Dreams Interpretation in Psychotherapy. Introduction
For almost over a hundred years, dreams have been incorporated into psychotherapeutic treatment. Studies have shown that even today, dreams are used in a variety of ways in therapies. Dreams are worked with in one out of every four therapy sessions, especially in psychoanalysis and depth psychology. Therapists generally find dream work to be very helpful. However, its effectiveness is fundamentally disputed. Although there are many individual reports, starting with Sigmund Freud, about the effectiveness of dream work in psychotherapy, there has been a lack of comprehensive studies on this topic since the 1990s. Therefore, since 1992, the American workgroup led by University of Maryland psychology professor Clara Hill has been researching the effectiveness of this therapy method. They first developed a model from existing dream work methods that is relatively simple to apply and versatile. Using this model, a six-week study on the impact of dream work in individual therapy was conducted. Sixty participants took part in a weekly 45-minute dream interpretation session. However, not all clients received the same treatment. One third worked on interpreting their own dreams, the second third worked on interpreting someone else’s dream, and the remaining participants discussed things that affected their daily lives. Those who worked on their own dreams found their method to be the most effective. They reported gaining self-awareness, although they did not feel an improvement in their complaints.
The U.S. researchers also explored which elements of dream work are the most helpful. It turned out that clients found the association phase, which involves connecting the dream to waking life, or working on a dream in written form, to be particularly effective. Additionally, the research team spent eight weeks on dream work with a group of women whose marriages had failed. The result was that the therapy increased the women’s self-esteem and they gained new insights about themselves.
In another study on short-term therapy, which included ten sessions, dream therapy showed as good an effect as other established therapy methods. Although the Hill group’s studies suggest that dream work is effective, many more aspects of this therapy form still need to be researched for their effectiveness. Proven medicine requires that all treatment approaches paid for by health insurance need to demonstrate their effectiveness. Therefore, it would be advantageous for therapeutic practice in the future if there were more studies on the topic of dream work.
Dream Interpretation Methods
Over time, a variety of dream processing methods have developed, and I would like to provide a brief overview of the most important ones. The focus of all these methods is on learning how to work practically with one’s dreams, either individually or in group work.
Free Association
Free association is an important component of psychoanalytic treatment and is based on the simple basic idea that the person who has described their dream should speak out spontaneously about everything that comes to mind afterward. Each of these thoughts could ultimately be related to the meaning of the dream. It does not matter whether an obvious connection exists from an external observer’s perspective. The question of whether the association might be embarrassing or negatively received by the listener should be disregarded as much as possible. Therefore, a pleasant atmosphere and a good foundation of trust between the storyteller and the listener are crucial in this method of dream work.
Dream Amplification
Amplification was used by C.G. Jung in his psychoanalytic dream work. This method initially moves away from the idea of dream interpretation and focuses intensively on the dream theme. For example, if the dream is about horses, the dreamer should explore this topic more closely by reading various books, fairy tales, or stories about it. Amplification has proven particularly effective in groups. When a group member’s dream is processed, the various associations and everyday experiences of the other members can contribute to illuminating the topic from different perspectives and stimulating new thought processes in the dreamer. The goal of this type of dream work is to both enhance the dream experience and initiate new cognitive processes through engagement with the dream theme.
Dream as Drama
The perspective of understanding the dream as a drama also comes from C.G. Jung. He believed that dreams follow an internal dramaturgy and analyzed the dream’s dramatic structure in four steps: exposition (introduction), desus (problem statement), climax (peak), and lysis (resolution). However, not every dream has this structure. Critics even claim that the dream only acquires a meaningful sequence through writing, thereby creating the dramatic structure. The actual structure of the dream is not the focus of this dream work. If parts corresponding to the actual dramatic structure are missing, they can be questioned. The second approach asks about the message of the drama. One can try to put oneself in the author’s shoes to get ideas about what messages the dream might convey and what the basic theme of the dream drama is.
