Dream Work: A Psychoanalytic Perspective ______________________________________________________
as little as three nights [28]. This seems to indicate retrieval of dream content is not as difficult as predicted, especially when appropriate guidelines for facilitating dream recall are provided. Even in the presence of neurologic injury, dreams persist due to the brain’s ability to retrieve forgotten information through a variety of cues. PSYCHOANALYSIS As described previously, Freud’s discoveries about dreams began as he treated clients. Psychoanalytic theory and practice continue to evolve from clinical work, such as work done with clients who have had post-traumatic nightmares [29]. Freud, and many theorists since, excluded these nightmares from the analytic attention given to other dreams. The nightmares were understood as instigated by trauma, as representations of the essence of that experience, and as free of hidden meaning. Freud suggested that their repetition might represent either an attempt at mastery or at restoration of psychologic balance. Treated more like emotionally charged memories than “real” dreams, post-traumatic nightmares were excluded from any wish-fulfilling function. Lansky challenged these assumptions and argued that post-traumatic nightmares belong in treatment as do other dreams [29]. He asserted that they can be analyzed for hidden content, they are related to conflicts and previous trauma in the dreamer’s life, they recur in response to events in the dream day, and they fulfill wishes [29]. Noting trauma victims’ increased vulnerability and need for environmental support, he emphasized their fractured sense of self (i.e., feeling disas- sociated, disorganized) and included shame as a prominent, painful, and often underemphasized result of trauma [29]. He argued that post-traumatic nightmares are not simply a replay of the traumatic event. Typically, significant discrepancies appear between the patient’s report of the trauma and the dream scenario. For example, a veteran dreamed of being captured and beaten in a prisoner-of-war camp. Analysis revealed that although the veteran had witnessed horrifying atrocities, he was never taken prisoner. In childhood, however, he was a vic- tim of brutal beatings from his father. “Replaying” the horrors of war protected him from the more threatening helplessness, rage, and shame he felt at the hands of his father. Lansky also found that post-traumatic nightmares often cast the dreamer as an intact, competent person who, although in danger, is neither disintegrated nor shamefully out of control; the nightmare fulfils the dreamer’s wish for psychologic survival and sanity in the face of adversity [29]. This illustrates that careful, clinical observation can lead to important changes in treatment. It also supports the extension of Freud’s wish-fulfilling function to dreams such as these. NEUROSCIENCE Investigators find that aspects of Freud’s account of the dream- ing mind remain consistent with the available neuroscientific data [29]. Contemporary laboratory methods demonstrate that dreams occur with the activation of brain pathways that govern goal-seeking and appetitive behaviors. (REM sleep often
triggers this pathway, but dreaming can occur during other sleep periods as well.) Dreaming occurs only with activation of the motivational pathway, characterized by Freud as “wishes” (i.e., activation of goal-seeking impulses). Activation of brain mechanisms capable of creating a dream can cause arousal during sleep. Freud posed the argument that dreams are a response to something that disturbs sleep. Dreaming requires both a trigger and an activated motivational pathway. Freud metaphorically described dreams as similar to a new business: both entrepreneur (i.e., a stimulus or a trigger) and capital (i.e., wishful impulses or goal-seeking activity) are required. Neuroscientists describe dreaming as a regressive process. That is, dream images result from information or stimuli traveling backward in the perceptual system. (Sleep blocks passage for- ward and prevents motor activity.) These images are fed into the cortex as if they were coming from the outside. The brain system that processes incoming stimuli responds to this rever- sal by converting the information into visual images instead of waking thoughts. Because critical or reflective functions are inactive in sleep, the images are mistaken for real percep- tions. Freud wrote extensively about the regressive nature of dreams. He acknowledged that science in his time could not trace precise pathways for dream activity but stated confidently that “deeper research will one day trace the path further and discover an organic basis for the mental event” [2]. PSYCHOANALYSTS: AN OVERVIEW Psychoanalysts generally share an approach that includes free association (i.e., the patient’s unreserved report of ideas, memories, feelings), dream interpretation, interpretation of resistance, and interpretation of transference. Resistance refers to both the conscious and unconscious efforts that clients make to counter therapeutic progress. Transference recognizes the patient’s tendency to perceive the analyst as an important figure from the patient’s past. Analysts also consider countertrans- ference (i.e., both conscious and unconscious feelings stirred in the analyst by the patient). Creating a therapeutic alliance, respecting and understanding the ego’s defense mechanisms (characteristic and/or transient means of adjustment), and strengthening ego functions are additional common aims. Many psychotherapists recognize these processes and use this language. TRAINING As with many mental health disciplines, psychotherapists’ preparation includes years of postgraduate study and hours of supervised practice. Course content and supervisory require- ments vary by university, by discipline, and by professional license. Psychoanalytic candidates, regardless of professional license or previous study, have an additional requirement to complete a personal analysis before earning the title of psychoanalyst. Psychoanalytic training institutes define their own curricular and supervisory standards, but all demand a personal analysis, which is unique to this profession. The
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