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The importance of dreams and the process of psychotherapy

The role of dreams, and the importance of the analysis of dreams, is given greater or lesser attention in any given psychotherapy process, depending on the school, or schools, of thought which influence how a particular psychotherapist works. Added to this, it is not everyone’s natural inclination to bring dreams into the therapy session, and there can be a feeling of resistance or a defensive lack of interest in dreams. Whether dreams play a central role in anyone’s therapy process or not, it can’t be denied that they are a crucial part of living. Dreams are what and how we think when we are asleep. They relate closely to what and how we think when we are awake, although this is often not clear when we wake from a dream. It is also often the case that on waking from a dream we are filled with a feeling that certainly wasn’t there, or wasn’t necessarily there, when we went to sleep. Such feelings as fear, anger, sadness, shame, confusion and panic can often accompany the sleeper as he or she emerges from a dream. And so it seems clear that there is something about dreams that relates very closely to who we are as people, and to what is happening now, and what happened in the past. Sometimes we find it difficult to think about our dreams, because unlike our daily thoughts, dreams are not regulated by the same kind of internal control or censorship, and so we may find that our dreams take us to places that we would prefer not to go. For these reasons, although we may struggle to acknowledge it, dreams can play a central role in any therapy that hopes to deepen and enrich our understandings of ourselves.

Although thinking and theorizing about the analysis of dreams predates Sigmund Freud, he is considered the pioneer in the development of understandings relating to the meaningfulness of dreams. Freud delivered dreams to their rightful place in terms of psychological theory, with his statement that dreams are the “royal road” to the unconscious mind. Dreams, for Freud, represented a portion of human existence which conveys to the waking mind those parts of our lives which we struggle to think about. In Freud’s day the emphasis was on repressed impulses, such as sexual and aggressive impulses, which, if we were to think about them during the course of waking life, would cause us to feel shame. In light of this Freud defined dreams as activities of the mind which are primarily about the fulfillment of a wish; to be able to experience, feel and enact something that we otherwise might prohibit in the course of waking life. Although the landscape of psychology has changed considerably since Freud’s times, his insights remain invaluable as we continue to think about the activities of the human mind. Current psychotherapeutic work, especially work that is less influenced by Freud’s thinking, would tend to give less consideration to the notion that dreams are about one particular purpose, such as wish fulfillment, and that they are an essential meaning-making activity from which we can learn a lot. It is often noted that when we dream, the images and objects in the dream sometimes make little sense to us; it is as if they belong to different and foreign world. The word used most commonly to capture this experience is that of “symbolism”. Just as in everyday life we may use a simile or a metaphor to say what something is like by comparing it to something else, so do dreams give us a visual representation which is aimed at revealing to the conscious mind what something is “like”. And so the deep dark ocean, the snake, the rising sun, the falling airplane, the unbridled racing horse, represent something of our experience of ourselves within our world, by conveying a sense of what it is like to feel like we feel within ourselves. Very often, and echoing Freud’s thoughts, dreams consist of activities, images, desires, fears, memories and thoughts which we struggle to allow ourselves to experience consciously. That which causes too much discomfort to think about can find its way into a dream, where it represents itself in a symbolized form, for us to make meaning out of. Importantly, in terms of the process of psychotherapy as it is thought about currently, this process of making meaning out of a dream’s content is not reliant on an “expert analyst” who knows what all the symbols mean and is able to tell the patient what their dream is trying to say. Rather, the process of thinking about dreams is entirely a part of the relationship between therapist and the patient. It exists in the same context of trust, in which the patient, in describing their dream, will be influenced by the extent to which they feel safe enough to talk about the difficult and potentially painful and unsettling dream content. The patient and therapist will then work together, thinking very carefully about the dream. The words used to describe the images in the dream, the images themselves, the atmosphere in the dream, the size and shape of rooms, the position of the sun, the particular colour of the walls, what the patient was wearing, if he or she was present in the dream. All of these and countless more minute details which form part of the universe of each dream will be spoken about in an effort to derive a complete picture of the dream. In the process of trying to understand the dream, the patient and therapist would wonder about what each part of the dream means, for the patient him or herself. With this in mind we are thinking about the “associated” thoughts and memories. This makes me think of that, and that makes me think of that. Through the process of thinking about the associations to the dream we are sometimes able to penetrate the layers of symbolism and get to a clearer sense of the dream’s message. Sometimes we are quite fortunate in having experienced a dream which itself seems quite clear, which we can recall clearly, and which we have a very strong feeling about, in terms of what it means for us. Of course it is very often the case that our memories of dreams are vague and confusing, and we are sometimes able to recall nothing more than a single image. That’s also part of the process, and usually represents the notion that we are trying to develop a closer relationship with our dreams, but something is making it difficult for us to do so. Some part of us is resisting our knowing about another part of us. Psychoanalytic psychotherapy speaks about this in terms of the role of the defences to keep certain thoughts and feelings in the unconscious, typically because the emergence of such thoughts and feelings into the conscious mind could cause pain, anxiety, shame, and a recollection of memories which we have tried to put away. Freud himself suggested that the resistance to recalling dreams, the resistance to understanding that which we recollect, and even the fact of waking from the dream, bringing the dream to a definitive end, forms a crucial component of what we think about when we think about dreams in the context of psychotherapy. The aim of such work, as I see it, is not only to explore and deepen the meaning which we make of ourselves as we live our lives, but also to free ourselves up, to become able to think about ourselves in a more accepting, compassionate and open way. This process could and often does impact positively on how we relate to ourselves and others in our lives.