Objective and Subjective Levels in Dream Interpretation
This method of dream work also traces back to C.G. Jung. It involves viewing the meaning of the dream from two different perspectives: the objective and the subjective. This method can be illustrated with an example: someone dreams of an argument with a man they perceive as arrogant and insensitive.
When examining the dream from the objective level, one might interpret it as a sign of the dreamer’s ability to handle conflicts. The dream reflects the person’s relationships with others in their waking life. From the subjective level perspective, however, the dream could be seen as a hint that the traits of the man in the dream are also present in the dreamer, even though they might not want to be like him.
Another example shows how closely linked the objective and subjective levels are: a person dreams of being chased by a monster. Viewed from the subjective level, the dream indicates how the dreamer deals with their own aggression. From the objective level, it relates to how they handle aggressive people in their environment.
When applying the thoughts of these two perspectives to our waking life, one can see how interconnected they are. A person who confronts and controls their own anger can better handle aggressive people around them. Therefore, it is advantageous to analyze everyday people from the dream from the subjective level to ask which traits of this person also apply to oneself. This approach can help one recognize bothersome traits within oneself, providing a good starting point for changing these old patterns.
Viewing the dream from the subjective or objective level can be very helpful in dream work. It not only establishes a connection to waking relationships but also reflects the strengths and weaknesses of the dream characters.
Dialogue with Dream Elements in Dream Interpretation
The principle of dialogue with various dream elements was developed by Friedrich Perls and is based on the idea of dream work with objective and subjective levels. Perls’ approach first requires the dreamer to identify with a person or element from the dream, as the dream should then be recounted from the perspective of that person or object. This enables the dreamer to better understand the situation and elements of the dream. In the second step, the dream-I engages in a dialogue with the chosen person or element.
The following example from Michael Schredl’s book “Dreams – Our Nightly Cinema” illustrates this concept:
Dream Segment: Another person and I (Michael Schredl) are playing frisbee on a glacier. The dreamer takes on the role of the other person: “I am playing frisbee with Michael. I throw to you and you have to catch. Conversely, I have to catch the frisbee when you throw it to me. There’s a constant back and forth.” Therapist: “Now please play the frisbee.” Dreamer: “I am being thrown back and forth and don’t know where I belong or what I want.”
Afterward, a dialogue is conducted with the dream-I. Either the dreamer or the therapist primarily asks questions to the dream-I. If no suitable question comes to mind, one can consider what question the dream-I might ask itself based on the dream action. For example, in a dream involving a monster, the question might be: “Why are you chasing me?” The dreamer then puts themselves in the position of the monster and listens to the inner responses that come to mind as an answer to the question. In this way, a dialogue can be conducted between the dream-I and the dream elements until a solution is found or even reconciliation occurs.
Finally, the dreamer should ask whether the feelings and thoughts associated with the dream elements also occur in their waking life. This establishes a direct connection between the dream and waking life.
Lucid Dreams
Lucid dreams, also known as clear dreams, occur during REM sleep phases, like all dreams. They fundamentally differ from other dreams in that the dreamer is aware they are dreaming and can consciously influence the dream action. Furthermore, lucid dreamers often remember their dreams particularly well after waking up and can confidently say they dreamt in color. In contrast, every second “normal dreamer” does not know whether their dream was in color or not. Additionally, most people find lucid dreams significantly more emotionally intense than other dreams. During lucid dreams, sensory perceptions and cognitive activities increase. Thinking, decision-making processes, and mental imagery play a central role during the dream. Studies have shown that pressure or pain is perceived less intensely, while skin stroking can be felt very strongly. Thus, dreaming and waking are closely related.
Lucid dreams are also often characterized by positive scenarios. Although some things appear just as they do in waking life, there are elements in the dream that are bizarre and unrealistic. Analyses have shown that lucid dreams often involve flying independently.
