s spontaneous thoughts on the dream: My first thought is that C reminded me of X, (a male family member). Then I thought maybe it was you. I mean they’re both about your height. They are both fair slim and tall. At first, I thought it was sort of a positive dream. I mean there I was taking control of a hang-glider, but you know, then it’s kind of negative I may get us out of harm’s way but far from town or village but maybe it’s not a positive picture anyway. I had an anxiety that bad things would happen as I was flying.”
One dream, like the saying about a picture, can indeed tell the whole story. I don’t need to tell you anything more about her dream beyond that she and a tall blonde thin man, maybe her cousin, go hang gliding and jump off a mountain. Initially she is frightened when she realizes she must fly it and might lose control but finally she deals with having to fly it on her own and lands it safely.
In her associations, my patient tries to emphasize her anxiety and indirectly asserts that she is not ready to fly on her own, but the dream image of successfully hang gliding and the implied exhilaration associated with these images, made me confident of her capacity to go forward without me.
Of course, in the sessions there were other clues as to her enlarged emotional capacities, but in the vividness of the dreamscape we see her new self-image. This is a person who feels a new inclination to challenge herself to do thrilling and dangerous (and sexy) things, and who, while scared of the future and a potential crash, is ready to take on the challenge while feeling herself capable of landing safely.
Judicious use of the dream depends sometimes upon an appreciation of the task at hand. I was focused on ascertaining my patient’s internal emotional competence, but the dream image equally represents a regressive and very meaningful wish that she could make me a member of her family and then we would never have to part.
So, in summary why dreams?
To my mind dreams are important because, in the most vibrant, alive and creative way, they are our true “soul.” They are the repository of our most human of selves: our unadorned hopes, fears, and desires. They are essential to mental health. In their disguised form, they represent a vital internal conversation with us and the internalized parental figure who loves us most about those issues at the center of our lives.
I hope this talk/paper may help you feel a greater measure of comfort and skill in using them clinically for they have a great deal of value to offer. Every dream sheds light on how your patient feels about his treatment, his life history and symptoms, about significant others and especially about you and the care you offer. Even if you don’t plan to mine dreams for historical details, a discussion of dream life energizes and animates the therapeutic interaction in the most remarkable way.
Like any other discipline, or perhaps like learning a foreign language, it takes time to learn and to feel one’s way into dream work. Here we are all students; there is no need or place for dogmatic interpretation or understanding.
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.
Photo by Jr Korpa on Unsplash
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