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Clinical Work with Dreams

Montague Ullman and Claire Limmer

The variety of Dream Experience - Expanding Our Ways of Working with Dreams, second edition. Edited by Montague Ullman and Claire Limmer. Chapter Twelve, pp 235-253. State University of New York Press, Albany, 1999.

I was a practicing psychoanalyst well over two decades before I began to devote my time exclusively to experiential dream group work. For Claire Limmer this sequence of events was reversed. Claire has been closely associated to me in the development of this approach to dream work ever since she joined the first group I started in the United States in 1976. She continued her participation in a weekly group and in a number of leadership training sessions over the years. During this time she also undertook her training in psychoanalysis which was completed in 1988. During these years she has been in psychoanalytic practice.

 

As we planned this current revised edition, it seemed logical to combine forces in a joint chapter with me focusing on those aspects of group dream work that were applicable in one-to-one therapy and Claire providing examples from her practice of how her experience in group dream work enriched the work she did on dreams with individual clients.

Part 1. Teaching the Basics (M.U.)

In September of 1974 another psychoanalyst and I were invited to Gothenburg, Sweden, to teach a group of young therapists in training the art and practice of dynamic psychotherapy. The students were mostly psychologists completing their graduate work at the Psychological Institute of the University of Gothenburg. Because of my special interest I was the one to give them the course on dreams.

It seemed to me, based on earlier experience,1 that the teaching of dreams to psychoanalytic candidates failed to prepare them for the kind of interaction with a patient that could systematically expose the associative matrix of the dream. Theoretical and practical knowledge about dreams came about in a piecemeal fashion that generally included one or more clinical seminars on dreams, a reading course on dreams, and exposure to dream work in personal analysis and supervision. In the clinical seminar the candidate presented a session in which a dream was worked on along with a brief account of the past history and progress in therapy. The focus was generally on the way the dream can shed light on the ongoing dynamics of the treatment situation. The problem with this approach is that we are working with a "dead" dream. Discussion is limited to the information the candidate obtained from the dreamer. There is no opportunity to learn how to engage the dreamer in a way that might have produced more material.2

The reading course in dreams that usually accompanies the clinical seminar is essential but is still heavily oriented towards Freud's theoretical constructs and the patient's task of free associating and not on the active exploratory role of the therapist. For the beginning therapist, theory is fascinating and readily mastered. When he discovers that in practice the spontaneous free association of the patient is not enough to do justice to a dream, then what does he do?

Much can be learned about dreams through one's personal analysis and in supervision. The final results, however, can be variable depending, as they do, on the skill and interest in dreams of the analyst conducting the therapy and the supervision.

It was the shortcomings and uncertainties built into programs of this kind that led me to consider a radical departure from the traditional approach when I arrived in Sweden. To have a "live" dreamer in the room and to be able to do dream work experientially transformed the situation from a clinically oriented one to one designed simply to teach the basics of dream work. The latter included the recognition of the precipitating factors in the current life of the dreamer, the way relevant aspects of remote memory come into play, and the view the dream provides of certain realities that have not yet found a place in the waking life of the dreamer. My task was to conceptualize and teach the skills I had learned in practice (see chapter 1). The task of the students was to engage in learning about dreams experientially by sharing a dream. Once the basics were learned the student could then gravitate toward any particular theoretical orientation they found helpful in integrating dream work into the practice of psychotherapy (see Ullman 1996 for a more extended discussion of the process and its connection to therapy).

There were none of the trappings of a clinical situation. The students were not there as patients. There was no obligatory contract. They were free to share a dream or not. If they chose to share a dream they were free to choose any one they wished to share. The extent of learning would depend on their own curiosity about what the dream had to say and the degree of trust they felt. I was not there as their therapist but as a participant while teaching the process at the same time. They were there to learn something about the technique of dream work that would later prove helpful in their practice.

There are seven basic premises underlying this approach.

First Premise

Dreams are intrapsychic communications that reveal in metaphorical form certain truths about the life of the dreamer, truths that can be made available to the dreamer awake. Dreaming consciousness serves the nighttime needs of the dreamer. The experience of dreaming itself is generally not intended to be a public communication. The dreamer awake can, of course, go public with it. Dream imagery is potentially metaphorical. To realize that potential, the dreamer is faced with the task of sparking across the metaphorical gap between dream image and waking reality. Our dreams have an incredible way of zeroing in on who we really are instead of who we would like to think we are or who we would like others to think we are.