Before the western world paid attention to lucid dreams, they were already known as a form of meditation in many branches of Buddhism, especially Tibetan Buddhism. The author Saint-Denys was the first to publicly address the topic of lucid dreams and published a book about it in 1867, which was only translated into English in 1982. He trained himself to lucid dream, and after a year, he experienced three out of four dreams consciously, and three months later, almost every dream.
An example of lucid dreaming in German literature comes from Wilhelm Weygandt, who wrote a philosophical dissertation on lucid dreams. He observed the phenomenon of “false awakening” in his own lucid dreams—the state in which one thinks they have woken up but are actually still asleep. The sequence after false awakening can be associated with great fear, as one believes they are no longer dreaming. The Dutch doctor Frederik Van Eeden also published a book in 1913 about his experiences with lucid dreams. He recorded a total of 352 lucid dreams over fourteen years and introduced the term “lucid dream” into common usage.
Over time, lucid dreams became less prominent, considered unimportant, and were mocked. The phenomenon barely appeared in the psychoanalytic movement. Sigmund Freud, for example, did not know lucid dreams from his own experience, and only his student Sandor Ferenczi wrote a brief but insignificant article about lucid dreams.
In the 1960s, empirical dream researchers criticized that lucid dreams were not real dreams. They had learned that during sleep, there are short waking phases, such as when turning over in bed, which are not remembered the next morning. Researchers concluded that lucid dreams occur during these waking phases and are therefore not dreams.
In the late 1970s, researchers Keith Hearne and Stephen La Berge independently attempted to study lucid dreams in sleep laboratories and disproved the empirical research hypothesis. Participants were instructed to watch their finger move back and forth in a lucid dream. La Berge then asked his subjects to follow his finger movements with their eyes during sleep, and he was able to record strong eye movements on his measuring devices several times.
These voluntary eye movements were almost 100 percent different from the normal movements during REM sleep. However, the recordings of brain waves and muscle tone corresponded to normal REM sleep values, clearly proving the existence of lucid dreams and their occurrence during REM sleep.
EEGs documented that certain brain areas are as active as in the waking state. When the subjects were asked to sing during a lucid dream, the right hemisphere showed significant activity in the areas responsible for singing.
Researchers emphasize that anyone can learn to consciously control their dreams. There are various techniques, some more successful than others. Since lucid dreams occur more frequently in people with good dream recall, the basic requirement for learning lucid dreaming is to improve one’s dream recall. This can be achieved by regularly writing down dreams upon waking, keeping a dream diary.
Techniques for learning lucid dreaming can be divided into three groups. The first group includes “clarity-gaining” techniques, methods by which the dream-I recognizes that it is dreaming (according to Tholey and Utecht). The simplest form of this technique is called autosuggestion. Before falling asleep, one should repeat the phrase “Tonight I will have a lucid dream” several times. LaBerge’s MILD method builds on this technique: “The next time I dream, I want to remember to recognize that I am dreaming.” This approach is particularly effective when the phrase is memorized after waking from a dream in the morning. Another principle is hypnotic suggestion, based on the American anthropologist and writer Carlos Castaneda. It involves imagining actions during the day that one plans to carry out in the dream. If the dream includes this action, it can lead to awareness. However, experience has shown that this method is very difficult to achieve and thus ineffective.
Paul Tholey’s reality-check method has proven to be the most successful technique so far, in which one asks oneself several times a day in various situations: “Am I dreaming or am I awake?” This practice aims to train questioning one’s current state of consciousness, developing a more critical awareness that reacts more sensitively to dream situations over time. Depending on the training intensity, the dream-I will sooner or later begin to ask the same question in the dream. However, this training should be done with some patience, as it can take several months to experience the first lucid dream. The spin test is the most reliable method, where the dream-I spins around its axis and then stops abruptly. If the images continue to spin around for a while, it is very likely that one is dreaming. Such “tests” also prevent loss of awareness through false awakening, as they repeatedly “remind” the dream-I that it is dreaming.
