Psychotherapeutic work with dreams

Inhaltsverzeichnis

1. Psychotherapeutic work with dreams

2. The psychoanalytical approach

3. The experiential approach

4. The systemic approach

5. The cognitive-behavioral approach

6. Nightmare therapy

7. Daydreams in psychodynamic psychotherapy

8. Conclusion

9. References

Abstract

Throughout recorded history, dreams have been an appearing mystery. Fields like art, religion, philosophy and many others capitalized on them. In this review paper, I bring close how psychotherapy can draw a profit from dreams. For that, I read a series of scientific papers and books about different approaches to work with dreams. I chose to describe the dreamwork and theories of psychoanalysis, Gestalt therapy, systemic therapy, cognitive-behavioral therapy and psychodynamic psychotherapy. An emphasis is especially put on the different techniques used by therapists and the positive effects of using dreams as a therapeutic tool.

1. Psychotherapeutic work with dreams

Since the beginning of mankind, dreams have been a fascinating and mysterious occurrence. Even for some significant scientists, dreams played an important role in their discoveries. As for the chemist Dmitri Mendeleev, who was working on classifying the elements according to their chemical characteristics in 1869 and “saw in a dream a table where all the elements fell into place as required” (Van de Castle, 1995). After he woke up he wrote his dream down hence creating the periodic system. Mendeleev’s case is not the only one known; reportedly many dreams helped to provide inventions or at least gave them a final touch. Men always tried and still are trying to construct theories of why we dream and what those dreams mean. In ancient times, people believed that dreams were messages transmitted from their gods (Reck, 2010). They gave their dreams a predictive and sacred meaning. Philosophers like Aristoteles and Platon were also involved in dream research but consider that dreams are in fact no prophecies but voices of our conscience. Today we know many scientifically proven facts about dreams. For instance, dreams have been examined on a biological, physiological, chemical and psychiatric level (Thomas, 1972). In neuroscience, it is currently suggested that dreams have the function of reappraising existing emotions toward memorized experiences and that they form new conjunctions in the brain (Adam, 2006). Not only do dreams occur in human beings, but it is also assumed that animals dream, which brings up the question in what way they might be beneficial and necessary. Revonsuo (2000) hypothesizes that dreams simulate threatening events in order to rehearse threat perception and threat avoidance which leads to a better dealing with dangers in waking life and therefore increases the probability of reproduction. Furthermore, it has been discovered that dreams are an accompaniment of rapid eye movement (REM) and changes of EEG waves in the brain (Aserinsky & Kleitman, 1953). The content of dreams varies from dreamer to dreamer but there is a consistent structure that can mostly be seen in every dream. It resembles the structure of a drama composed of four segments: exposition, development of plot, culmination and resolution (Jung, 1970). Dreams do not only process the most relevant daily experiences and encounters, but most importantly they depict an emotional, meaningful, mostly colorful, tense and symbolic situation (Thomas, 1972). They are not only perceived in a visual way but rather all senses are intact in the dream world, while the dreamers body itself is paralyzed. As it can be seen, dreams cover a wide range. They have gained popularity in psychology when Sigmund Freud, the father of psychoanalysis, worked with them in his psychotherapies.

2. The psychoanalytical approach

Sigmund Freud was one of the first therapists, who seriously involved his patient’s dreams in his therapy sessions. In Freud’s (1953) opinion, dreams have mainly two functions. One function is to release psychic tension that grows out of prior repressed wishes from the id. Freud’s idea was that dreams are an expression of these repressed wishes. The other function of dreams is to protect the sleeper from being disturbed. Freud realized that dreams do not happen randomly but can be connected to unprocessed experiences. He figured that a dream is a meaningful reprocessing of central vital questions and a past that has not been managed with yet. Also, he gives dreams a very sexual meaning. With all this knowledge he integrated dreams as analyzable statements in his therapy sessions. He separated the dreams content into two sections: the manifest dream content and the latent dream content. The manifest dream content he described as the actual dream that the patient experiences and reports. The latent dream content is the true meaning of the dream. His therapy work consists of discovering the dreams latent content, since in Freud’s opinion dreams are always dreamt with a censorship that can be deciphered. In order to encourage the dream analysis, Freud used the method of free association. When using free association, the client is asked to filter out the main elements of a dream and then tell the therapist an uncensored description of the thoughts and feelings that arise from each element. Freud interpreted dreams on an object level, which means that the dream elements can be related to situations or persons in the dreamer’s external reality. The therapist plays a consequential role in the dream interpretation; he does not only sit and listen but he offers his patients his own interpretation based on the knowledge he has about his client’s dynamics. For Freud, this kind of work was very useful since the result was the dreams latent content.

