Dreams in Psychotherapy In an average lifetime, a person spends about six years dreaming. All the images seen over these six years must mean something right? That is the age-old question asked by thousands of people and the focus of many famous psychologists research. In 1900, Freud theorized that dreams could reveal information that was being hidden by our unconscious. Since then, many psychological approaches including the Psychoanalytical, Jungian, Existentialist, Culturalist, and Gestalt approaches have developed to explain the purpose of dreams. Many therapists of various backgrounds can now be found integrating dream work into their method of therapy. Recently, researcher Clara E. Hill has begun to study the benefits of using dreams in a clinical setting. Hill, in addition to many other psychologists, has developed a model of dream interpretation to be used in psychotherapy. While the effectiveness of incorporating dream interpretation in therapy is a highly debated topic, studies have shown that clients often rate all types of dream interpretation as equally effective and overall, more effective than regular therapy ( Dream Interpretation Sessions 57). This statement holds true regardless of the model used, the setting it is used in (single or group therapy), and the gender of the client. The History of Dreams When researching the use of dreams in psychotherapy, several different approaches can be found. There is the Psychoanalytic approach and the Jungian approach, in addition to the Existentialist, Culturalist, and Gestalt approaches just to name a few. While there seems to be an overwhelming number of routes to take when looking at dreams, each theory has something beneficial to offer. Chart 1 on the following page organizes the various theories.
Founders/ Important figures Purpose of dreams Concepts/ vocabulary Tools used in therapy Role of the therapist Dreams in Psychotherapy CHART 1 Psychoanalytic Jungian Existentialist Culturalist Gestalt Freud Jung Adler Bonime Perls Dreams have 2 functions: (1) expression of unacceptable unconscious wishes, often with sexual underlying (2) to protect sleep from being disturbed Dreams serve a compensatory function. They express viewpoints opposite of those expressed consciously. Dreams exist as an extension of waking life experiences. They are not considered separate from the dreamers conscious life. Dreams can help reveal aspects of the dreamers personality. All elements of a dream are extensions of the dreamers personality. Dreams are broken into the latent dream and the manifest dream. The manifest dream is the actual dream as experienced by the dreamer and the latent dream contains the true meaning. Free association the dreamer relates their immediate thoughts and feelings about each aspect of the dream to the therapist. Dreams are a direct expression of the psyche no latent content exists. There are objective dream interpretations relating elements to someone or something in the dreamer s life, and subjective dream interpretations relating elements directly to the dreamer or their personality. Subjective interpretations are emphasized. The content of the dream is related to the dreamer s waking life. Active imagination is also used. The dreamer enters a quiet state, focuses on the dream and recalls as much imagery as possible. Dreams are allowed to unfold without being interpreted and analyzed. A dream is just as real as any waking-life experience. The dream is not interpreted; it is examined as any waking-life event is examined. Emotions are very important to revealing aspects of the dreamers personality. Emotions evoked by the dream and those represented symbolically in the dream are both very important. The dreamers ultimately interpret their own dream. A large emphasis is placed on emotions evoked by the dream. Some elements of the dream are extensions of accepted aspects of the dreamers personality, while other elements are extensions of unwanted aspects of the personality. Through dream work, attempts are made to integrate the unwanted aspects into the dreamers personality. The dreamer retells the dream as if they are reenacting it. They describe the emotions, thoughts, and actions as if they actually were those elements in order to highlight conflicts in the dreamers personality. The therapist plays a crucial role. They offer their interpretation of the dream based on the associations that the dreamer makes. The therapist plays an important role. They look at the context of the dream in the dreamer s waking life and interpret it as it relates to their personality, their life and their culture. The therapist encourages the dreamer to looks at every aspect of the dream and pay attention to emotions in order to relive the dream. The therapist is a helpful guide, not an expert. The dreamer is the only one that can judge the value and meaning of the dream. The therapist encourages the dreamer to reenact the dream and looks for conflicts within their personality rather than offering an interpretation of the dream.
