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The dream: A psychodynamically informative instru ment
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J Psychother Pract Res, 10:4, Fall 2001 223The Dream
A Psychodynamically Informative Instrument
Myron L. Glucksman, M.D.
Received March 8, 2001; revised June 24, 2001; accepted July 3, 2001.
From the Psychoanalytic Institute and the Department of Psychiatryand Behavioral Sciences, New Y ork Medical College, Valhalla, NewY ork. Address correspondence to Dr. Glucksman, 68 Marchant Road,West Redding, CT 06896.
Copyright /H170152001 American Psychiatric AssociationThe dream is a unique psychodynamically informative
instrument for evaluating the subjective correlates ofbrain activity during REM sleep. These includefeelings, percepts, memories, wishes, fantasies, impulses,conflicts, and defenses, as well as images of self andothers. Dream analysis can be used in a variety ofclinical settings to assist in diagnostic assessment,psychodynamic formulation, evaluation of clinicalchange, and the management of medically ill patients.Dreams may serve as the initial indicators oftransference, resistance, impending crisis, acting-out,conflict resolution, and decision-making. A clinicallyfunctional categorization of dreams can facilitate anunderstanding of psychopathology, psychodynamics,personality structure, and various components of thepsychotherapeutic process. Examples of different types ofdreams are provided to illustrate their relevance anduse in various clinical situations.
(The Journal of Psychotherapy Practice and
Research 2001; 10:223–230)Unique among the medical and psychiatric treat-
ment modalities, psychoanalysis and psychody-
namically oriented psychotherapy do not make use of
laboratory tests or measuring devices for diagnostic pur-
poses. During the period described as the “decade ofthe brain,”
1psychiatry began utilizing neuroimaging
techniques and neuroendocrine measurements that
have provided us with relevant information about brain
functioning. Nevertheless, as exciting and informativeas these neurobiological tests are, they remain within
the realm of objective biological measurements of brain
function and activity. As technologically sophisticated
as we have become, we still lack a reliable measurement
of self-experience; that is, a diagnostic instrument de-signed to assess the subjective correlates of brain activ-
ity, both conscious and unconscious. These correlates
include feelings, percepts, memories, wishes, fantasies,
conflicts, impulses, and defenses, as well as images of
self and others.
Y et there does exist a time-tested psychodynami-
cally informative instrument that I believe is as quali-tatively reliable as any current psychometric evaluation,PET scan, or neurotransmitter measurement. I am re-
ferring to the dream, a singularly subjective mental ex-
perience that Freud
2began investigating over a century
ago in order to understand unconscious mentation.

TheDream
224 J Psychother Pract Res, 10:4, Fall 2001During the one hundred years since Freud pub-
lished his original hypothesis, our understanding of thefunction of dreaming has changed significantly. Freudbelieved that the dream was a mental phenomenon de-signed to censor biological impulses and unconsciouswishes in order to preserve sleep. Subsequent to Freud’sobservations, a multitude of sleep laboratory and clini-cal studies have suggested that the dream and/or REMsleep is an inborn biological phenomenon designed tofacilitate memory processing, problem-solving, moodregulation, and psychological adaptability.
3–12
Neurophysiological studies indicate that dreaming
occurs when the brain is activated during REMsleep.
11,13,14This consists of excitation of forebrain cir-
cuits due to activation of the pontine and midbrain re-ticular activating systems. In addition, there is selectiveactivation of occipital, parietal, and limbic regions alongwith excitation of cholinergic neurons and inhibition ofnoradrenergic as well as serotonergic neurons.
Reiser
4observes that current and past conflicts or
problems, derived from memory, are reflected in dreamimages and are connected by similar affects. A numberof investigators emphasize the adaptational, learning,and problem-solving functions of dreaming.
5–10Kou-
lack5points out that stressful experiences are incorpo-
rated into dream content in order to promote mastery.Greenberg and Pearlman’s
9,10research suggests that the
manifest dream represents the dreamer’s attempt tocope with meaningful issues and problems. Palombo
15
views REM sleep or dreaming as a vehicle for matchingand storing recent memories with those from the pastfor the purpose of integration and adaptability. Kra-mer’s
12experiments indicate that dream content is
linked to waking, pre-sleep emotional concerns and ispredictive of the mood of the dreamer on the subse-quent morning. A “successful” night’s dreaming is theresult of progressive-sequential emotional problem-solving throughout the night.
