A Clinician's Guide to Dream Therapy

Implementing Simple and Effective Dreamwork

Leslie Ellis

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367029159
• eBook ISBN: 9780429671326
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

A Clinician's Guide to Dream Therapy demystifies the process of working with dreams by providing both a grounding in the current science of dreaming as well as a simple, practical approach to clinical dream work.

In addition to a survey of the current science and neuroscience of dreaming, this book includes clinical examples of specific techniques with detailed transcripts and follow-up commentary. Chapters cover how to work with PTSD nightmares and how to use experiential dreamwork techniques drawn from current neuroscience to engender lasting change. Readers will be able to discuss their clients' dream material with confidence, armed with an approach that helps them collaboratively tap into the inherent power for change found in every dream.

Backed by research, common factors analysis and neuroscience, the approaches described in this book provide a clear map for clinicians and others interested in unlocking the healing power inherent in dreams.

1Fast-Track to Deep Waters

Why Work with Dreams?

Illustrations by Leah Lyon

Dreams are the touchstones of our characters.

Henry David Thoreau

Why should therapists in clinical practice have a practical understanding of how to work with clients’ dreams? There are many good reasons, now more well-understood than ever, that dreamwork can deepen and accelerate the process of therapy. Dream researchers have been working for decades amassing evidence that supports the notion that dreams are relevant and helpful to us in many specific ways. But the worlds of dream research and dream therapy rarely overlap, though each could inform and enrich the other. Many clinicians and clinical training programs reject dreamwork as too esoteric or antiquated for modern psychotherapy, but I would argue that an appreciation of the science of dreaming may help to restore dreamwork to its rightful place as an essential aspect of psychotherapy, and a critical part of any therapist’s skill set.

I will begin with a personal example which demonstrates how dreams can facilitate more efficient therapy by bringing the conversation right to the heart of matters that concern us most deeply. This story will show how dreams can reach far back into our personal history and weave together experiences that have important features in common. Such dreams can be a way to help us manage and integrate the intense feelings associated with the events they portray. Hartmann (2001) believes dreams are like therapy because both activities involve “making connections in a safe place.” The following example illustrates how the beneficial effects of dreams and psychotherapy can be combined for an even more powerful effect than each would have on their own.

A Matter of Life and Death

The subject of this clinical example is literally a matter of life and death. I’ve had more than one close encounter with death, and the first was very early in life. I was born two months premature, weighing just three pounds, and although survival rates for preemies have improved dramatically since the mid-60s, back then I was not expected to survive. In fact, of the four preemies born in that cold midwinter week in Saskatchewan, I was the only one that did not die. While I have no explicit memories of those first precarious days, I know that at the time, there was no understanding of the physical holding and comfort every newborn needs to thrive. Instead, we were kept in pristine incubators and touched only as needed to meet our basic needs because germs were considered the biggest threat to survival. It was two months before I was deemed healthy enough to go home, so my start in life was marked by minimal physical contact and a deep sense of aloneness.

I had another near-death experience 17 years later. Feeling all the invincibility of an adolescent, I attempted to dive under a waterfall into a glacial mountain river. I got caught in a strong current that pulled me deep under the surface. Many years later, I had a vivid dream that blended images of both of these experiences. I was in a clear glass box that was caught in the whirlpool of a river, and when I reached out for help, no one was there. The dream brought intense feelings and sensations of that day on the river back to life and it put me in direct contact with a deep, familiar sense of aloneness that I had known all my life. I was in therapy at the time with a Jungian analyst, sorting through my personal history, informing my own work as a therapist and amassing the hours I needed so I might train to become an analyst myself. Naturally I told the dream to my analyst, and as is often suggested in Jungian therapy, drew images of the dream, and spent time in direct experiential contact with the powerful feelings it evoked. In one unforgettable session, we enacted the dream, and when I reached out for help, he took a firm grasp of my hand and met me there, reaching across the years and letting that newborn part of me feel his clear and solid contact. It was so unexpected it sent a shock wave through my body. The work we did with that dream was probably the most profound of any therapy I have done. Yet if I had not had the dream, I think I might have stayed with more everyday subject matter such as my relationship concerns and the personal decisions I was contemplating. This dream took me into much deeper, more meaningful terrain and was a catalyst for change at an implicit level that is difficult to describe. Some tangible changes were that I deepened many of my relationships and became less of a lone wolf, much more readily able to recruit support and company in personal and professional endeavors. Some impactful dreams bring about changes like this all by themselves, but sometimes, as in this case, the dream was the catalyst, but the change took place in the context of therapy. I would suggest that even if the dream itself is transformational, working with it in therapy provides a venue for integration of the insights and concrete realization of the changes the dream has the potential to engender. Dreams unfold in the telling, and can stay relevant and alive, and at various stages in our lives can reveal additional facets of meaning.