Once several theories explaining the purpose of dreams had been developed, psychologists began putting together models that could be used to interpret clients dreams. Chart 2 on the following page describes a few of these models. Does the Model Matter? One model that many therapists often use as a starting point is C.E. Hill s Cognitive-Experiential Dream Interpretation Model. As described in chart 2, this model consists of three stages and relies heavily on both client and therapist participation. The first stage is exploration, in which the therapist helps the client retell their dream, explore the images and symbolism of the dream, and connect the images to the clients waking life. The second stage is the insight stage. Here the therapist helps the client find meaning in the dream that relates to conflict in their waking life or to past memories. The third and final stage is the action stage, in which the therapist helps the client come up with ways to change his or her lifestyle or behavior based on what they learned from the dream ( Dream interpretation Sessions 56). Several studies have been done to gauge the effectiveness of using this model in therapy, with an overall conclusion that "volunteer clients report higher session quality and gain more insight from dream interpretation than from other forms of talk therapy (Davis 493). One such study conducted by Hill, Diemer, and Heaton found that out of 65 volunteers that partook in a therapy session using C.E. Hill s model, 64 volunteers found some element of the session to be helpful. The most common aspects that were found to be helpful were insight (55% of volunteers), links to waking life (31%), and having
CHART 2 Process used Hall & Van de Castle coding system This process is conducted on a series of dreams from the same dreamer and requires no additional information. The dreams are analyzed to determine the frequency with which certain elements appear. Those elements that appear frequently reveal the dreamers preoccupations and/or interests. Dream Interview Method The therapist pretends to be from another planet where he/she is not an expert and has no preconceived ideas about what dreams mean. In phase 1 the therapist interviews the dreamer trying to get them to develop a description of each major element of the dream. In phase 2 (bridging) the therapist asks questions that make the dreamer see that the dream may be a metaphor for a current situation in their life. The dreamer is then encouraged to make changes in their life based on what they learned from the interview. Cognitive-experiential model There are 3 stages: exploration, insight, & action. In the exploration stage the dreamer describes the dream, reenacts any major emotions related to major elements and provides any associations or triggers in their waking life. In the insight stage the therapist helps the client find a meaning for the dream based on the exploration stage. They can look at the dream in several ways including how it relates to current waking life situations or what it says about their personality. In the action stage possible changes that can be made in the dreamers life are considered. Dream Appreciation approach This approach was designed specifically for group therapy. The dreamer describes a dream to the group and then listens as the group members offer their own associations and reflections as if the dream were their own. This helps broaden the dreamers own reflections. An interactive discussion between all members of the group and the dreamer ends the session. Type of therapist that most commonly utilizes this method Any background is fine since psychological theories don t play a large part in this model. Popular among Gestalt psychologists and some Jungian psychologists Psychologists of any background can use this model. The approach used during the insight stage may vary depending on the psychologists background. Any background can be adapted to this method.