Although some argue that dream imagery is ran-
dom and devoid of meaning,
11,13,14the majority of in-
vestigators believe that dream content subservesimportant psychodynamic functions. Whereas Freud
2
concentrated his efforts on discovering the latent mean-ing and hidden impulses or wishes underlying thedream, contemporary analysts focus more on the man-ifest imagery and the metaphorical meanings containedwithin it.
16,17T o be sure, dream imagery often reflects
impulses and wishes, as Freud observed, but it also con-veys a spectrum of emotions, past experience, recentevents, defensive operations, perceptions of self and
others, conflicts, problems, and attempts at their reso-lution.
The time-honored approach to understanding the
meaning of dreams has been through the use of freeassociation, usually during therapy sessions. This re-mains the most productive method of comprehendingthe dreams of patients. However, in the current practiceclimate of managed care, with emphasis on time-limitedtherapy and psychopharmacologic intervention, we of-ten do not have the leisure of analyzing our patients’free associations in the absence of a time constraint.Moreover, an increasing number of psychodynamicallyoriented psychiatrists work in diverse clinical settings,including emergency departments, inpatient units, out-patient clinics, consultation-liaison services, and partial-hospitalization programs. As a consequence, cliniciansare often required to evaluate and diagnose patientsover a briefer time span than previously allowed.
Although careful history-taking and assessment of
mental status remain the foundations of clinical evalu-ation, dream material may provide additional infor-mation and insight into the patient’s psychodynamicand diagnostic status. For example, dreams may serveas early warning signals of suicidality, homicidality,ego-disintegration, psychosis, and impending acting-outbehavior. Manifest and latent content may lead towarda particular diagnosis when conscious symptoms andbehavior seem confusing or ambiguous. The presenceof an affective disorder or emotional dysfunction mayinitially be manifested in dream material. Medically illpatients can be managed and treated in a more in-formed way through an understanding of the hopes,fears, and beliefs connected to their illnesses as reflectedin dream imagery. For psychiatrists who work in out-patient and inpatient settings, dream material may in-dicate clinical improvement or regression. Transferencereactions are sometimes initially presented in dreamsprior to their conscious expression. Likewise, counter-transference may first become evident in the dreams ofthe therapist, informing him or her of unrecognizedfeelings and attitudes toward the patient. The salientpsychodynamics underlying therapeutic impasses andpersistent resistance may also be reflected in dream ma-terial. Often, the initial indication of a significant deci-sion, change toward healthier behavior, or readiness toterminate treatment may be signaled in dreams. In ad-dition, conflict resolution and solutions to problems arefrequently previewed in dreams. Thus, dreams provide

Glucksman
J Psychother Pract Res, 10:4, Fall 2001 225useful information throughout the entire spectrum of
clinical activity. In a broad sense, the dream can beviewed as a psychodynamically and psychodiagnosti-cally informative instrument.
In order to be more rapidly understood, dreams
require an active process of free association on the partof both patient and therapist. This entails a collaborativeeffort whereby therapist and patient work cooperativelyin arriving at a mutual understanding of the dream. Thisapproach contrasts somewhat with the classical model,where the patient free-associates while the analyst usu-ally listens passively, and subsequently interprets thedream.
In the free association model I am describing, the
therapist uses the patient’s associations, as well as his orher own associations and knowledge of the patient, inorder to intervene more actively with questions, obser-vations, and trial interpretations. In my experience, pa-tients can be oriented to this process rather quickly,provided that they possess some measure of intelli-gence, imagination, and psychological-mindedness. Ifthe dream is experienced by the patient as his or herown unique creation that can be understood by meansof an active dialogue, its meaning usually has greaterimpact than if it is viewed as a mysterious occurrenceto be analyzed by an outside observer. Moreover, thepatient’s active participation in the process of under-standing the dream empowers him or her to makechoices, change behavior, or take action based on thedream’s meaning. This can be particularly helpful insettings where contact with the patient is brief in dura-tion (e.g., consultations). Likewise, information fromdreams can help the clinician formulate opinions andarrive at decisions in a more expedient fashion (e.g.,pharmacological intervention, hospitalization). Becausethe patient is an active collaborator in this endeavor,there is a greater likelihood of compliance regardingdecisions growing out of dream analysis (e.g., beginningmedication).
