The Usefulness of Dream Interpretation in Psychoanalytic Psychotherapy
Some Tips on Working with Patients on Dreams in Psychoanalytic Psychotherapy.
Since recorded time human beings have been fascinated by dreams, and have had some sense they had meaning perhaps prophetic in nature.
This is seen in the Biblical story of Joseph who was called upon by the Egyptian Pharaoh to help him understand a series of dreams that disturbed him. Joseph was able to assist the Pharaoh, (perhaps having a preconscious sense of the Pharaoh’s anxiety), and told him that there would be seven years of abundance, followed by seven years of famine, and they, therefore, were able to come up together to place in storage a portion of the crops during the abundant years. Like Joseph Psychoanalytic Psychotherapists and Psychoanalysts serve to mediate with patients the various aspects of their inner experience to help them understand deeper portions of themselves, their current anxieties, and links to some of the roots of their worries and conflicts.
Freud in his seminal work The Interpretation of Dreams brought the understanding of dreams to the forefront of understanding the human psyche. Based on his analysis of his own dreams and those of his patients he came to see dreams main function as “the guardians of sleep.” By means of the primary process, that is, visual images, the dreamer can express disturbing thoughts and wishes in a disguised form which protects the dreamer from waking up.
The processes involved are displacement, condensation, and symbolization. For example, if the dreamer wanted to express hostility towards a person in his life he might have a dream about a fight with another person, or have a dream about a literary character in a dual. This dream then would protect the relationship with the person in question by disguising the dreamer’s thoughts and prevent aggressive feelings from coming to consciousness (a conscience-driven motive). Or, the dream could be an attempt to contain aggressive feelings so as not to have an actual fight in reality, and thus protect both the dreamer and the person in question (an ego-driven motive).
As the therapist, one could explore in the example above if the patient identified having negative feelings towards a particular person what this meant to him.
In their update of Freud’s theory of unconscious motivation being disguised in dreams Arlow and Brenner in their 1964 book Psychoanalytic Concepts and Structural Theory describe more in detail the inner conflicts that could be manifested in a patients thoughts and dreams.
Others have extended the understanding of the function of dreams as Alan Eisnitz (1987) who indicates that the dream is “the inner eye” of the dreamer, that is, it is a message to the dreamer (and if in
psychotherapy
a message to the psychotherapist) whereby in the relaxed position of sleep the dreamer can express and sometimes work out problems and anxieties. It is a relatively ubiquitous phenomenon that when individuals awaken they can have the solution to a scientific, or social problem, or find something that they feared had been lost, and or identify an issue that is quite problematic for them.
Eisnitz (1987) also proposes that dreams can be a way for an individual to balance the pressures of maintaining sanity. This is illustrated with Hamlet in Shakespeare ’s play. Hamlet a character besieged by many conflicts and trying to come to terms with life’s “slings and arrows of outrageous fortune” says at one point “to die to sleep, perchance to dream-ay there’s the rub for in this sleep of death what dreams may come.” So here Hamlet equates what he anticipates as nothingness of sleep with death, that is non-activity with death or his own struggles with suicidal impulses. One could surmise that in this quotation Hamlet is hoping for inner help or his mind’s eye to restore his mental balance. Traumatic dreams and nightmares can be a magnification of the anxieties of the dreamer, and forewarn the dreamer that dreadful things could occur or have occurred.
In recent years there has been less discussed with reference to dreams and more writing and reporting on the here and now of what is going on between the patient and the psychotherapist. The influence of interpersonal and intersubjective theory, and perhaps some discomfort working with dreams may be factors. Often though dreams can be a rich supplement to the here and now, and help the patient maintain their autonomy from the therapeutic process when needed.
Some Tips on Working with Patients on Dreams in Psychoanalytic Psychotherapy.
1 - Some patients will spontaneously report dreams, others will not. For those who bring dreams to sessions, it is a message to the therapist to help them identify some of the sources of their anxiety. For example, a highly anxious female patient has several dreams of her devoted husband leaving her for other women.
Abandonment and betrayal seem obvious here, but is that the real issue? It is important for the therapist to always ask the patient about their thoughts. No interpretation needs to be given at the initial presentation of a dream. The patient can be told to continue to think about the dream and that she and the therapist can both continue to ponder it and raise some possibilities as to its meaning. If at some point some meaning is reached having the dream can be very convincing to the patient that she is having some particular problem as she is the dreamer.
2 - For patients who may not spontaneously report dreams, and the patient is at a loss as to what to discuss in the treatment session, it is frequently a good time to ask the patient if they have had any recent dreams. If not recent, one could ask them if they remember any dreams from the past. Asking about dreams give patients the idea that there are other sources of information that provides clues as to what is going on inside of them. This can break the inertia or stalemate unless the silence and or repression is severe, and the latter would need to be pointed out or interpreted. For example, when asked a patient has a dream of a family member sitting outside a house, the dream could signify some feelings of being on the outside with others in her life. This could open up a field of inquiry in the treatment process.
3 - If presented dreams are long and complex, and if the patient is utterly perplexed, which can happen, it can be helpful if the therapist takes one of the visual images in the dream and asks the patient if she or he had any thoughts about it. Freud suggests one can ask the patient about the day residue that is thoughts or events in the patient’s recent life that might have contributed to the creation of the dream. These two approaches could open up areas that are on the patient’s mind.
4 - It is best to remember that dreams are the productions of the patient, and it is for them to hold on to. The ultimate meaning or meanings of dreams may occur several years after the psychotherapy has been completed, and can continue to be a useful tool for the patient as he or she continues to meet life’s challenges.
References
Arlow,J., & Brenner, C. (1964), Psychoanalytic Concepts and the Structural Theory, New York: International Universities Press.
Freud, S. (1900) The Interpretation of Dreams. Standard Edition 4,5. London: Hogarth Press.
Einitz, A.J. (1987) The Perspective of Self Representation in Dreams. Monograph Three. The Interpretation of Dreams in Clinical Work. Arnold Rothstein editor. American Psychoanalytic Association, pp. 69-85.
Dr Carol Lachman a psychoanalytically trained psychologist who has been practising psychoanalytic psychotherapy with both adults and children for the past thirty-five years. She has many interests linking psychoanalytic understanding to artistic and literary expression. She has written and presented on Louise Bourgeois, depression, and child development.
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