Dreamwork

Dreamwork is a broad term used to describe the exploration and incorporation of dreams in psychotherapy. Modern dreamwork models hold true to the tenet that any meaning one can pull from a dream should be personal to the dreamer. Mental health professionals who integrate dreamwork into their practice often use it to help people problem solve, gain self-awareness, or improve overall well-being. 

• Understanding Dreamwork
• Development and History
• The Science of Dreams
• Theory of Dreamwork
• Exercises in Dreamwork
• Dreamwork Training
• Criticisms and Limitations of Dreamwork

he Understanding Dreamwork

   Dreamwork is a key component of several different therapeutic models and can be used as a self-help technique or as part of a broader therapy program. The term dreamwork can refer to the dreamwork field as a whole or to the technical process of using dreams in therapy. Though many psychotherapy frameworks use dreams in one form or another, not all models use them in the same way.

The most important distinction between dreamwork and dream interpretation is that in dreamwork, the therapist does not analyze the person's dreams or provide a clear interpretation. In dream analysis or dream interpretation, the therapist is the expert on the the symbolism and meaning of the dream. In dreamwork, the therapist acts as a guide in the exploration of the dream, allowing the dreamers to discover meaning for themselves.

During a dreamwork session, while the dreamer is sharing a dream, the therapist may ask probing questions in order to gather as much information as possible. Only after all material has been explored does the therapist share any reactions to the content, symbols, or imagery discussed. 

For example, if a man talks about a dream in which he was in a small boat floating away from shore on a calm sea, the therapist might ask exploratory questions about the various symbols the man mentions. The therapist would gather information about the scene, asking for more visual detail as well as the emotional mood of the dream. Investigative questions like “What does the water look like?” or “Where is the boat headed?” can be helpful. In addition, depending on which treatment model the therapist subscribes to, the dream might serve as a beginning point for deeper, broader, or future-focused work.

In general, most dreamwork models help the dreamer determine what the dream represents. Therapists who practice various forms of dreamwork partner with “dreamers,” the people in therapy, to not only investigate what their dreams mean but also in an attempt to determine how those dreams may be used to inform treatment goals and directions.

Development and History

People have been fascinated with dreams for thousands of years. Over the centuries, dreams have served as the inspiration for scientific discoveries, creative masterpieces, and inventions. Philosophers, scientists, and psychologists alike have long been intrigued by the mysterious nature of dreams. The first official use of dreams in psychotherapy came with the publication of Freud's The Interpretation of Dreams in 1900. Freud believed dreams were comprised of manifest and latent content, both of which could be interpreted and deciphered via the psychoanalytic technique of free association.

Freud's student and friend, psychoanalyst Carl Jung, took dreamwork in a different direction with his use of archetypes and artistic expression. He believed psychotherapists should use dreams in ways that are most beneficial to the participants in therapy. Even today, this form of dream interpretation remains a key component of Jungian therapy.

In the 1930s, psychiatrist Alfred Adler used dreams to identify the personality, “lifestyle”, and presenting problems of the people he worked with in therapy. He saw dreams as an opportunity for problem solving and a means to improve one's sense of self-worth. This dreamwork method is often folded into current models of Adlerian therapy.

Throughout the remainder of the 20^th century, other theoretical models utilized dreamwork in their practice. Therapeutic frameworks such as Gestalt therapy, cognitive behavioral therapy, and existential therapy all developed some form of dreamwork or dream analysis for use within their respective models. In the 1990s, therapist Clara E. Hill developed the cognitive experiential dream model, which was based on many of the tenets of earlier dream theories. Dreamwork is widely used today in many countries around the world. More information is available on the International Association of the Study of Dreams website.

The Science of Dreams

People have been interested in dreams for centuries, and some ancient civilizations believed them to be a way in which humans could connect with the gods. As technology has advanced, scientists have gained a better understanding of dreams, though they remain a topic of ongoing inquiry. 

One popular theory in neuroscience suggests dreams, nothing more than brain impulses that occur while people sleep, have no significant meaning or relevance to our waking life. Freud and a number of other psychologists, however, have emphasized the importance of dreams in building an understanding of the unconscious mind. Evolutionary psychologists today tend to agree that dreaming does, in fact, serve a purpose.

One emerging theory suggests that dreams help people process emotions by turning the emotions into memories. According to this theory, emotions experienced in dreams are real, and dreams attempt to take the emotion out of the dream and turn it into memory. Thus, dreamwork could be considered a way to tap into and process emotions, though more research is needed to fully understand both the phenomenon of dreams and how the use of dreamwork can be beneficial to the therapy process. 