From a psychodynamically functional viewpoint,
dreams can be classified according to the followingtypes:
1. Presenting conflict-issue.
2. Impending crisis.3. Psychodynamic-diagnostic.4. Affective state.5. Self-representational.6. Relational-transferential.7. Resistant-defensive.
8. Problem-solving, decision-making.
These categories are constructed arbitrarily, but I
find that they can be useful from a functional and clini-cal point of view. Recognizing that one or more of theseelements is present in every dream, I nevertheless haveobserved that a central psychodynamic theme or func-tion is often embedded in each dream. In effect, thisclassification can provide the clinician with a frameworkaimed at organizing the data from dreams that is rele-vant to the various components of the psychotherapeu-tic process. The following examples illustrate thesedifferent types of dreams and their application in theclinical setting.
CASE EXAMPLES
1. Presenting Conflict-Issue: A 40-year-old married
woman entered treatment with feelings of anxiety and inad-equacy, especially at work and in social situations. She wasobsessed with her physical appearance and worried that herhusband might have an affair. She reported the followingdream in her first therapy session: “I was at a concert wherea woman conductor was leading an all-female chorus. Myhusband was in the audience and I looked for his secretaryin the chorus. Then I realized the conductor was myself.”With little encouragement, the patient talked about her in-terest in music and singing. However, her older sister wasmore talented musically and obtained better grades inschool. Her father often commented that the patient had“the looks” in the family, but that her sister had “thebrains.” Throughout her childhood and as an adult, shecompeted with her sister for her father’s attention and com-pliments. At work and in social gatherings, she constantlycompared herself with other women in regard to her intelli-gence and attractiveness. She was particularly threatened byher husband’s relationships with other women, especially hissecretary. By the end of the session, the patient more fullyappreciated her excessive need to dominate and competewith other women, especially in the presence of men.
2. Impending Crisis: A 35-year-old married woman was in
treatment for recurrent depression, self-mutilating behavior(cutting her arms), and several suicide attempts. A majorpsychodynamic theme was her need for self-punishment be-cause of her past history of promiscuous behavior and multi-ple abortions. She often experienced terrifying feelings ofaloneness and inner emptiness. Over the course of severalsessions, she reported the following recurrent dream: “I’min an ocean with giant waves, and I’m trying to cling tosome rocks. I see you in a rowboat with your hand out-stretched, but I cannot grab hold of it and you cannot reachme. My hands keep slipping off the rocks and I’m afraid I’ll

The Dream
226 J Psychother Pract Res, 10:4, Fall 2001let go and drown.” Each time the patient had this dream,
the waves grew larger and her hold on the rocks becamemore tenuous. She associated the power and intensity of thewaves to her suicidal impulses and the rage she felt towardherself. Her loosening grasp of the rocks was connected toher diminishing capacity to control her suicidal impulses.Finding herself alone in the ocean and lacking the strengthto save herself reminded her of her sense of inner alonenessand emotional fragility. Although she believed I was tryingto help her, nothing I said or did seemed to be effective. Ifinally hospitalized her when she could no longer hold ontothe rocks in the last dream of this particular sequence.
