The Integrative Therapist and the Dream

by Margaret Brady

While many humanistic and integrative therapists are fascinated by dreams on a personal level, they may groan inwardly when a client presents with a dream. Unlike our Freudian or Jungian colleagues, humanistic and integrative therapists often lack a framework for working with dreams and may feel unqualified to engage with them.

Of course, there are reasons for this. With the notable exception of Gestalt, dreams have traditionally been avoided in most humanistic and person-centred psychotherapies. This may be due to the perception of dreams as unconscious processes that require an ‘expert’ to interpret, in opposition to the person-centred view that the client is the expert in his or her own life. In addition, person-centred therapy tends to posit the therapeutic relationship rather than the client’s unconscious inner world as the locus of therapeutic change, which may lead to a preference for the ‘here and now’ over the telling of dreams.

Dreams have been an important part of my own inner life for many years now, and I have studied them from many perspectives, ranging from the mythological and archetypal to the creative, spiritual and cultural. However, when I attempted to integrate my dreams into my psychotherapy journey (as client), I was often left feeling frustrated. It seemed very difficult to integrate my felt sense that the stuff of my dreams was important and significant, with my internalised expectation that therapy should be about the ‘here and now’ daytime issues and the therapeutic relationship. As my training progressed I realised that therapy is what we make it, but I was still left with the lingering feeling that something was missing.

The completion of my training required an MSc thesis (Brady, 2012) and I seized the opportunity to delve again into the questions that still intrigued me. Did dreams have a place in humanistic and integrative psychotherapy? What was it like for clients to share dreams? Was this experience significant for them? I designed and completed an interpretative phenomenological analysis of the experiences of four clients who had shared a dream with their humanistic and integrative psychotherapists. Interpretative phenomenology typically deals with a small number of cases in great depth (an idiographic approach), and investigates both the nature and significance of an experience – exactly what I was after (see Smith et al., 2009, for methodological details). As these things tend to be, it was a long process. I carried out an extensive review of the literature on dreams in psychotherapy and discovered only five studies with the client’s experience of sharing a dream as a main theme (Boyd, 2005; Boyd, 2007; Crook & Hill, 2004; Crook-Lyon & Wimmer, 2005; Tien et al., 2006). only two of these (Boyd, 2005; 2007) investigated the personal significance of the dream sharing for the client. Clearly, the area was open for further research. So, I interviewed, I transcribed, I coded, analysed, re-analysed, drew out themes, combined themes, separated themes, drank a lot of coffee, and constantly questioned my own assumptions and findings. Gradually, strands began to emerge, and in the end, this is what I found:

• The dreams shared in therapy were exceptional.
  
• The dream sharing experience was associated with feelings of
  vulnerability.
  
• The therapist’s positive response to the dream enhanced the
  therapeutic relationship.
  
• Different methods of dream work proved equally therapeutic.
  
• Dream work provided insight into personal process and helped
  identify therapeutic issues.
  
• The dream sessions were highly valued by the clients.

The rest of this article will discuss these findings in more depth, as well as their implications for professional practice.

The dreams shared in therapy were exceptional
It was notable that the dreams shared by the participants in this study were not ‘normal’. They described the dreams as extraordinarily bizarre, vivid and intense, persisting unusually in the memory and described using terms such as ‘dark’ and ‘horrendous’.

Research has shown that dream emotion tends to be negative (nielsen et al., 1991), and in these cases it was the emotional disturbance caused by the dreams that prompted the participants to bring them to therapy – as one participant said, ‘I was bringing [it] because I was terrified’.

It is now widely accepted (Hobson & Schredl, 2011) that much dream content reflects the inner life of the dreamer. In these dreams, although the imagery was bizarre and discontinuous with the daily lives of the dreamers (from corpses to castles, cracking ice to rotting trees), there was, as Hartmann (2011) suggests, a strong emotional continuity between the dream feelings of anxiety, panic, sadness and frustration and the waking emotions of the dreamers. This is interesting in light of research suggesting that dreams may have an emotionally integrative function, helping us to process difficult emotions as we sleep (Edge, 2010).

We often think of dream images as being strange in nature. However, dream content analysis studies have found that up to 90% of dreams are prosaic and contain no elements that would be out of place in waking life (Dorus et al., 1971). Bizarre dreams are in fact unusual, which may explain why they stood out so greatly in the minds of these participants.

The exceptional nature and the emotional impact of the dreams made them important to the dreamers. Therapists should be aware that if a client brings a dream, particularly if it is either upsetting or bizarre, it may be unusually significant to them and indicative of the processing or integration of difficult emotions.

The dream sharing experience was associated with feelings of vulnerability

The participants in my study all felt vulnerable about sharing their dreams, and were worried about being dismissed, or thought stupid, selfish or self-indulgent. Sharing a dream required trust in the therapist.