Second Premise

If we are fortunate enough to recall a dream, we are then ready, at some level, to be confronted by the information in the dream. This is true regardless of whether or not we choose to do so. Freedom and truth are inextricably linked. The more accurate our perception of an issue, the more freedom we have in coping with it. To experience freedom in that sense requires a level of honesty not always easily available to us while awake. Situations arise where, consciously or unconsciously, we act out of expediency. The dream offers us the opportunity to confront an issue with greater clarity and a deeper honesty. We get a bit closer to ourselves and a bit freer.

Third Premise

If the confrontation is allowed to occur in a proper manner the effect is one of healing. The dreamer comes into contact with a part of the self that has not been explicitly acknowledged before. There has been movement toward wholeness. Healing is simply another name for being more in touch with our own historical past and its influence in our relationships with others. It is as if the dream furnishes us with the connective tissue needed to repair areas of disconnection with our past and with others.

Fourth Premise

Although the dream is a very private communication it requires a social context for its fullest realization. The dream is the waking remembrance of the raw content of our nighttime dreaming consciousness. Once removed from its natural environment, it has to undergo a socializing process if the information embedded in the imagery is to play an explicit and active role in our waking life. That process begins with taking the dream seriously and engaging in the work necessary to allow the metaphorical potential of the imagery to unfold.

Fifth Premise

Dream images arise out of the unique life experiences of the dreamer. The fit between image and meaning is something that the dreamer alone can validate. The dreamer is the only one who can judge the effectiveness of the help offered. He or she alone has that resonant gut feeling when a truth strikes home. There is a distinct difference between intellectual acceptance and the spontaneous and richly generative response to a true fit.

Sixth Premise

Everyone's life experience is unique. Any symbolic image can be used in a highly idiosyncratic way. No a priori categorical meanings are assumed. One has to have a certain humility in dream work and realize that there is more to learn from the dreamer than we have to offer to the dreamer. The reason is simple. Nothing in our prior learning and experience is a substitute for the work that has to be done to discover how these particular images emerged out of the idiosyncratic life experience of the dreamer and why they came together to shape the dream on that particular night. The task is to help the dreamer uncover the answer.

Clinical dream work. Before discussing the carry-over from the experiential dream group to one-to-one therapy, there are important differences between the two situations to be noted.

First, there are differences in motivation. People seek therapy for relief from emotional distress. People seek dream groups out of the interest they have in their own dream life and their desire to learn more about the unique features of dreams. There are occasions when someone drifts into a dream group when they are really in need of therapy, a fact which should be recognized and acted upon early. There is no intrinsic incompatibility between being in therapy and in a dream group at the same time. In fact, they can very well complement each other.

Second, there are differences in the training and skills of the helping agency in the two instances. The psychotherapist undergoes rigorous training in preparation for the management of the various manifestations of emotional disorder. Therapy involves, among other things, the recognition of and techniques for dissolving the defensive structure of the patient - for example, the transferences and resistances that arise. By virtue of this special training, the therapist is in a unique relationship to the patient and operates with a body of knowledge and techniques the other is not privy to. The dream work is geared to and incidental to this therapeutic task. It is only one of many therapeutic tools and one not always optimally available to use in the crowded therapeutic hour. Dream work is time consuming. The therapist is at the mercy of how much time is available to make the best use of the dream. Other items on the patient's agenda often crowd it out. A dream presented ten minutes before the end of the session leaves no time for any in-depth exploration of it.3 There is also the problem of the many ways in which the patient may use dreams in the service of resistance - for example, offering it compliantly or as a gift without any genuine concern about its message.

The therapist as an authority, the one-sidedness of the situation with regard to dream sharing and the hierarchical arrangements this engenders, is precisely what is lacking in the experiential dream group. In the latter an egalitarian arrangement prevails where everyone, including whoever may be responsible for teaching the process, participates in every phase of the process, including the sharing of dreams. There is no hidden agenda, and the rationale for everything that goes on is known to everyone. Once the process is mastered it becomes the responsibility of the entire group to carry it out.

There are, of course, other specific features of the therapeutic situation with regard to dreams that distinguish it from the experiential dream group. The therapist listening to a dream has at hand an historical perspective on the life of the dreamer, as well as a knowledge of personality patterns as they have unfolded in the course of therapy. This offers the therapist the freedom to test out ideas based on prior knowledge and to offer broadly based interpretations. In the group process it is the work with the current dream alone that leads us into the past.