another person s insight and feedback (15%). Furthermore, 56% of the volunteers could not come up with a response when asked what the least helpful element of the session was ( Dream Interpretation Sessions 59-60). Another study conducted by Timothy Davis and Clara. E. Hill also supports the effectiveness of the Hill model. This study evaluated the effectiveness of incorporating spirituality into dream work. While they found that this did increase the effectiveness of dream work in spiritual clients, they also found that increased insight into dreams was achieved without the use of spirituality (Davis 501). These results show that it doesn t matter if Hill s model is elaborated on or used as is, the model is effective more often than not. Dream Work in Group Therapy From looking at the vast amount of research conducted on Hill s dream interpretation model it can be seen that when used in a traditional one-on-one therapy session it is effective in a majority of cases. However, group-therapy is another popular form of treatment. Is dream interpretation helpful in this setting as well? Studies have also been conducted with the hope of answering this question. One study that explored the use of dreams in group therapy dealt with a group of patients suffering from posttraumatic stress disorder. Many of which suffered from recurring dreams or nightmares. The patients were asked to keep a dream journal for a few weeks and then participated in group-therapy sessions that followed the Shuttleworth-Jordan method of dream interpretation. This method is very similar to the Dream Appreciation approach described in chart 2. It began with breathing exercises to relax at the beginning of the session
followed by one patient s description of a dream they had had. The other members of the group then asked questions to clarify the dream, or offered their own associations with the dream. The other patients did not however try to interpret the dream. After each group member and the therapist had offered their comments, a basic interpretation of the dream began to come together (Reeskamp 28). At the end of the study, using dream work in a group therapy setting was found to be beneficial. Patients reported a gain in insight after having other people look at their dreams from a fresh perspective that they were not able to see themselves (Reeskamp 35). This study shows that in addition to the cognitiveexperiential model, the dream appreciation model is also beneficial to patients when used in group settings. The Effects of Gender In addition to research on the use of dreams in group therapy, studies have been conducted on the effectiveness of using dreams in therapy with men. Men were the test subjects in one particular study performed by Rochlen and Hill. This study focused on men particularly because of the differences between a stereotypical man and the ideal client. An ideal client tends to be emotionally expressive, comfortable with ambiguity and vulnerability, and able to ask for help ( Gender Role Conflict 227), all of which defy the typical conventions of masculinity. Men were also chosen as the subjects of this study because previous research by Cowen and Levin has shown that men have lower dream recall and more negative attitudes towards dreams than do women (qtd. in Gender Role Conflict 228). In order to improve the chances of successful therapy sessions with men, Hill s model was used.
This model is structured and it was thought that men who normally conform to the rules of masculinity would be more likely to respond well to a structured form of therapy ( Gender Role Conflict 229). Before conducting this study, Rochlen and Hill reasoned that men with high gender role conflict men that conformed to the rules of masculinity would be less likely to benefit from therapy. They also believed that men with high gender role conflict would reveal this conflict when talking about dreams with a therapist ( Gender Role Conflict 229-230). Despite what seemed like logical reasoning, after conducting the study, it was found that the benefits of dream work were not affected by gender role conflict. In fact, it was found that men rated dream work sessions equally as helpful no matter how high or low their gender role conflict had been rated. Also, whether or not the men had previously shown a positive or negative attitude towards dreams did not affect the session outcome ( Gender Role Conflict 237). This study once again enforces the idea that incorporating dream work into therapy is effective. Dream work is beneficial no matter what model is used and no matter what gender the model is used on. It has been shown by countless studies (Reeskamp, Pesant, Lyon) that in a majority of cases, clients that are exposed to dream work as part of their therapy benefit from such practice. It has also been shown in a study conducted by Halliday that patients that are encouraged by their therapists to remember their dreams and bring them to therapy show higher dream recall (68%) in the next therapy session (qtd. in Client Reactions 217). Similarly, clients that did not discuss dreams in therapy often had a lower rate of dream recall and more negative feelings towards dreams ( Client