Clinicians who do not pay attention to their clients’ dreams are missing an opportunity to add a compelling dimension of depth, meaning and emotional authenticity to the therapy process. Because dreams often speak the language of metaphor, even the most seemingly mundane content may carry important meaning that is outside of the dreamer’s immediate awareness. For example, a client who regularly brings dreams to therapy told me in one session that she had lots of dreams the previous night, but nothing important. Her dogs were in the dream, doing what they always do: the younger one pestering the older one who was, in the dream, getting to the point where she simply couldn’t take it anymore and was ready to snap. While acknowledging the dream snippet was literally true, the simple query, “Is there anything in your life like that, anything that you are completely fed up with?” opened up a whole avenue of process around her situation at work that was aptly represented by the dogs. It also turned out to be a huge relief to discuss a topic that may well have been left unexplored had she not mentioned her dream.

In addition to turning our attention to deeper matters, the benefits of working with dreams in clinical practice include the fact that dreams are creative and engage clients in the therapy process. They point to our most salient emotional concerns. They bypass our internal editing process and normal defenses, and so are unflinchingly honest representations of our life situation. Dreams can bring a new and wider perspective on a situation that seems otherwise stuck. They provide diagnostic information and can be indicators of clinical progress. They help to regulate our emotions, and working directly with the feelings dreams engender may strengthen this positive effect. They can be a safe pathway to working with trauma. The “big” dreams we occasionally experience can literally change our lives, and dream therapy can facilitate and integrate this transformation. (Each of these benefits will be discussed more fully later in the chapter.)

A Brief Summary of Research into Clinical Usefulness of Dreams

Much of what we know about how clinicians use dreams in their practice is captured in a handful of studies that were reviewed by Pesant and Zadra (2004) with the goal of making clinicians aware that integrating dreamwork into their practice is both beneficial and accessible. The researchers found that while most therapists do work with dreams at least occasionally in their practice, the majority are not comfortable doing so because they feel they lack expertise or the necessary specialized training. In fact, it is most often the clients, not the therapists, who initiate dreamwork. The review also found evidence that dreamwork helps increase clients’ self-knowledge and insight, and increases their commitment to therapy, which can be a predictor of good therapy outcomes. The researchers concluded that “there is strong evidence that clinicians have much to gain by attending to their clients’ dreams, and that effective dream work is accessible to most clinicians.”

A year later, Eudell-Simmons and Hilsenroth (2005) reviewed the clinical literature on dreamwork with a focus on four areas: therapeutic process, client insight and self-awareness, dreams as a source of information for the therapist and dreams as a measure of therapeutic change. The latter two categories have received less attention than the former. The authors found evidence that dreams are an excellent source of client information, especially of details the client is otherwise unable or unwilling to reveal. They also found evidence that changes in dreams can indicate progress in therapy, and overall that dreamwork is at least as effective a form of therapy as other approaches.

There is some evidence that there may be particular benefit to discussion of dreams (Edwards et. al., 2015). A study of dream group experiences compared discussion of a significant life event versus a discussion of dreams and found participants perceived significantly higher insight gains as a result of discussing their dreams. The study was with a non-clinical sample and the insight gains were achieved using the Ullman group method. Edwards noted the importance of distinguishing true personal insight from the “aha” of recognition the dreamer has from merely identifying the memory source of the dream. Many times I have seen people dismiss their dreams once they recognize the actual life experience that the dream was drawn from, as if that explains it away. But in my experience, it’s better to think of life events as the palette from which the dream draws its material, though the final work of art may represent something else entirely.

The majority of research into the effectiveness of dreamwork in a clinical setting has been led by Clara Hill, and taken as a whole, the results supporting the use of dreams in therapy are convincing. More than 25 studies are summarized in two reviews (Hill & Goates, 2004; Hill & Knox, 2010) and all were conducted using the dreamwork method Hill developed, the cognitive-experiential dream model. The method begins with an experiential exploration of the dream, followed by a stage where the client offers insights into the dream’s meaning gained from the experiential phase, and finally, there is an action step where client and therapist discuss changes the client might make as a result of the dreamwork.