There is a final and most important point and that is that the patient in presenting a dream has the freedom from the very beginning to offer his or her associations and ideas about the dream. In the group process this amplification of the dream is delayed until after the group has offered their projections in the second stage. In therapy, while the therapist is free to offer a projection of his own if he feels it might be helpful, it is not done as a separate stage as in the group process.

There are, however, aspects of the group process that can be carried over in a helpful way in individual therapy. Take, for example, the dating of the dream. In the dream group we make a specific point of asking the dreamer when the dream occurred before hearing the dream. Preliminary ideas can then begin to germinate as one listens to the dream. A dream dreamt after a work day may be different from one dreamt on a weekend or holiday. In therapy, a dream dreamt after the previous session or just before the present one is apt to have some reference to therapy. A dreamer may, of course, spontaneously date the dream prior to telling it. If this does not happen and if only an approximate date is given, the dreamer can sometimes be helped to zero in on the actual date. It may take a little time and encouragement to more accurately locate the dream in the context of his or her life.

The various steps in the dialogue that take place in the dream group can all find a useful place in individual therapy. I place great emphasis in what I refer to as the search for the emotional context in the life of the dreamer connected to the occurrence of a particular dream on a particular night. The dreamer may spontaneously describe events going on in his or her life around the time of the dream. It is my experience, however, that in almost every case a good deal more can be elicited by systematic questioning designed to elicit further feeling residues, particularly ones that seemed too fleeting or incidental to be spontaneously recalled.

In the group, after the dialogue the dream is read back aloud to the dreamer in the hope of eliciting further associations. In therapy this can be done very much the way it is in the group or the therapist can simply call attention to specific images that have not yet been clarified. The techniques for helping a dreamer go further with elusive imagery are the same as described in the group approach. The effort is designed to reconnect the felt aspect of the image to feeling residues past or present in the life of the dreamer. Calling attention to the feeling aspect of the image or simply helping the dreamer move from the literal image to its more abstract metaphorical potential is often enough to help the dreamer see the image in a new and more helpful way.

Walter Bonime (1962), an analyst who has written extensively about dreams, refers to his role in dream work as offering "interpretive hypotheses." This is a most important statement about the role of the helper, either in clinical work or in the group. It indicates the helper's awareness that all interpretive efforts are hypotheses unless they resonate at a feeling level with the dreamer. The term I use to convey this in the group approach is orchestrating projection. This occurs in the final stage of the process where any member of the group may offer projected thoughts about the dream images and waking reality that they think might be helpful to the dreamer. Again, it is only the dreamer who can truly judge the fit and reject what does not fit.

Any therapist who has been exposed to experiential dream group work will become more aware of the many pitfalls that lie in wait when a patient seeks help with a dream. Two in particular are worth knowing about. The first is an overreliance on theory in lieu of an adequate search for the data. This results in a priori assumptions of what certain dream images mean as symbols derived from a particular theoretical orientation.

Aside from the features of the group situation that can be carried over to therapy there are beneficial results for the dreamer and for the therapist. For the dreamer the group process has the effect of demystifying the dream. The dreamer learns how to develop the relevant associative context which, in turn, results in an increased ability to do more on his or her own in gaining leverage on the dream. Much of the same thing will happen in therapy as the dreamer learns how to go about recovering the information that he or she put into the dream while asleep. The task of the therapist then becomes easier as learning takes place. A specific benefit to the therapist is the increased sensitivity he acquires in group dream work to his own projections in working with dreams in his practice.

In the presentation of dream work in the next section I want to call attention to the care the therapist takes in dating the dream, pursuing the search for the recent context by simply encouraging the dreamer to gather further details about recent events and playing back images that have not yet been clarified. In the first instance she notes the extent to which Helen managed to work out the dream. The orchestration served as a helpful summation that validated the very fruitful work Helen had done. It also conveyed to the dreamer, as orchestrations often do, that the dreamer had really been heard.

In the second instance, the therapist notes the wisdom of holding her own ideas in abeyance until the data have fully (as fully as possible) emerged. Her sharing this with the dreamer was a good example of what true collaboration is and how salutary it can be for the dreamer (as well as for the therapist). The therapist's summary statement at the end, carefully constructed on and limited to what the dreamer herself had disclosed, is a good example of an interpretive hypothesis or, had it occurred in a dream group, an orchestrating projection. The session with the dream also did what dream work should do, namely, lead to behavioral change. The dreamer had the insight and support she needed to face up to a difficult step.