Reactions 217). Discussion of dreams in a therapy session, no matter what model this discussion follows, benefits patients in that it encourages higher dream recall in addition to positive feelings towards dreams. The Opponents While there are copious amounts of research showing the benefits of using dream work in therapy, every theory will have its opponents. In this case, Mazzoni et al have conducted a study based on Freud s idea that dreams are a means of hiding traumatic childhood experiences. The study focused more specifically on whether dream interpretation actually helps clients uncover traumatic events or whether the suggestion of traumatic events by a therapist causes clients to inadvertently make up memories from their past. The basic procedure involved asking participants to recall any traumatic experiences that occurred in their lives before the age of three. The participants later took part in a therapy session in which their dreams were analyzed. In each case, the therapist suggested that something in their dream was representative of a traumatic experience early in their lives. They were later asked once again if they had experienced any traumatic events before the age of three. The results of this study revealed that most of the people involved that had not reported a great likelihood of having a traumatic experience before the age of three at the beginning of the experiment, actually reported a greater likelihood of having a traumatic experience after talking to the therapist about their dreams (Mazzoni 48). While this study demonstrates the negative effects that dream interpretation can have on clients, these effects are not common when therapists are
properly trained. In this study, therapists were told to suggest that some element of the dream represented a traumatic experience early in life no matter what the content of the dream happened to be. In real therapy sessions, therapists are not told to make this suggestion. They interpret dreams based on details told to them by the dreamer rather than on instructions given to them by the administrator of an experiment. Therefore, negative effects of this type occur in a minority of cases. In the Future Dream work is currently the focus of much research, but in the future, much more needs to be done. First, further research examining the biological aspects of sleeping may suggest a purpose for dreams that has not yet been explored. Next, further research could be conducted on the relationship between the types of dreams that are examined in therapy and the effectiveness of the therapy. That is, do clients benefit more when a nightmare is interpreted than they do when a more pleasant dream is looked at? Also, focusing on the long-term effects of using dreams in therapy may reveal new benefits. Potential Determining the effectiveness of using dreams in psychotherapy has the potential to greatly impact the world. In 1997, 9.69 million Americans visited mental health professionals to undergo therapy (Goode). With recent research supporting the theory that incorporating dream interpretation into therapy is beneficial to patients, more of those 9.69 million Americans may be able to engage in more successful therapy sessions. Research, specifically numerous studies conducted by Clara E. Hill, has shown that no matter what method is used, dream interpretation provides additional insight for a majority of patients. With such potential success, why do dreams continue to be left by
the bedside rather than brought into therapy? It is up to each and every therapist to be educated in the field of dream work and to be more than willing to put their knowledge into practice. Works Cited Davis, Timothy L., and Clara E. Hill. "Spiritual and Nonspiritual Approaches to Dream Work: Effects on Clients Well-Being." Journal of Counseling & Development 83.4 (2005): 492-503. Academic Search Premier. 23 Oct. 2006 <http://web.ebscohost.com>. Goode, Erica. More Americans Under Psychotherapy Treatment. New York Times 20 Nov. 2002. 28 Nov. 2006 <http://sfgate.com>. Hill, Clara E., and Aaron B. Rochlen. "Gender Role Conflict and the Process and Outcome of Dream Work with Men." Dreaming 15.4 (2205): 227-239. Science Direct. 25 Nov. 2006 <http://www.sciencedirect.com>. Hill, Clara E., and Rachel E. Lyon. "Client Reactions to Working with Dreams in Psychotherapy." Dreaming 14.4 (2004): 207-219. Science Direct. 13 Oct. 2006 <http://www.sciencedirect.com>. Hill, Clara E., Roberta A. Diemer, and Kristin J. Heaton. "Dream Interpretation Sessions: Who Volunteers, Who Benefits, and What Volunteer Clients View as Most and Least Helpful." Journal of Counseling Psychology 44.1 (1997): 53-62. Science Direct. 25 Nov. 2006 <http://www.sciencedirect.com>. Lyon, Rachel E., and Christian L. Wimmer. "Spirituality and Dream Work in Counseling: Clients Experiences." Pastoral Psychology 54.1 (2005): 35-45. Academic Search Premier. 23 Oct. 2006 <http://web.ebscohost.com>. Mazzoni, Giuliana A., Stefano Malvagia, Pasquale Lombardo, and Elizabeth F. Loftus. "Dream Interpretation and False Beliefs." Professional Psychology, Research and Practice 30.1 (1999): 45-50. Social Sciences Full Text. 24 Oct. 2006 <http://www.sciencedirect.com>. Pesant, Nicholas, and Antonio Zadra. "Working with Dreams in Therapy: What Do We Know and What Should We Do?" Clinical Psychology Review 24.5 (2004): 489-512. Science Direct. 13 Oct. 2006 <http://www.sciencedirect.com>. Reeskamp, Herma. "Working with Dreams in a Clinical Setting." American Journal of Psychotherapy 60.1 (2006): 23-36. Academic Search Premier. 24 Oct. 2006 <http://web.ebscohost.com>.