Sunday, January 24, 2010

Dream Interpretation in the Clinical Setting

Attaching meaning to dream content via psychoanalytic approaches has taken a back seat to short term, behavioral and cognitive therapy in the past three decades. Those clinicians still practicing psychoanalysis still try to find significance in interpreted symbols derived from the dream narrative. They attach meaning of these representations to the client's past in order to help them become more aware of how they were affected by significant events during their upbringing. This is of course a big ball of yarn to untangle and warrants a lengthy course of treatment.

Although extremely qualitative and subjective, I do believe dream interpretation can be part of a repertoire for cognitive therapist. Since we are concerned with how thoughts effect motivation, the representations and underlying messages in dreams can lend to us understanding how profound thinking in the dream state affects our cognition and in turn our day to day behavior. A growing body of literature supports the continuity hypothesis of dreams from sleep to waking reality. The continuity hypothesis suggest that the content of dreams is not remote from the waking reality, but, rather, portrays the most prominent feelings, interests and concerns of the individual.

Call it the subconscious, the inner mind, suppressed thinking or subliminal thought, we all must acknowledge that there is this highly active yet less than apparent process that dualistic-ally parallels our conscious state. When we have an opportunity to digest the storyline and details of a dream, we are given a chance to gain insight into the significant events and relationships in our lives. Often these are realized as symbols and metaphors. So while the meaning may be obfuscated and coded, the insight and honesty are of value once these representations are untangled.

Some of these symbols are universal, others are not. For instance, the house is often symbolic of the body and the condition and constitution of the home points towards the health and well being of the body and mind. If we dream of a home with a dwindling fire in the hearth, this may be universally symbolic of a weak heart. Bats in the belfry? Toys in the attic? You get my point.

Sometimes dream symbols are very individualized. For instance, if someone was bucked or kicked by a horse at a young age, the horse may symbolize danger of the threat of personal injury. To others, the horse may symbolize freedom, mobility or virility. Our personal experiences shape the meaning of the symbol and the context in which it is used in the dream further shapes its significance.

Years ago, I had a dream about a romantic interest and myself. We were in a rowboat, sitting side by side. My partner was rowing and I was oar-less. The symbolic interpretation I had was that she was in control (held the oar) of the relationship. The metaphor was the boat (relationship) going around in circles. The dream was affirming my feelings that this romance was going nowhere, although consciously at the time I may have not wanted to admit it to myself.

So I would argue in the conscious state we cloak some pretty obvious things. It could be due to defensiveness or denial, or it could be that we are so caught up with the bustle of everyday life that we are denied the opportunity to really analyze some important social phenomena and our emotional reactions to them. In having clients relate their dreams in the past, I have helped them extract buried and difficult to resource fears. Often these fears are irrational or exaggerated and this opens a dialogue conducive to altering some unhealthy thought processes and schema that are affecting the client's functioning and well-being. Using this form of dream interpretation in the cognitive setting may open some doors in terms of treatment that would otherwise be left unaddressed. It has found a place in my therapeutic repertoire.

Next: A look at Mindfulness Cognitive Therapy

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