When time does not allow a more extended exploration of the dream, Walter Bonime (1962) resorts to what he refers to as "Headline" interpretation. This is an attempt to identify the one most helpful metaphorical statement pertinent to the work going on.

In the early fifties I began exploring an idea that later became part of the dream group process I now use. I would begin the seminar by suggesting that we initially limit our knowledge to the age and sex of the patient, duration of therapy and the dream itself. The class and I would then offer our own projections of what the dream might be saying about both the dreamer and the dreamer's relationship to the therapist: Despite some initial resistance to saying anything about a dream before the associations were at hand, it proved to be a surprisingly helpful exercise.

Part 2. The Clinical Use of Dreams (C.L.)

The effectiveness of my work as a therapist has almost without exception depended on developing with the client a sense that we are embarking on a collaborative effort to look at the present-day concerns that brought him into therapy against the background of his personal history. Therapist and client together will attempt to come to an understanding of the way the client's life has been shaped by his history. This way of working has grown out of a realistic assessment of my therapeutic skills as well as an ever-renewed appreciation of the complexity of human existence, of how much there is to learn, and an openness to learn with the client about his life.

Nowhere does the spirit of collaboration shine more brightly than in the work therapist and client undertake with a dream. For this reason, I view the initial phase of treatment as a period of preparing the groundwork that is needed with a new client, a process that includes some teaching about how we will work together in order to create the kind of rich medium I think we should be digging in. This includes teaching the client how we will be approaching dreams. This holds true when working with teenagers, adults of any age, and with couples as well.

Clients come into treatment with a variety of preconceptions about dreams. Some think of dreams as new-age, flaky stuff. Others think of dream symbols as something you look up in a book. Others have had previous periods of therapy with good or not-so-good dream work or very differing orientations. There may need to be a process of reeducation. Sometimes I find myself sharing my view of the dream as a shortcut to understanding the work we need to do. This is reassuring to the client who fears the mention of dreams means we are embarking on a very long process.

It is important to clarify for the dreamer right from the start that the therapist does not have immediate insight into what the dream is about; that is, he or she does not know what the dream is about at the moment it is presented. Sometimes this is exactly what the client both hopes for - some magical insight - and fears - that the therapist knows something about him that he doesn't and is keeping it from him. That dream images have meanings idiosyncratic to the dreamer is a new concept to most clients. If we work together, hopefully we will come to understand the dream's meaning, or better yet, with the help of the therapist the dreamer will arrive at the meaning of the dream himself. The therapist's experience in working with dreams is what she brings to the effort.

Just as an experiential dream group coming together needs to be taught the process of drawing out the contextual data that will illumine the dream, the individual client learns (through the questions the therapist asks as well as through moments of actual instruction) that the meaning of the dream will come to him as he makes connections between the concerns and emotions he fell asleep with as well as any other feeling residues of recent experiences and the dream images, in short when he can answer the question, Why did I have this dream that night.

Gradually and naturally, if he's lucky enough to wake with the memory of a dream, he will have trained himself to think about what was on his mind as he fell asleep. He notes the day of the dream (because he knows this is the first question I will put to him). Hopefully, if the client's early experiences working on dreams are felt ones, he learns to value his dreams to appreciate their beneficial effect, and to give them priority in a session.

This point of view did not evolve out of my own training as a psychoanalyst, and perhaps something needs to be said about this. I had been a member of a dream group and leadership training groups preceding and concurrent with my training as a psychoanalyst in the seventies and eighties. I had an advantage over my classmates whose insecurities about becoming therapists showed themselves mostly in working with a dream. To my mind they had every reason to be insecure. The curriculum, although otherwise an excellent one, provided only two courses on dreams. These were devoted to reviewing the massive literature on dreams, with no readings at all, however, on the phenomenological approach to dreams; that is, working with the manifest content. There were one or two occasions in class for each of us to present a dream of a patient. Some background about the patient was offered, the dream was presented, questions were asked about the session in which the dream was presented, and the class was left to speculate about the dream's meaning. The focus was always on uncovering the latent content; that is, viewing the manifest content as a disguise of the latent content rather than seeing the manifest content as being the dream with no disguise intended. Some connection was made to day residue, but the focus in working on a dream was almost always on returning to the patient's past and the origins of his pathology, with little or no focus on the dreamer's present-day struggles as illumined in the dream. No effort was made to systematically derive more information about the immediate context of the dream, and it was never made clear that if the dream's meaning remained obscure it was because not enough data had been acquired about what triggered the dream. The analyst was viewed as the authority. Analysts in training often felt they were supposed to know with very little effort what the dream meant and that their clients believed they did. The idea of collaboration was not conveyed. Apart from classwork, the only other experience analysts in training had in working with dreams was in their own psychoanalysis and in supervision where the same hierarchical inequality may or may not have been conveyed.