“Clarity-maintaining” techniques are based on the idea of not losing consciousness while falling asleep. La Berge’s WILD technique involves counting while falling asleep: 1…I dream, 2…I dream, 3…I dream, and so on. The goal of this technique is actually contradictory, as one tries to relax the body and fall asleep while keeping the mind awake. There are no studies yet proving the effectiveness of this method. Additionally, some researchers aim to make the dreamer aware they are dreaming through external stimuli, such as acoustic signals. However, this approach can also cause the person to wake up. The most effective methods have been light flashes emitted by LEDs attached to sleep masks or mild electric shocks.
The applications of lucid dreams are also very diverse. The body-mind interaction that occurs during lucid dreaming opens up many areas for exploration. Researchers tested how far imagination extends in dreams by attempting to perform waking-life activities in dreams.
Moreover, it has been found that training complex sports activities, such as skateboard tricks, in lucid dreams can improve performance in waking life. This type of training works particularly well in sports like high jump or gymnastics. Lucid dreams can also be used in psychotherapy, as confrontations with dream characters can be resolved, and reconciliations can be achieved in dreams. Thus, lucid dreams can also provide a solution to nightmares, as being aware that one is dreaming removes the fear of the dream events.
In Tibetan Buddhism, the technique of lucid dreaming is seen as a form of meditation in sleep, supporting spiritual development.
In summary, lucid dreaming is an exciting phenomenon in many ways and offers a new possibility to better understand one’s own psyche, alongside “classical dream work.”
Nightmares
Almost everyone knows it or has experienced it at least once in their childhood: you suddenly wake up drenched in sweat and breathing shallowly from a terrifying situation, such as being chased by a group of criminals or watching a loved one die before your eyes. Only after a few seconds of relief do you realize that this scene was “just” a nightmare.
However, not all “bad” dreams are considered nightmares. A dream is only classified as a nightmare when its content provokes such strong negative emotions and deep emotional impact that it wakes the dreamer from sleep. Shortly after, one often experiences immobility or inability to act and feels completely devastated.
Nightmares occur more frequently in children and adolescents. Common dream motifs include being chased, one’s own death or injury, the death or injury of others, or falling into a bottomless pit. However, nightmares are not uncommon among adults either. A study even suggests that 10% of adults experience a nightmare on average once a month, and 70-90% can still recall a nightmare from their childhood.
Over time, scientists have also discovered that there are three different types of nighttime awakenings, each requiring different therapeutic approaches:
- Nightmares occur most frequently between the ages of 6-10 years and usually happen in the second half of the night, between midnight and the early morning hours, during REM sleep phases. People can remember the dream content particularly well and clearly afterward.
- Pavor nocturnus, also known as night terror or sleep terror, typically affects children aged 3-7 years and primarily occurs in the first half of the night during deep sleep. Since the brain does not fully awaken during pavor nocturnus, the fright often leads to sleepwalking, during which the person is completely disoriented and unresponsive. The next morning, the nighttime events are often forgotten.
- Post-traumatic recurring dreams are a special case. They stem from experienced trauma, such as sexual abuse or natural disasters, and occur in both REM and NONREM sleep phases. The dreamer remembers the contents very clearly the next day. The age is event-dependent and thus varies widely.
In recent years, efforts have been made to clarify the factors of nightmares, definitively disproving the 19th-century notion that nightmares are caused by breathing difficulties. The possible causes of nightmares can be divided into different groups. For example, a Finnish study found that genetic factors play a role in the frequency of nightmares.
People with a so-called “thin boundary,” i.e., particularly sensitive, creative, empathetic, and open individuals who are very susceptible to stress, are more frequently plagued by nightmares than others. According to another study, stress alone can also be a reason for these nightly horror scenarios. Traumatic events that cannot be processed often contribute to the development of nightmares. In many cases, this leads to post-traumatic stress disorder (PTSD), where nightmares are a common symptom. However, nightmares can also occur without this disorder. Another possible cause of nightmares can be medications such as antidepressants.