One finding that emerged from Hill’s studies is that clients clearly enjoy working with their dreams; in 12 separate studies, clients consistently rated the quality of the dreamwork sessions as significantly higher than the quality of their regular therapy sessions. Clients also consistently reported gaining greater insight into their dreams after dreamwork sessions, and this insight increased in the two weeks following the session. Before the dream therapy, clients generally reported poor understanding of their dreams, suggesting that working with dreams in therapy brings benefits from dreams that would otherwise not be realized. Spangler and Hill (2015) summarized the results of the research noting that positive change in outcomes related to dreams was clear, with significant improvement in session quality, attitude toward dreams, insight, ideas for ways to take action and specific problem solving. More general outcomes were mixed, although some of the research showed a decrease in depression and an increase in well-being after dreamwork, as well as higher self-esteem and greater insight for those engaged in dream groups compared to waitlist controls.

The other area where there is clear evidence of the efficacy of working with dreams is in the area of treating PTSD nightmares. Imagery Rehearsal Therapy (Krakow et al. 2000, 2001) has been shown in several large clinical trials to significantly reduce PTSD symptoms. Lucid dreaming as a nightmare treatment method is also gaining empirical support (Spoormaker & van den Bout, 2006). These and other ways to treat nightmares using dreamwork will be discussed in the chapter on nightmares.

More recently, Leonard and Dawson (2018) mapped out the historical and cultural reasons dreamwork has been marginalized in psychotherapy, and they strongly advocate for change. The authors point to many important reasons to include dreamwork in clinical practice (all of which are covered in this chapter). They also warn of the potential loss of rapport with the client and the sense clients will have that the therapist is not interested in their inner life if they do not engage with their dreams. The authors conclude that change is needed, and should begin with telling a more complete story about the state of modern dreamwork:

The dominant discourse of dreams having no psychological meaning or clinical value is only one side of the story in a short chapter within humanity’s long history of fascination with dreams. In our view, the theoretical diversity in dream theory offers multiple pathways for contemporary psychologists to engage in dream work in ways that are achievable within the constraints of contemporary practice, including time limits and preferences for particular theoretical orientations.

(Leonard and Dawson, 2018)

Why Work with Dreams?

They Are Creative and Engage Our Clients in the Therapy Process

Dreams are novel and fascinating products of our imagination and consciousness and as such are inherently interesting. Everybody dreams and has had the experience of waking up terrified, excited or deeply moved by the drama that just unfolded in their mind while they were sleeping. Although the process of therapy can be challenging, one of the things that keeps clients engaged is the incredible gift of being listened to deeply and respectfully. We are human; we all love to be seen and appreciated, and sharing our dreams with an interested, curious listener is compelling and engaging. As a therapist, you will engage your clients more deeply, and also help them step outside of their habitual dialogue when you pay attention to their dreams.

They Point to Our Most Salient Emotional Concerns

It may seem that we don’t need dreams to do this, but that we are always well aware of our most pressing emotional concerns. However, human consciousness is not always straightforward or consistent, and people can be very good at unwittingly deceiving themselves. In fact, one of the most popular forms of therapy (cognitive-behavioral therapy, or CBT) was founded on the premise that our mind leads us astray and distorts our experience in a number of ways. One example is rationalization, a habit of talking ourselves out of our feelings using “rational” arguments, such as, “I’m not sad that she left; I didn’t really love her anyway.” We can often fool our conscious mind, but such a person may dream of losing something of great value and wake up crying. If they pay attention to their dream, they will realize that they are in fact very sad about the loss of their relationship. Dreams are like that very good friend who is willing to be honest with us even when what they have to say is not easy to hear.

Dreams can also provide therapy clients with a way to introduce important yet deeply personal topics in the course of therapy, subjects they may want to bring up but are reluctant to do so due to fear, embarrassment or cultural norms that discourage personal revelation, even in therapy (Tien, Lin & Chen, 2006). Goelitz (2007), who works with clients preparing for death, found that dreamwork brought the focus of the session to the deeper emotional concerns rather than the more...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgments
• Introduction
• 1 Fast-Track to Deep Waters: Why Work with Dreams?
• 2 Bringing It Home: Inviting Dreamwork into Your Practice, and Your Life
• 3 Common Factors: Toward a Universal Approach to Working with Dreams
• 4 Mapping the Route: The Science of Dreaming
• 5 Understanding the Terrain: The Dream Is Born in Metaphor
• 6 From Ordinary to Sublime: Kinds of Dreams
• 7 Navigating the Dream Divide: Woman in the Mirror Dream
• 8 The Central Quest: Finding the Life Force Inherent in All Dreams
• 9 Avenues of Exploration: Visual Art and Technology
• 10 The Inner Journey: Dreams and the Body
• 11 Perfect Storms: Working with Nightmares and Bad Dreams
• 12 Fellow Travelers: Working with Dreams in Groups
• 13 How Dreams Enlarge Us: Big Dreams
• 14 Transformation: Applying Neuroscience to Dreamwork
• Index