I knew as a student that I was miles ahead of my classmates in this area, not only because of the years of work on my own dreams in psychoanalysis but because of my years of training in working with the dreams of others, focusing on the manifest content and the context in which the dream emerged including connections to the past. One has to learn the skills needed to draw out information from the dreamer that would help make his dream come alive.

I have made one or two rather weak efforts to teach courses on dreams at this institute. I have not been persistent because I'm aware I'm up against a wall. In the first place, to maintain the hierarchical system, there is a need on the part of many therapists to augment, not diminish, their positions as authority figures. In my opinion, the issue of power as a motivating force in becoming an analyst is not sufficiently addressed. Secondly, and most importantly, the training of psychoanalysts in institutions such as mine places the student in a fiercely and precariously defensive position. He or she faces one committee after another in the course of training, committees that are always on the look-out for countertransference issues to cause the analytic candidate grief. This leaves the student uncomfortable about any self-disclosure that might come up either in presenting a dream of his own or in the projections he might offer in working experientially with the dreams of others.

How then does individual dreamwork differ from experiential group dreamwork? For one thing, the dreamer has many life issues, and oftentimes crises, he needs to talk about. He may not be able to give the dream priority, although experienced dream workers come to recognize the dream as the "royal road to the unconscious" and give it precedence or certainly try not to leave it out. He may remember the dream in the middle of a session or close to the end. Assuming, however, that the dream has been offered early in the session, it can be worked with methodically using many of the principles of group dreamwork. After the dream is recorded I will begin to ask questions to uncover first the immediate context and then the extended context in the effort to shed light on the connection between image and reality. This is generally the longest part of the work, to follow up one bit of data after another with questions that will draw the dreamer out as fully as possible. When there is a sense that the context of the dream is fully known, there are often interesting results if the dream is played back aloud to the dreamer at this point . . .with a bit of drama or emphasis or even humor: "So - - - after all you told me about last night, why do you think you dreamt you were in a subway going to the west side?" or "Why, last night, of all the hundreds of people you know, do you think you brought Jessie into your dream?" The questioning (dialogue) continues, becoming more and more refined in terms of the specific dream imagery and its metaphorical meaning until the dreamer begins to get in touch with his dream, to experience a felt connection between his emotional state at the time he fell asleep, the pertinent historical data, and those curious personages and settings of the dream. Most often, and especially with a patient who has worked on his dreams for a long time, this is enough. Nothing more needs to be said by me. At other times, when the client is just beginning to close in on the meaning of the dream - that is, when the connections he's making feel tenuous or uncertain - it seems helpful, if possible, to offer an orchestration to bring together the work the client herself has done in a more integrated way. This is often experienced as an affirmation of the client's effort. If the context has been fully developed and the client still cannot connect to the dream, I will try to orchestrate it for him. I always make it clear that what I am saying is offered in the spirit of a question. "Given what you have said about what was going on in your life yesterday . . . or what you fell asleep thinking about (with highlights offered briefly), do you think your dream might be saying something about ....

The beauty of all this, especially with young adult patients who are often in conflict with their parents and society, struggling with issues about their own emerging identities and the crises of growing up, is that they start to experience an inner sense of their own authority. One is teaching the young person to wait for that felt sense, oftentimes a clear feeling of relief like that of suddenly being able to take a deeper breath that is experienced when the dream's meaning becomes known. This may be one of the first experiences the young person has had of knowing inside what he is about. He can learn to rely on that felt sense in other areas of his life, to know when he is acting truly in advocacy of his own integrity or not.

What are the advantages and disadvantages of individual dreamwork? First, the disadvantages, and there are basically only two. The first is that there are only two of us in this consulting room. We do not have the benefit of the input of eight or ten individuals who are there for the sole purpose of working on a dream, the rich input of Stage II when the group members play with the feelings the dream evokes and the possible metaphorical meanings of the imagery. The dreamer does not experience the wide band of support and caring that the dream group offers as it participates in his dream. The second is the issue of timing. In contrast to a dream group where there is an hour and a half set aside for each dream, in an individual session we have at best a half hour or forty minutes to work on a dream, assuming time has been taken up with other matters. Sometimes the dream is not presented in a session until a few minutes before the end.