Freud’s colleague and friend, the psychoanalyst Carl Gustav Jung, followed Freud’s method in psychotherapy but added several aspects in his dream analyses. In his opinion, a dream is not only interpretable on an object level but also on a subject level (1964). This means that instead of relating the dream elements to the external reality, the components are referred to the dreamer’s psychological life and personality. Likewise, Jung did not agree on Freud’s theory of a censorship that causes a falsification between the manifest and latent dream content. He believed that the dreams elements stand for themselves as symbols and in order to understand one’s dreams, it is required to know the meanings of the symbols that appear. For Jung, “a symbol always stands for something more than its obvious and immediate meaning”, it is an emotional message from the collective unconscious. One of the main statements Jung made about dreams is that they also exist for the purpose of compensation. For instance, people who have a “too high an opinion of themselves, or who make grandiose plans out of proportion to their real capacities, have dreams of flying or falling”. Someone who feels constantly inferior might have dreams that encourage, someone who is bothered by self-doubts lately, might have dreams that strengthen and someone who underestimates someone else might have a dream that criticizes and warns (Adam, 2006). He used his patients dreams in order to spot which waking life events try to be compensated and why. In his therapeutic work the phenomenon of recurrent dreams drew his attention. Jung reports that he had patients that “have dreamed the same dream from childhood into the later years of adult life. A dream of this kind is usually an attempt to compensate for a particular defect in the dreamers attitude to life; or it may date from a traumatic moment that has left behind some specific prejudice.”. As Jungian psychoanalyst Klaus-Uwe Adam (2006) states, dreams can be used as a common theme during psychotherapeutic work. Emergencies are of course to be prioritized, but if there is no urgency, dreams can determine the topic of a session since there is something about them that tries to generate awareness.

3. The experiential approach

The content of the following section is based on the considerations of Alban & Groman (1975), who assumed that dreams are relevant in Gestalt therapy sessions for the reason that they expose the dreamer’s relationship to his external situations, his own organism and to various facets of his personality. Primarily the theory considers that a dream expresses rejected or separated subjects of the dreamer’s self-concept. For Perls (1970) working with dreams is “the royal road to integration”. Other than in psychoanalytical therapy, the therapist neither shares his associations nor does he interpret the dream’s meaning. In Gestalt therapy it is considered that the meaning can only be revealed by the dreamer. “[A dream’s meaning is whatever meaning you give to it]” said Brigitte Holzinger on the TV-show “scobel”, aired on 03-25-2016. The therapist can help his client to understand the metaphoric message of the dream by providing him three directories in which dreams can be viewed in Gestalt therapy. One form of a dream might be the “condensation of reality”. This reality is mostly part of the dreamer’s idealized or abstracted personality. When someone, for example, repeatedly dreams of being a hero, a villain or a gangster it might apply that the dreamer constantly, unknowingly plays out that role in his waking life. Another form is the “reversal of reality”, similar to Jung’s theory of compensation. In this kind of a dream, a situation in reality can be shown reversed, e.g. if the dreamer struggles to get what he desires, his dreams might be about the world being at his feet. The last dream form is the “resistance against reality”, which means that resistances in the waking state express themselves more blatantly in dreams. It can lead to a very enlightening therapy session, when a dream is put in these three forms since it gives the patient a frame. A noticeable aspect is that all three forms concern avoidance. In condensation, the dreamer acts a part avoiding his needs and his being in real life, in reversal the dreamer avoids his inability to win through and in resistance the dreamer avoids to get in touch with certain facets of himself. The enormous difference between analytical and experiential dream work is the proper handling. The goal in Gestalt therapy is that the patient involves himself in the dream situation while the therapist does not interpret but simply asks some questions. The method used is called “empty chair”. In this method the patient sits facing an empty chair. The chair is e.g. used to play the roles appearing in the patients dream. Renate Frühmann (2004) gives a good example of using dreams in her Gestalt therapy work. She introduces a 33-year-old patient, Miriam, who tells her about a dream that frightens her and which she wishes to get rid of: “[Two figures are sitting around a fire in a dark wood glade. Human bones are burning in the fire. I am only a bystander in this dream, I shudder and know it is a woman is burned. She died because of madness.]” In order to elaborate the message of the dream, they use the empty chair technique so that Miriam can start to project her feelings and inner images on it. They first start with the dream. The therapist asks her to express her fright. “[Why are you coming at night, why are you chasing me, I am scared of you, I want you to go away.]” Now, roles are swapped. Miriam answers as the dream:”[You can’t get rid of me because I want to caution you against madness.]” She understands the message and is curious about it. They try to get a deeper understanding of the dream by integrating emotions and imagination. In this next step, Miriam will revive her dream images and explore them. She is asked to close her eyes and imagine herself in the dark wood glade. She shall take a closer look at the unknown figures. Miriam identifies one of the figures as a peaceful, omniscient man who is there to take away the other figure, a mad man, who did not kill out of malice. Miriam says:” [The mad man does not have a shape, he remains untold. I cannot recognize him.]” The therapist asks if the mad man has a message and Miriam answers:” [He mumbles: ‘Do something, do something, do something’.]” At a stroke she is startled and realizes:” [The dead woman is my mother. She died young because of a brain bleeding. She was always under stress and pressure. She had us three children. She was an artist. My father used to encourage (in German “anfeuern”. The word “Feuer”/fire is included) her while not relieving her but demanding more and more. It was madness.]” The therapist suggests to peer at the madness. Miriam emphaticizes with her mother. She talks about her life, how she feels raising three children and being with an inactive husband, who behaves like the fourth child. She cries while expressing her wish to be an artist and says she always wanted to function one-hundred percent, which burned herself out. Back at her seat, Miriam realizes the madness. Further, she realizes that she adapted the same patterns as her mother. She is ready to have children but does not know how to reconcile it with her job and her husband. With the help of the dream work, Miriam realized that her recurrent dream appeared to warn her. She says that she does not want to end like her mother. In order to guide her to a solution process, the therapist asks Miriam to speak for the fire. She says:” [Everything can burn to ashes.]” She remembers that her mother wished for a cremation but got buried instead. Miriam realizes:”[ The point is that I should burn the madness instead of becoming a victim of it. Now I understand what the ‘do something’ means.]” Along with the therapist, she reflects her life and looks at situations where she has to give one-hundred percent. She comes to the conclusion that being one-hundred percent is madness.