3. Psychodynamic-Diagnostic: A 30-year-old single man
was referred by his family physician with a history of tachy-cardia, palpitations, and atypical pain in his left arm andprecordium. A complete physical workup, including a car-diac evaluation, was normal. In his first session, he reportedthe following repetitive dream: “I’ve killed somebody, butnobody knows I did it. I feel very guilty and am afraid ofbeing found out.” The patient had recently joined his fa-ther’s professional firm with the understanding that hewould eventually take it over. However, his father had apartner, and the patient had been concerned about the part-ner’s feelings regarding his entering the firm. Approximatelysix months prior to his joining them, the partner had a sud-den heart attack and died. In discussing his feelings aboutthe partner’s death, the patient revealed that he had har-bored conscious death wishes toward the partner as a solu-tion to the problem. Soon after the partner died, the patientdeveloped his somatic symptoms and became convincedthat he had a heart problem and might die. Over the courseof succeeding sessions, we became aware of the connectionbetween the patient’s guilt over his homicidal fantasies andhis fear of retribution in the form of a heart attack. His car-diac symptoms were clearly a somatization of this conflict.The diagnosis of an anxiety disorder with conversion fea-tures appeared validated by the psychodynamic factors thatemerged from the dream content.
4. Affective State: A 40-year-old married woman was at-
tempting to cope with various stressors, including her 9-year-old daughter’s brain tumor, a difficult supervisor atwork, and her husband’s lack of emotional sensitivity. Shereported the following dream: “I was swimming up a hill ofwater, and it was very icy. My daughter was swimming withme, but she slipped under the water and I couldn’t find her.I finally reached her and pulled her up. I was terrified.” Thepatient associated to the terror she felt in connection withher daughter’s brain tumor. It had been successfully re-moved, but she knew the possibility of a recurrence existed.Her daughter was scheduled to have a follow-up MRI, andthe patient was terrified that evidence of a recurrence wouldbe found. She felt her life was an uphill battle in which shewas struggling with her daughter’s illness, her husband’semotional remoteness, and her supervisor’s lack of support.The icy water reminded her of the emotional coldness sheexperienced with her husband and her supervisor. It also
conveyed her inner sense of extreme isolation and loneli-ness.
5. Self-Representational: A 38-year-old married woman
was suffering from the complications of radiation treatmentfor a malignancy. Although her malignancy was in remis-sion, she felt despondent because the side effects of the radi-ation (pain, nausea, fatigue) were unrelenting. She believedthat she was going to die prematurely, and worried aboutthe well-being of her husband and children after her death.She reported the following dream: “I was in the hospital dy-ing of metastatic disease. A lot of my friends were there andthey were very upset, but I wasn’t. I kept telling them aboutwhat’s meaningful in life
—things like love and peace. My
doctor came in and I asked him to take my hand and staywith me until I died. He did, and I knew I was going to die,but I felt content and at peace.” The patient was hoping thatshe would die in order to avoid living with the complica-tions of the radiation. She was in constant fear of developingrecurrent disease and felt that no one could understandwhat she was experiencing. At the time of this dream, shehad made up her mind to kill herself. The fact that I was theonly person to whom she could entrust these thoughts andfeelings made her feel more comfortable and reconciled toher impending death. In this sense, the dream reflected herpositive transference and a trusting therapeutic relationship.
6. Relational-Transferential: A 43-year-old married man
was in treatment for inability to control his anger. He had ahistory of alienating friends, family members, and colleaguesat work. He viewed himself as ineffective and a failure in hiscareer. His father was extremely critical and demeaning ofhim during his childhood, and the patient felt that he nei-ther loved nor cared about him. During therapy, the patientbecame increasingly insistent that I cure him of his angerand feelings of inadequacy. He related the following dream:“I went to my friend Mike’s office to ask him for help. Ilooked out the window and saw a man get into my car anddrive it around until he smashed into a wall. I ran out andasked him what he was doing. He replied that he was tryingto park the car and it wasn’t his fault. I returned to Mike’soffice, but he was gone.” The patient felt that the car repre-sented his life
—emotionally abused by his father and littered
with wrecked relationships as well as career failures. Smash-ing up the car reminded him of the uncontrollable ragesthat played a significant role in the rupture of past relation-ships. His friend’s disappearance, as well as the man whosmashed up the car and refused to take blame, reflectedboth his father and myself. He felt that I was unconcernedand uncommitted in the effort to understand and control hisanger. Moreover, he believed that I was dishonest and disin-genuous in my statements and actions. Not surprisingly, thepatient left treatment soon after having this dream.