What then are the advantages of individual dreamwork? For some, the privacy of the setting and the longstanding relationship between client and therapist allow for fuller disclosure and less discomfort. The sense of safety is implicit in the setting. In fact, if in the dream group there is a need to follow the structured process carefully to preserve safety, in the individual setting the issue of safety is implicit and the therapist may feel he can confront the dreamer with greater boldness about what the dream might be saying. We know, as an important principle of dreamwork, that the dreamer is generally ready to confront the issues in a dream that has been remembered. It is always the ongoing sense of respect for the dreamer's ultimate authority in working with a dream that makes such confrontation possible.

In addition, the therapist knows a great deal about the client's life. They have worked together on many dreams. Dream images are frequently repeated - horses figure into one client's dreams over and over again, elevators in another's. The question centers on how the same image is presenting itself now - with what variations, with what indicators of growth. It is for this reason that even when a dream is presented close to the end of a session, with only ten or fifteen minutes remaining, we can often get to the heart of its meaning. We can also work with a dream over a number of sessions.

Perhaps what I have taken from group dream work is already clear, but let me restate briefly the important points I use daily in my practice with clients. First is the belief in a collaborative effort. This requires careful listening and following on the part of the therapist to everything a client is saying about the dream with no prejudgment about what is important and what is not. This is sometimes very hard to do, and self-reminders never cease. The client may have presented many dreams. We know a great deal about him or her. The dream may be similar to others, but the important question is what is this one about. Second is a conviction that the meaning of a dream will unfold when we have made a thorough effort to search for the contextual material that prompted the dream. When the dream is not clear it simply means we have more work to do. The techniques for conducting a dialogue apply here - drawing out the context, asking open-ended questions, following the dreamer rather than leading her, emphasizing the dreamer's own idiosyncratic associations to the dream images, and waiting to see if the dream's meaning will come to the dreamer himself. As therapist, one has to discipline oneself to work in this structure. It's such a temptation to jump in with an interpretation we are convinced fits, especially when a dream seems simple. They never are. The benefit for the therapist in holding back his or her own ideas is the reassuring knowledge that this method works, that the dream will come alive with much richer meaning than the therapist might have anticipated if s/he just gets to work. This knowledge does wonders for the therapist's own level of anxiety which is attenuated when both s/he and the client have learned how to collaborate. If the dreamer is experiencing difficulty connecting to the dream, there is opportunity to remind the dreamer of the key contextual issues she developed and then to play back the dream in the hope that connecting links will be made then. Finally, just as one does in a dream group, there is opportunity to offer an orchestration, using the material that has been presented and all that is known about the dreamer. Sometimes the dreamer needs reminding of one piece of context often ignored - an earlier session. If the dream occurred after a session and the dreamer does not mention the session, it is often helpful to ask the client what thoughts the session produced.

Now for some dreams.

Helen's Dream

The first dream I would like to discuss was that of a client who has been in therapy for a number of years. She has learned how to work with a dream, how we focus first on the events and emotional state preceding the dream, and then look at the imagery together.

The dreamer is about fifty. She was born in Europe right after the end of World War II. The family was stateless for the first eight years of her life, and she grew up in a household oppressed by her mother's countless recollections of the horrors of the war. She saw her role as the one to bring "sunshine" to the family, and her responsibility to try to be the pleasing child. She has struggled with depression most of her life, been hospitalized twice, and made one suicide attempt.

The dream occurred on a Monday morning. "I was in a chair, confined, paralyzed, incontinent. I felt myself to be my grandmother. I was wearing something like a corset around my waist. It was strangling me. I couldn't move my legs, couldn't have sex, couldn't function as a woman."

Nothing much was needed from me at this point except a question about what the weekend had been like. "We had had a conversation with some close friends on Saturday night, a couple we've known a long time, about gender differences - how males deal more in a world of ideas rather than emotions. Sometimes with Will (husband) I feel my own perceptions are not tolerated - like they are being squeezed, pushed out of me. When I have a view that is different than his, it's not allowed - I can't really be myself. I was saying to Will as we went to bed that we should keep talking to our friends about this since we trust each other."

A simple question from me followed: "Did anything else occur?" Helen responded.

"My Mother called (calls every Sunday). Within a few minutes it felt like oxygen was being knocked out of me. 'You're doing it again,' I thought; 'You have no regard for me.' I had the unsettling feeling afterward that I had married my mother . . . when Will looks at me and refuses to listen to what I am saying or when I don't mirror his admiration for something."