This example shows a successful guidance by the therapist. The therapist does not interpret. It is too problematic to differentiate between the therapist’s projections and perceptions but the therapist has the ability to direct. In general, it is said that the patient has a better approach to his created contents so that the main dream analysis should be accomplished by the client. Also, the noninterpretive way allows the patient to unfold at his own pace.

4. The systemic approach

In systemic therapy, a branch of psychotherapy for interpersonal relationships, counting families and couples, mixed techniques of psychoanalysis, Gestalt and psychodrama can be used in therapy sessions (Sanders, 1994). The use of dreams in systemic therapy turns out to be very helpful, considering that they reveal important family dynamics. Dream interpretation is not “done by the therapist alone but by cooperation of all family members.” (Buchholz, 1990). Catherine Mary Sanders (1994) was able to identify different categories of dreams that contribute for one thing an exchange of the family members and for another thing an exchange of patient and therapist. One category, Sanders (1994) calls “dreams that provide hypotheses”. In her therapy work she experienced that some relationships and structures within a family life can be explored and uncovered more easily by using dreams. Questions like “Knowing your daughter as you do, how do you make sense of this dream?” or “What else do you think is your sister afraid of?” promote the therapeutic work with the involvement of family members. Many people feel like dreams are not their fault, they just emerge at night. If a dream is told to a family member, it is told with distance since the images and thoughts were not created consciously. This might be a very useful strategy that helps family members to collect information and, in the best case, allow uncomfortable discernments in an indirect way. Hypotheses that may exist on an unconscious level and lead to certain ways of behavior can be exposed in dreams. Michael B. Buchholz (1990) gives a good example of a dream that occurred in one of his systemic psychoanalytical therapy sessions and revealed the family’s dynamic. Billy, 18-years-old, reported a recurrent dream he had when he was 13-years-old and that now returned again: “I am trying to go up the stairs in our cellar and suddenly a door sort of closes behind me and I am like paralyzed, I can’t go on because a woman is after me, a witch, and she is getting closer and closer. Then I woke up petrified.” It seemed odd to Billy that the dream came back at that moment. It occurred to Buchholz that the topic of the witch was present a session before when the family talked about how Billy’s father got married to his mother, who got declined and reviled as a witch by her mother-in-law. The family seemed to have forgotten about that topic, they did not want to see the connection between the mother and the appeared witch in Billy’s dream. Buchholz asked Billy about what happened when he was thirteen and Billy somehow automatically made a connection to his mother, telling about how she used to enter the unlockable bathroom when he was using the toilet, telling him he does not have to be ashamed by her. He also remembered times when they sat together, drinking tea and reading stories. Sometimes she placed her hands on his thighs in an uncomfortable way for Billy. Billy realized that in these times he would have the same feeling as in the dream, the feeling of being paralyzed and not being allowed to move. The family’s relationship and distribution of roles was brought forward by this dream. Billy’s mother realized she sometimes used her son as a substitute for her husband who did not stimulate her emotionally. The father who sometimes physically abused Billy’s older sister, who then moved out as soon as she was 18-years-old, let Billy do whatever he wanted and never set boundaries. Because of the tensions within the family, Billy often felt followed by his mother. It was normal for him to talk to her about his sexual life but according to Buchholz, Billy was “suffering from an oedipal guilt” (p.391). Sometimes, forgotten events can be remembered and brought up by dreams. “Dreams as memories” is another category by Sanders (1994). Traumatic events that have been rejected or forgotten in order to keep a patient save might occur in dreams. Also, transgenerational topics can be explored through dreamwork (Andrews, Clark & Zinker, 1988).

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