Crook and Hill (2004) found that the most common reason clients did not bring dreams to psychotherapy was, unsurprisingly, that it never occurred to them. However, some of the other factors that prevented the participants in that study from bringing dreams were remarkably similar to the reservations overcome by my participants: feeling that the therapist was not interested, fear of ridicule, discounting the importance of dreams, fear of what might emerge, and lack of trust in the therapist. Rejection of a client’s dream, for whatever reason, might confirm these fears and thus impede the development of the therapeutic relationship.

One theme that emerged strongly in the interviews, but not at all in the literature, was the feeling that talking about dreams was self-indulgent or selfish. It would be interesting to discover whether this feeling would translate to participants of different gender or culture (all of my participants were Irish and female). The fear of being judged by the therapist as self-indulgent or selfish brings up wider issues of trust. By being aware that presenting a dream may be problematic for the client, and by warmly receiving the dream (as with other therapeutic material) the therapist creates confidence and opens the doors for further disclosure. one woman’s reaction to her therapist’s treatment of her dream illustrated this clearly: ‘I felt if she can handle this, she can handle anything’.

There is disagreement in the literature regarding a possible correlation between positive attitudes to dreams on the part of the clients and positive outcomes to dream work sessions (Hill et al., 2006; Tien et al., 2006). My study found no suggestion of correlation. Despite significantly greater reservations and initially negative attitudes to their dreams on the parts of two of the participants, all four felt that they benefitted from the dream work and their initial attitudes did not seem to determine the level of benefit.

The therapists’ positive response to the dream enhanced the therapeutic relationship

The therapists’ response to the dream defined the nature of the experience for the participants. As discussed above, the act of dream sharing was associated with feelings of vulnerability, and the therapists’ openness to and willingness to engage with the dream led to the participants feeling accepted in a very significant way. It affirmed to them that their therapists found their dreams, and by extension themselves and their other concerns, worthwhile. The disclosure of sensitive material (the dream) was a challenge which the therapist, by meeting, could use to deepen and strengthen the relationship. As one client said: ‘I felt that if she’d listened to my dream that she’d listen to lots of other things and take them seriously too’. This is in line with findings (Boyd, 2005; Hill & Goates, 2003) that dream work can be effective in strengthening therapeutic alliance.

The importance of the therapists’ response to the dream shows that dream work is not incompatible with a relational approach to therapy. Indeed, the humanistic view that the therapeutic relationship is the locus of change (Mearns & Thorne, 2000) is borne out by the experiences of these participants, who emphasised relational qualities such as empathy, unconditional positive regard, acceptance, respect, connection, being taken seriously, being understood, and being listened to. Similarly, research has shown that the relationship is one of the key factors in successful therapeutic outcome (Ardito & Rabellino 2011; Norcross 2002). The possible contribution of dream work to the therapeutic relationship should not be discounted but incorporated into the body of knowledge so that humanistic and integrative psychotherapy can evolve to better meet the needs of its clients.

Different methods of dream work proved equally therapeutic

Although the therapists in my study approached the dreams in different ways, they all worked in ways that their clients perceived as therapeutic. This suggests that perhaps the specific technique used to engage with a dream is less important than the general willingness and competence to engage with it at all. This view is supported by findings from Hill et al. (2001) that dream interpretations reached by treating the dream as a reflection of waking life concerns (for example, an associative approach), and interpretations reached by treating the dream images as a reflection of parts of the self (for example, a Gestalt approach) are equally effective.

It is unclear whether the humanistic and integrative therapists described in this study are typical of a wider sample in their attitudes to dreams. They may not be. The literature shows that many therapists avoid mentioning dreams because they do not feel competent to work with them (Schredl et al., 2000). This would suggest that much therapist anxiety around dreams is due to lack of basic training, a conclusion supported by findings that therapists who have been trained in dream work feel more competent and are more likely to work with clients’ dreams in therapy (Crook & Hill, 2003).

Dream training need not be lengthy and complex. When Crook and Hill (2003) surveyed therapists to find out what exactly they did when working with a dream in therapy, they found that the most common activities were the simplest: listening to the dream, exploring its connections to waking life, asking clients to describe dream images in more detail and collaborating with clients to construct an interpretation. More specialised activities such as encouraging the client to re- experience feelings in dreams, changing the dream, acting out parts of the dream, or interpreting with reference to archetypes were engaged in only by a minority of therapists, and art therapy was not mentioned at all. This suggests that most of the dream work that occurs in therapy is not particularly elaborate, and might not need to be so in order to be of benefit to the client.

Two of the therapists described in this study used a Gestalt approach to dreams, although one therapist also used elements of art therapy, and this was a third therapist’s primary approach. All three therapists might be said to have had a humanistic approach to dreams in that they adopted a supportive role in helping their clients to explore their experience. The clients led the experience. only one therapist in this study offered an interpretation, and it was unclear whether this was a spontaneous reaction or part of a conscious approach to working with dreams. The client experienced the interpretation as proof of how well her therapist understood her, ‘I suppose I would have felt that he really got that from the sense of knowing me…as well as being really able to look at a dream and interpret it’, but from a humanistic perspective, interpretations can be problematic. Firstly, they turn the dream into something that requires an expert to decode: the client is no longer the expert. Second, while an interpretation that is meaningful for the client can foster a deeper connection, an interpretation that is either inaccurate or which the client is not ready to hear can have the opposite effect, either alienating or silencing the client.