"Anything else?" I asked.

"It had been Tom's (her son) birthday earlier in the week. He told me my mother had called him to wish him a happy birthday. I said, 'That's nice.' I didn't want to diminish his pleasure in her call. But Sunday after I got off the phone with my mother I wanted to talk to Tom, to tell him there's a side of grandma you don't know. I wanted to say 'Do you know she doesn't call me on my birthday or your sister, just you and your father?' I wanted to ask 'What do you make of this - the different ways she treats girls and boys?'

"I had also been working on my thesis. My wrists were hurting from working at the computer."

At this point there were four strong bits of context developing - the conversation with friends about gender differences, the call from her mother, thoughts abut Tom, and the work on her thesis. I suggested we look at the dream and asked her to think about why she had dreamt about her grandmother that night. Helen began to speak about this woman. "She was such a joyful young person. My grandfather adored her. She loved to dance. I thought of her as the keeper of the heart. When she got sick, she never complained. She would look out the window for beautiful things to see. But when she got sick my mother had total control of her as she always controlled me. She made me stay in after school and take care of my grandmother. I did my homework after school and wanted to go out and play. At times grandmother also yearned to die. She had lived long enough, and she needed relief. That's me too (Helen had made one suicide attempt). I am not going to let that happen to me. I wanted to dance as a teenager. My mother wouldn't let me. I want to live now. I don't want her to have that power - that numbing power. So much pleasure was robbed from me - including my sexuality as a girl. It was okay for my brother to have fun - not me. I was so involved in pleasing her."

Helen had arrived at the meaning of the dream herself. There was no need for an orchestration from me except to bring together all that Helen herself had come to see and feel that weekend, the heightened awareness of male/female gender differences that emerged from her talk with friends, the way this had been played out in her family of origin where males were valued and females devalued, the way this was being repeated in her mother's relationship with Helen's husband and son, the problems that existed along these lines with Helen and her husband, the telephone conversation with her mother that left Helen feeling suffocated, the physical tightness she experienced in sitting at her computer (as well as the constrictions being imposed on her creativity by her faculty adviser). All of this had contributed to the dream image that helped her see herself like her grandmother - in her capacity for joy, warmth, and largeness of heart, her role as keeper of the heart, and in the way constrictions to her spirit had been and still were being imposed on her.

Emma's Dream

The dreamer is a seventeen year old who had been in therapy only two months when this dream was presented. She is a beautiful young woman, highly intelligent, an outstanding student, extremely shy, with high ideals and a strong need to see herself as a "good" person. She had experienced some months of depression a year earlier that she had endured alone, but as this depression began she feared she could not tolerate its duration and asked her parents if there was any way they could get help for her. She was a "natural" for dream work as she saw herself becoming a writer someday and kept a daily journal, which included some of her poetry and in which she now kept a record of her dreams. The language of metaphor was not foreign to her but something she responded to spontaneously. On the surface the dream Emma presented did not appear to be an especially difficult one. I found I needed to control the impulse to offer ideas too quickly. It is given here as an example of what is gained by not jumping in too quickly, by waiting for the dreamer's own thoughts to unfold. Able to do that, I saw once again the much richer vista offered by the dream than I had anticipated.

The dream was brief and was presented toward the middle of the session. It had occurred on a Saturday afternoon waking Emma from a nap. "I was going to the prom with a group from school. I was wearing the wrong clothes, a shirt that didn't match. I decided to stay behind and said I'd meet up later. Then I was in a car, driving, feeling lost, trying to find the way. A dead body was in the passenger seat. I woke up thinking, That's a perfect description for how I feel."

Emma was sleeping a lot during the day, and I knew that she was preoccupied with suicidal thoughts. I asked her to describe the day up until the point she napped. "I had been trying to write a paper for school. I couldn't concentrate. I didn't understand why I felt so bad. I didn't know how to put it into words. I was carrying around something terrible." (She was already connecting to the dream imagery.)

I encouraged Emma to say as much as she could about that afternoon. "I felt I had bumped up against a wall. I started thinking about the school newspaper (she works on it), about something I hadn't done, what Mr. X (faculty adviser) would say to me, (the beginning of feelings of self-criticism).

"Was there anything else?" I asked.

"It was my first day taking P- - - - (an antidepressant). I felt sad about having to take it. Maybe my depression isn't bad enough" (to warrant taking it). Stronger feelings of self-criticism were emerging. "I feel so bad about being depressed."