7. Resistant-Defensive: A 28-year-old single man entered

Glucksman
J Psychother Pract Res, 10:4, Fall 2001 227treatment with a history of poor motivation, procrastination,
and self-sabotaging behavior. Although he was extremely in-telligent and held an advanced degree, his career was at astandstill and he felt paralyzed in his attempts to change it.Despite our discovery of some of the sources of his self-de-structive behavior, he remained at a therapeutic impasse.Approximately two years into treatment, he told me the fol-lowing dream: “I hired someone to kill me for $7,000. Iknew that I could call off my own murder at any time, butthen I would lose my money. I finally called it off and lostmy money.”
The dream occurred just before the patient’s 30th birth-
day. He had resolved to make a significant change in his lifeby the time he was 30. The $7,000 was the amount ofmoney he had paid me over the prior two years. Essentially,he had hired me to “kill off” the part of himself that wasself-defeating, but he resented paying for it. Over the courseof the previous two years he had failed to change, and hefelt that he had wasted his money. On the other hand, mur-dering himself symbolized his self-destructive behavior thathe hoped to change through therapy.
8. Problem-Solving, Decision-Making: A 39-year-old di-
vorced woman was in treatment for depression, bulimia,and obesity. She was an executive in a corporation that wasdownsizing, and her responsibilities kept increasing as hercolleagues were leaving. She was also in a relationship withan older married man. He provided her with emotional sup-port, but the time they spent together was limited, which re-sulted in the patient feeling unfulfilled and dissatisfied. Inthis context, she reported the following dream: “I was on abus in California that was traveling eastward. I knew I wasgoing in the wrong direction but felt helpless, and that mydestiny was out of my control. Somehow, I got off, rented acar, and headed west.” The patient associated the busload ofpeople to fellow employees who were taking early retire-ment, including her boyfriend. She was unable to do like-wise because she had to raise and support her young son.She also realized that her relationship was unsatisfactory,and deliberated over accepting a date with another singleman who had expressed an interest in her. She had lived inCalifornia following her divorce, and recalled it as a timewhen she felt happy and independent. In addition, she wasgaining weight and knew that she had to begin dieting in amore serious way. Shortly after having this dream, the pa-tient broke up with her boyfriend and began a relationshipwith the other man. She remained at her job and began los-ing weight.
DISCUSSION
These clinical vignettes illustrate how dreams can fa-
cilitate an understanding of various aspects of our workwith patients. Similar to other diagnostic and projectivetests, they can be extremely informative if used judi-ciously in the context of the entire clinical situation. In
Example 1, the patient’s dream highlighted her centralconflict and led us to a significant etiological componentof it (e.g., sibling rivalry). This was the first dream shereported, and in addition to shedding light on the de-terminants of her conflict, it also revealed some of thedefensive maneuvers she employed (attention-seeking,controlling behavior). This dream, like many other firstor initial dreams reported in therapy, was instrumentalin paving the way to an understanding of the patient’scentral conflict, defenses, self-representation, and inter-personal relationships.
18
The dream in Example 2 dramatically portrayed
the progressive self-disintegration of the patient andclearly signaled her impending suicide. The manifestcontent provided a metaphorical presentation of the pa-tient’s losing struggle against her self-directed rage andinner helplessness. The vivid portrayal of the patient’sfeelings and her self-perception in the manifest contentdemonstrate that manifest imagery is not always a cen-sorship process requiring laborious deciphering. In thiscase, it presented as a thinly disguised pictorial se-quence requiring translation into a meaningful story.The nature of the transference was also reflected ingraphic, undisguised imagery (i.e., my helpfulness wasineffectual).
The dream in Example 3 communicated the pa-
tient’s central psychodynamic conflict, subsequentlyleading to a definitive diagnosis. Frequently, dreamsmetaphorically portray a patient’s physical or psychi-atric illness. For example, an 83-year-old man dreamedthat he was planning a trip. However, he was unable tofind his belongings that were to be packed, and thenlost his way while driving. He awakened feeling con-fused, lost, and frustrated. The patient was originallyreferred for repetitive nightmares and declining mem-ory. An MRI and psychometric testing revealed de-mentia secondary to multi-infarct disease. Anotherpatient, a middle-aged woman with vague, puzzling so-matic symptoms, dreamed that she was walking up asteep hill with great difficulty. This dream helped to es-tablish a diagnosis of major depression. According toFiss,
19dreams are sensitive to subliminal physical stim-
uli and may serve as early detectors of somatic illness.Freud
2made the same observation when he noted that
“disorders of the internal organs obviously act as insti-gators of dreams.” (p. 34).