Dream work offered insight into personal process and helped identify therapeutic issues

All of the participants found that working with their dreams provided insight into personal process and that the issues highlighted by the dreams were relevant to therapy. In each case, the participant came to understand herself and her situation differently as a result of working with her dream. For example, one participant’s dream showed her how she had been affected by her father’s breakdown and also highlighted how isolated from her family she felt. Another, dreaming of herself as a small child standing alone, came to recognise the sadness, loneliness and disappointment of her childhood. The dream of a third participant, falling through ice, and holding a bird that began to fly away, showed her that she had the power to create changes and resolve ‘impasse’ situations in her life, while the fourth, dreaming herself trapped in a collapsing tower, gained insight into her fear of being trapped and overwhelmed by potentially devastating emotions.

In all cases, the participants had a strong subjective positive reaction to the insight, which might be described as an ‘aha moment’ or a ‘felt sense’ (Gendlin, 1986; Perls, 1969). Their language in describing this was unambiguous. For example, one client felt that her therapist’s interpretation ‘completely made sense’, while another stated ‘as I described things then I understood what it meant’. Another participant described the dream work as ‘enlightening’, while for the last, ‘that really clicked then, I thought that’s absolutely it’. Although some clinicians feel that unconscious resistance or a need to please the therapist might make the ‘aha moment’ unreliable as a way of judging a dream insight (Shafton, 1995), for a humanistic therapist the ‘felt sense’ of the client is a most valuable tool in assessing the value and direction of the work.

The therapists in this study were able to work with the dreams to help their clients gain insight into key issues; for example, when one therapist reflected back to her client the loneliness of the younger dream self, the client recognised that this was how she had felt for much of her childhood. other studies have also found dreams to provide a source of clinical material for the therapist (Eudell-Simmons & Hilsenroth, 2007), and have found that dream work can facilitate awareness, insight, understanding or recognition in psychotherapy (Hill et al., 1993; Hill et al., 2000; Zack & Hill, 1998).

Finally, the speed with which the dream work enabled the participants to reach insight on important issues was notable. In all cases, considerable progress was made in a single session, and this was especially remarkable in the two cases which involved the second session with a new therapist. This finding is consistent with other studies, which have found that dream work can help clients overcome defences (Kramer, 1991) and reach core issues in psychotherapy quickly (Boyd, 2005; Cogar & Hill, 1992). This finding is particularly relevant to brief therapy and suggests that the potential of dreams in this context should be recognised, especially where there is client resistance or inability to identify core issues.

The dream sessions were highly valued by the participants

The dream sharing session stood out as a special experience for all of the participants, described in terms such as ‘powerful’ and ‘profound’. one participant remembered thinking after the session ‘my goodness, the amount of work we’ve done in this session today’. Another described the experience as a ‘turning point’ and ‘the start of a big piece of work’, made all the more significant by her previous scepticism: ‘I had always thought that dreams were maybe boring or pointless, it was a huge thing to happen for me’. While the literature shows that ratings in client insight are high after dream-based therapy sessions (Heaton et al., 1998), and that dream work can be effective in strengthening working alliance and increasing session depth (Hill & Goates, 2003), little has been written on the subjective perception of the client’s experience, and this stands out as an area that would benefit from further research.

Conclusions and implications

I was in some ways surprised by the research. I had unconsciously expected to hear experiences that mirrored my own and was taken aback to hear such positive experiences. The dream sharing experience was highly valued by the participants, and judged to be significant in two main ways: it served to deepen and strengthen the therapeutic relationship, and also provided insight into personal process, identifying key issues for therapy. It was notable that the different methods of dream work used by the different therapists all proved equally therapeutic for the participants.

There are various implications of these findings: firstly, that there are benefits to be gained on several levels from working with dreams; secondly, that technique is less important than the ability and willingness to work with dreams in any therapeutic way; and finally, the potential of dream work to contribute so strongly to the therapeutic relationship suggests that its absence from basic training is a missed opportunity. Perhaps it is time for humanistic and integrative psychotherapy to reconsider its stance on dreams. A model of dream work rooted firmly within a humanistic and integrative framework – whether Gestalt-based, or integrating several models – would address the problem of therapist reluctance and apprehension about engaging with dreams. Teaching such a model in basic psychotherapy training would do much to see dreams demystified and brought back from the realm of the esoteric to the everyday therapy room.

Margaret Brady MIAHIP MIACP is a humanistic and integrative psychotherapist based in Dublin.

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