At this point my thoughts turned to Emma's relationship with her father. I knew he was having difficulty with his daughter's need for medication, being someone who believed in wholistic and nonpharmaceutical treatment. I got off the track; that is, I began leading the dreamer a bit rather than following her own thoughts as Emma had not yet mentioned her father. I asked her how he had seemed to her the morning she began taking antidepressants. "He seemed sad," she responded, "but I had decided I wanted to give P- - - - a try."

At this point I had formulated some ideas about the dream. Emma's decision to take antidepressants had been an act of independence (like driving - an act of independence most teenagers long for) but she would have to bear the burden of her father's sadness about this (the dead body next to her.) But I held back my own thoughts and began playing back some of the images.

"Why do you think you were going to the prom on this particular afternoon, wearing a shirt that didn't match?"

"I think it says something about all my difficulties getting involved in school" (her shyness and reticence to speak in social situations and her almost total shutdown when she gets depressed). "Also, its probably a representation of my own self-criticism. I was thinking about Mr. X saying to me "What's wrong with you? Why are you still so shy? What is wrong with me?"

"And what about being in a car driving?" I asked. At this point I was surprised to learn that Emma had not gotten her learner's permit to drive, that she didn't feel ready to drive, she felt it was too much of a responsibility - supposing she hurt someone? "So. . . "I asked her," why do you think you were driving in this dream?" "Well," she replied," if I think of driving as a kind of independence, I don't like the idea of being dependant on anything. I don't like the idea of having to take a drug. I could decide not to take P- - - --- I could force myself to do the driving (that is, not take the medication) "but I'd be lost and carrying a big burden" (the dead passenger).

It became clear Emma was struggling with issues of dependency (wanting to force herself to be independent). In fact this was one of the central themes beginning to emerge - the style she had developed of smiling, being good, not causing trouble at home, repressing anger and hiding her own needs in order not to burden her mother (who struggled with serious illness) and her father (whom she saw as unhappy). In short, she was having difficulty accepting dependency on them, letting them see her depression (rather than singing to cover it), asking for help, (getting a therapist) rather than trying to manage it on her own, and wanting medication despite her father's feelings against it. Even her suicidal thoughts had much to do with not wanting to be a burden to her family. She wasn't a very good daughter, sister, etc. She was too depressed for that. What stopped her was that she knew an act of suicide would hurt them. She wanted their permission to end her pain. The dream was an important one as it helped Emma see clearly the heavy weight she had carried by trying to force herself to manage her depression alone. A week or two after this dream Emma allowed herself to be hospitalized briefly. I use the word allow in the sense that she experienced more fully than she had previously permitted herself the need to be taken care of - by doctors and nurses certainly, and by her family who began the process of family therapy to support her work with me. Shortly thereafter she withdrew from high school, relieving herself of the expectations and pressures she placed on herself, and she entered a hospital day treatment program for the weeks remaining in the school year.

As we concluded the session I took a moment to tell Emma what had just occurred for me - that I had initially seen the dream in a more superficial way her decision to take P- - - - was an act of independence (which in fact it was) that might distress her father - but that in holding back my own thoughts we had come to a much deeper understanding of her struggles with dependency. I did this to reinforce for her the emerging sense of her own authority and the power of a dream to do just this. She smiled with delight.

"It makes all the difference," Jung wrote, "whether the doctor sees himself as part of the drama or cloaks himself in his authority." Nowhere is this reminder to therapists more fitting than in our work with dreams.

Notes

1. Faculty member, The Comprehensive Course in Psychoanalysis, New York Medical College, 1950 to 1962.

2. In the early fifties I began exploring an idea that later became part of the dream group process I now use. I would begin the seminar by suggesting that we initially limit our knowledge to the age and sex of the patient, duration of therapy, and the dream itself. The class and I would then offer our own projections of what the dream might be saying about both the dreamer and the dreamer's relationship to the therapist. Despite some initial resistance to saying anything about a dream before the associations were at hand, it proved to be a surprisingly helpful exercise.

3. When time does not allow a more extended exploration of the dream, Walter Bonime (1962) resorts to what he refers to as "Headline" interpretation. This is an attempt to identify the one most helpful metaphorical statement pertinent to the work going on.

References

Bonime, W. The Clinical Use of Dreams. New York: Basic Books, 1962.

Ullman, M. Appreciating Dreams. Thousand Oaks, Calif: Sage, 1996.