The dream in Example 4 reflected how feelings are
manifested both overtly and symbolically in dream con-

The Dream
228 J Psychother Pract Res, 10:4, Fall 2001tent. The affective component of dreams is of major
importance because the patient is not always con-sciously aware of feelings. Kramer’s
12selective mood-
regulatory theory of dreaming suggests that animportant function of dreaming is to contain the affec-tive surge that occurs during REM sleep. According toKramer, if the dream is successful in processing theemotional concerns of the dreamer, the latter has nomemory for dreaming. Partially successful or unsuc-cessful processing of emotions leads to disturbingdreams or nightmares. Moreover, the mood of thedreamer on the following morning is connected to thesuccessful or unsuccessful processing of emotions dur-ing the night. Bonime
20observes that feelings in dreams
are either experiential or symbolic. In Example 4, thepatient experienced terror directly in her dream. How-ever, her feelings of emotional isolation and lonelinesswere represented symbolically by the icy water. Al-though Freud
2believed that affect was generally sup-
pressed in dreams by means of the dreamwork, he alsoobserved that intense affect may be directly expressedin dreams. Lack of feeling in dreams is an equally im-portant finding and may indicate repressive or dissoci-ative defenses as well as alexithymia. Exploration of thepresence, absence, and quality of feelings in dreamsmay lead to a wealth of information about the patient’sdiagnosis, dynamics, sense of self, and defensive style.
The dream in Example 5 validated the patient’s
conscious communications about her self-experience.In addition, it alerted us regarding her impending de-cision to commit suicide. This patient viewed herself asirreversibly damaged and on a trajectory toward anearly death. Although she reported conscious feelingsof fear and hopelessness, the mood in her dream wasone of contentment. Her sense of resolve about dyingwas an important clue to her suicidal intent. The dreamalso indicated a strong element of trust in the transfer-ence. This was validated by the patient’s assertion thatI was the only person with whom she felt comfortableenough to share her feelings. Self-representational orself-state dreams reflect various aspects of a patient’sself-function, including body image, physical attributes,character traits, feelings, values, hopes, and ideals.
21
Similar to this patient’s dream, they may also includetransferential, conflictual, and problem-solving ele-ments.
The dream in Example 6 had been preceded by
several weeks of complaints by the patient that his pro-gress was too slow. Others, including his wife, experi-enced him as angry, critical, and intimidating. From the
patient’s perspective, the men in the dream displayedqualities of his father and myself, indicating the trans-ferential aspects of the dream. His father was critical andinsensitive and had emotionally abandoned the patient.He felt that I was indifferent, untrustworthy, and notcompetent enough to help him. The dream also re-flected the patient’s projected feelings of rage, helpless-ness, and abrogation of responsibility. Transferencedreams often occur well before a patient consciouslyexpresses either positive or negative feelings toward thetherapist. Not only can they make the therapist awareof unspoken attitudes and feelings, but they can alsoserve as dramatic illustrations for the patient of distortedperceptions of others.
The patient in Example 7 resisted change by means
of avoidance, procrastination, and indecisiveness. Hewas unwilling to take risks in his career and relation-ships, fearing rejection or failure. The extent to whichhe engaged in self-sabotaging behavior was character-ized in the dream by his willingness to lose $7,000 inorder to avoid change. The patient also had a repetitivedream in which he found himself in a plane taxiingdown the runway but unable to take off. We often usedthe imagery in these dreams as our private code or ref-erence to instances of his self-destructive behavior. Ifind that such references to dream imagery can be help-ful in promoting a patient’s awareness of specific char-acter traits, conflicts, and defenses. For example, wefrequently referred to the image of the plane sitting onthe runway and unable to take off whenever the patientengaged in self-paralyzing behavior. For him, self-de-feating thinking and behavior were often synonymouswith resistance. As an example, he continuously de-layed writing an article for publication and kept forget-ting to show it to me as he had promised.