What works for you?: A general description of the psychoanalytic approach to psychotherapy

One of the strengths of a practice such as this one is that it consists of six psychotherapists who each have a unique way of thinking about and approaching the work that we do. Psychotherapeutic practice has many many faces, even though there are certain grounding principles which unite the efforts of psychotherapists. But the fact is that even though we all call ourselves psychotherapists, the actual work that we do can be vastly different, and so what happens in each separate space is not only a matter of individual creativity, but also of a choice made by each psychotherapist to follow a particular path based on what we believe to be therapeutically useful. Of course this is directly affected by each person who enters the room, and so the nature and quality of the work done is, in the end of the day, affected by a mutual and reciprocal relationship which develops between therapist and patient. Aside from what happens in the therapist-patient relationship, there is nonetheless the question of "What kind of psychotherapist are you, and does that work for me?" that needs to be thought and talked about when a therapy process begins. With this in mind, and with a view to taking some ownership of the therapy process, I would always encourage people to do a bit of research before entering a process, to explore the forms of therapy that they feel would work for them, and to search for a therapist who engages with these forms of therapy.

The form of therapy that I believe in, and that I offer to the people I work with, is very broadly defined as psychoanalytic psychotherapy. Psychoanalysis, as a form of treatment that has about 150 years of history, is defined in various ways by a number of schools, branching out from classical Freudian thinking. As a method broadly defined, psychoanalytic psychotherapy engages with various levels of depth experience. Firstly, and perhaps most centrally, psychoanalytic psychotherapy concerns the process of drawings links between conscious and unconscious experience; links between the things we know about ourselves, the things we know but don't think about (because it is too painful or anxiety-arousing), and the things we don't know and cannot think about (because it is potentially traumatic). This is why the beginning phase of a psychoanalytic psychotherapy is often focused on asking very detailed and specific questions about history of relationships, family patterns and attachments to the primary people in our lives, as this kind of historical information is an important route to getting to know our unconscious mental life.

Psychoanalytic theory maintains that the vast proportion of mental life is unconscious, meaning that there is much that we don't yet know or understand about the Hows and Whys of our thoughts, feelings and behaviour.  One of the most fascinating and ongoing experiences that we have during the course of a psychoanalytically-oriented psychotherapy is that of discovery, sometimes shocking discovery, as we become acquainted with parts of ourselves which we did not know about. In this sense the psychoanalytic process is one of developing an awareness of - and relationship with - as yet unknown parts of the self, and doing this within the context of a relationship with the therapist, in which there is enough safety and trust for this development to happen; a feature which of course applies to all forms of psychotherapy. For psychoanalytic psychotherapy, however, there is a strong emphasis placed on the dynamics of the therapist-patient relationship. Here we have the second core aspect of the psychoanalytic process: what happens to you, what happens to me, and what happens in between us in the 50-minute hour.

 

The basic principle in psychoanalytic psychotherapy, as far as the relationship is concerned, is that our internal world influences how we relate to people, and so the kinds of relationship conflicts and struggles that take place out there in the world are likely to find their way into the therapy, where they play out in the space between therapist and patient. When this transference of feelings, from the outside in, takes place, we have a unique opportunity to examine and reflect on the known and as-yet-unknown thoughts and feelings taking place in you, me, and us. Often this kind of work can cause a lot of anxiety, especially when there is not enough trust in the therapeutic relationship. This is one of the reasons why psychoanalytic psychotherapy emphasizes the importance of long-term, routine, weekly work, that gives absolute respect to the importance of trust and safety as something that develops over time.

Beyond exploring the ongoing here-and-now dynamics of the therapeutic relationship as a vehicle for developing understandings of the self, psychoanalytic psychotherapy places a very strong emphasis on the notion that therapy mimics and replays the developmental process that we all undergo from infancy to adulthood. The idea here is that the deepest level of psychological injury is that which occurs to us when we are most vulnerable, and least developed. Any form of deprivation, neglect, loss, separation or trauma occurring at this level therefore forms a central part of the therapeutic search, and is considered as an experience which disrupts our development. The work of psychoanalytic psychotherapy is to recognize this level of disruption, and provide the patient with a safe enough relationship which can enable these undeveloped parts of the self to grow.

With considerable emphasis being placed on the notion of developmental trauma, psychoanalytic psychotherapy attends to the various ways in which we defend ourselves against the awareness of too much pain and anxiety. Coming to understand our internal defensive processes, and coming to know how these defensive processes play out in our behaviour, thoughts, feelings and relationships, forms a central part of the focus of the work. With this in mind, and considering the emphasis on psychoanalytic work as a developmental process in itself, it is an important feature of the work that it is not too focused on being directive, and on having a specific plan or structure in mind. The work does not involve any particular step-by-step activities, it is not shaped according to a particular framework other than the absolute boundary of same time, same place, every week. as such, it is a very carefully boundaried, but not particularly directed approach. Often patients struggle with this, and it would be an important aspect of the decision to enter therapy that this aspect is known and understood. And so the question "What works for whom?" is absolutely relevant, and is one that we need to ask before entry into therapy, for the sake of feeling ownership of the process, and knowing that you have arrived at the place you intended to arrive at when you walk into the room. The next big question, and one that I might think about in the next newsletter, relates to the actual fit between the person of the patient, and the person of the therapist.