Since nightmares are now known to be a phenomenon of fear, one should confront these fears to learn to cope better or even overcome them entirely. If you do not face them, they become more entrenched, and it becomes increasingly difficult to confront these fears.
Dream Content Analysis
To understand what dream content analysis is and why it is needed, I will explain the process using a simple example. Suppose a psychotherapist discusses with her scientifically working colleague her impression that the theme of “rejection” appears more frequently in the dreams of depressed patients than in those of healthy individuals. While this statement sounds entirely plausible, it must be scientifically verified to be presented at a dream research congress. To do this, the researcher, along with her colleague, creates a catalog of criteria that fall under the theme of “rejection.” Based on these criteria, the dream reports of 100 depressed patients and 100 healthy subjects can then be examined to see whether elements of rejection are present. The reports are evaluated by a person who has no information about the study and does not know which dreams belong to depressed or healthy individuals. The evaluator is only familiar with the criteria for rejection and checks their presence in the dream reports. The characteristics of the reports are converted into numbers, which are then statistically analyzed to calculate the probability that the result was due to chance.
My first task in the scientific sleep laboratory was to evaluate the dreams from a series of studies conducted by the Zurich Research Institute. These studies aim to answer the scientific question of whether dreams really process and consolidate what has been learned during the day.
Approximately 400 subjects were shown a series of about 100 images, each paired with a word, before going to bed, which they were to remember roughly. The subjects then went to bed; however, part of the group was read some of the words again while they slept, to determine whether the learning process was even more effective in this case. My task was to evaluate their recorded dreams, taking into account these words and several other criteria. Mr. Schredl provided me with a seven-page “evaluation guide,” listing and explaining all these criteria:
First, the reality character of the dream is to be assessed, i.e., the extent to which the dream tells a realistic or fantastical story. Four levels can be distinguished:
- Realistic: The dream’s action is possible in waking life and occurs in the normal, everyday world of experience.
- Dream Example: “I am walking in the woods with a group of people, suddenly one member is missing. We all wonder where they are.”
- Inventive: Many elements of the dream come from waking life but occur in unusual sequences and connections, yet are still realistically possible.
- Dream Example: “Blood was drawn from a cut on my wrist. For some reason, it couldn’t be taken from the other side. Instead, I had to name household items as a test.”
- Partly Fantastical: The dream contains one or two fantasy objects, and bizarre connections or actions occur that are impossible in waking life.
- Dream Example: “I go shopping in the pedestrian zone with swim floats, and the buildings bend.”
- Fantastical: The dream contains many fantasy objects and bizarre connections or actions that are impossible in waking life.
- Dream Example: “I fly in a rocket and land on a cloud where a soccer game is taking place.”
Evaluating Feelings in Dream Content Analysis
When assessing feelings, one should first pay explicit attention to the emotional expressions of the dream-I, but also consider emotional moods that become clear through actions or situations. The expressed positive and negative feelings are classified on a scale from 0 to 3. A 0 means the dream is neutral, a 1 stands for mild feelings, a 2 for moderate feelings, and a 3 for very intense feelings.
The individuals who appear in the dream scenario are also recorded. Here, individual persons (e.g., father, child, or friend) are considered. Groups perceived only as a whole, even if the number of members is, for example, eight people, are counted only as one individual. If individual members of this group appear later on, they are again considered as individual persons. If children appear in the dream, a 1 is noted; a 0 indicates no children in the dream. The same procedure applies to animals appearing in the dream, including primal or mythical creatures.
Sporting activities performed by the dream-I, as well as the general theme of sports when it appears in the dream, are also considered in the evaluation. If food is mentioned, talked about, or thought about in the dream, this must also be recorded in the protocol.
Motorized vehicles such as cars, motorcycles, public transportation, and trucks that appear in the dream are given attention. If a stream, river, canal, pond, lake, or the sea appears in the dream, this is recorded under the category “water.”