Example 8 demonstrates the problem-solving func-
tion of dreaming. The bus heading in the wrong direc-tion symbolized the major issues with which the patientwas struggling, including the demands of her job andher unfulfilling relationship. However, she was able toovercome her helplessness, make a decision, and takeaction (getting off the bus and renting a car in order totravel in the right direction). Greenberg and Pearlman’sstudies, in particular, have suggested that dreams facili-tate learning and problem-solving.
9,10Palombo15ob-
served that dreaming provides an opportunity to storerecent memories by matching them with past memoriesas part of a problem-solving, adaptive process. In this

Glucksman
J Psychother Pract Res, 10:4, Fall 2001 229dream, the patient’s current feelings of conflict and
helplessness were juxtaposed with her sense of effec-tiveness and independence when she lived in Califor-nia. The solution to her dilemma in the dream waspredictive of her subsequent decisions regarding herjob, boyfriend, and diet. Decision-making dreams canbe informative regarding imminent constructivechanges, or they may indicate impending acting-out, re-sistance, and premature termination (Example 6).
I have attempted to demonstrate by means of these
clinical examples how the dream can be effectively em-ployed as a psychodynamically and psychodiagnosti-cally useful instrument. Although I have arbitrarilyclassified dreams into eight discrete categories, I rec-ognize that most dreams contain one or more of thesepsychodynamic elements. Basically, this classification isa way of structuring and understanding dreams in a clin-ically pragmatic fashion. Frequently, dreams may vali-date the known clinical data; at other times, they arethe first indicators of central conflicts, impending deci-sions, transference reactions, or suicidal impulses. Suc-cessive dreams over the course of long-term treatmentmay also be used to validate and facilitate clinicalchange in regard to core conflicts, transference, resis-tance, self-representation, and interpersonal relation-ships.
22However, the clinical application of dream
material need not be limited to long-term psychoana-lytic treatment; this material may also be used in a va-riety of clinical encounters, including singleconsultations and time-limited therapy.
Dreaming is a uniquely personal, creative phenom-
enon. It is a profoundly subjective experience that pa-tients can acknowledge and value as a deeplymeaningful communication within themselves. Fre-quently, patients dismiss or minimize a dream by com-menting: “it’s only a dream,” as though it were notsomething “real.” I respond by saying that the imageryin dreaming is as “real” and tangible as any waking
thought or feeling. In addition, I explain that dreamsconstitute our subjective perception of brain activityduring sleep.
Most patients can be taught how to process their
dreams through free association without necessarilystruggling to discover an underlying, esoteric meaning.The key lies in appreciating the symbolic message con-veyed by the manifest imagery. Rather than alwayscamouflaging an obscure wish or conflict, the manifestimagery often informs us metaphorically about the cen-tral problem or clinical issue. In fact, the manifest con-tent itself has been the focus of investigation regardingchildhood traumatic experiences, assessment of egofunction, and the quantification of hostility in hyperten-sive and normotensive patients.
23–25Nevertheless, I do
not wish to minimize the importance of latent content,nor the fact that significant psychodynamic elementsare invariably embedded in manifest imagery.
The essential point for patients is to appreciate the
meaningfulness of their dreams and to realize that theyare quite capable of understanding them. For therapists,it is important to keep in mind the spectrum of psycho-dynamic information provided by dreams in connec-tion with conflicts, problems, feelings, relationships,transference, resistance, self-image and decision-mak-ing. In referring to the dream as a psychodynamicallyinformative instrument, I am essentially paraphrasingwhat Freud
2so presciently observed one hundred years
ago: “By analyzing dreams we can take a step forwardin our understanding of the composition of that mostmarvelous and most mysterious of all instruments”(page 608).
This paper was presented, in part, at the 44th Winter Meeting
of the American Academy of Psychoanalysis, Miami Beach, FL,December 8, 2000.
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