Theory of Dreamwork

As evidenced by the number of therapeutic models that use dreams as part of therapy, dreamwork draws from several theoretical frameworks. Although earlier models like Freudian psychoanalysis and Jungian therapy are more focused on dream analysis, they heavily influenced the use of dreamwork in psychotherapy. The theories listed below serve as the foundation for modern dreamwork as it is used today:

• Adlerian: Dreams relay information about personality, lifestyle, and presenting concerns. The emotional content of dreams promotes self-worth and can be used to solve problems.
• Gestalt: Dreams are existential messages sent from the unconscious mind. They serve to help people focus on the here and now in order to integrate disparate parts of themselves.
• Cognitive behavioral: Dreams are influenced by cognition. Dreams serve many functions, one of which is to help people become aware of their distorted thinking. Dreams can also be used to develop a thematic approach to problem-solving.
• Cognitive experiential: Dreams involve cognitive, emotional, and behavioral elements. They are personal to the dreamer and are continuations of waking experiences. Dreams are not easily deciphered with dream dictionaries, are best understood by the dreamer, and can bring about self-awareness. 

Exercises in Dreamwork

Group work: In group settings, the facilitator, often referred to as the dreamworker, will not offer any interpretations until all questions have been answered and examined. At that point, the facilitator may preface feedback with a neutral statement that allows dreamers to make up their own minds about the interpretation. For example, a dreamworker might say, ”If this were my dream, the cat might represent excitement.” During the group work, multiple interpretations and comments often arise. Sometimes, the dreamers themselves may not realize the significance of the comments until after the session.

Image Rehearsal Therapy: Image Rehearsal Therapy (IRT) is a common type of cognitive behavioral dreamwork that is used most often with people experiencing recurring dreams or nightmares. In IRT, the therapist assigns homework to the person in therapy. The homework often instructs the person to rewrite their recurring nightmare every day for at least 20 minutes a day. The dream is rewritten over and over with new, more pleasing endings. The goal is to use cognition to influence the dream creation process, thus effectively changing the content of the dream via conscious means.

Cognitive experiential dreamwork: This type of dreamwork has three basic phases: exploration, insight, and action. During the exploration phase, the dream is told in present tense; images and symbols are identified; and details, emotions, and associations are revealed for each image or symbol. During the insight phase, connections are drawn to the imagery. These connections may include real-life experiences, areas of concern, and personality dynamics. During the last phase, the action phase, the therapist helps the person in therapy decide what to do with the information gleaned from the dream. They might decide to creatively adapt or rework the dream, make changes in waking life, or delve deeper into the dreamwork.

Dreamwork Training

Many counseling and psychology graduate programs provide a basic overview of the various dreamwork models. Graduate studies devoted solely to dreamwork, however, are limited. Nonetheless, some graduate programs offer certification or specialization in dream studies as part of a larger program. In addition, The Institute for Dream Studies in South Carolina offers a two-year certification program on using dreamwork in clinical settings. 

Interested professionals can find more information about training, certification, workshops, and conferences by visiting the official website of the International Association for the Study of Dreams.

Criticisms and Limitations of Dreamwork

According to an article co-written by cognitive experiential dreamwork developer, Clara E. Hill, and her colleague, Sarah Knox, there is a fair amount of research that supports the efficacy of dreamwork. For example, a study conducted by Krakow et al. (2000) found that Image Rehearsal Therapy reduced the instances of nightmares in people who were victims of sexual assault. Additionally, a case study review conducted by Eudell-Simmons and Hilsenroth (2005) found that dreams were impacted by psychotherapy experiences. Lastly, Dimaggio et al. (1997) found that pleasant emotions in dreams increased as therapy participants improved.

Nevertheless, one criticism of dreamwork, more specifically cognitive experiential dreamwork, is that more empirical research is required to further validate its efficacy in treating mental health issues. Most existing dreamwork research is based upon case studies or single-session data. Although this research shows promise, further studies on the use of dreamwork in ongoing psychotherapy are likely to be beneficial.  

References:

1. Dreams. (n.d.). In International Association for the Study of Dreams. Retrieved June 30, 2015, from http://www.asdreams.org/aboutdreams/
2. Graduate Studies in Dreams and Dreaming. (n.d.). In International Association for the Study of Dreams. Retrieved June 30, 2015, from http://www.asdreams.org/subidxedugraduatestudies_98.htm
3. Hill, C. E. (Ed.). (2004). Dream Work in Therapy:Facilitating, Exploration, Insight, and Action. Washington, DC: American Psychological Association.
4. Hill, C. E., & Knox, S. (2010). The Use of Dreams in Modern Psychotherapy. International Review of Neurobiology, 92. doi:10.1016/S0074-7742(10)92013-8
5. IASD Continuing Education. (n.d.). In International Association for the Study of Dreams. Retrieved June 30, 2015, from http://www.asdreams.org/iasdce/
6. Noronha, K. J. (2014, July). Dream work in grief therapy. Indian Journal of Psychological Medicine, 36(3), 321-323. doi:10.4103/0253-7176.135390
7. Steps to the Dream Interpretation Model. (n.d.). In Therapy Changes. Retrieved June 30, 2015, from http://therapychanges.com/wp-content/uploads/2011/07/StepsDreamInterpretation.pdf
8. Van der Linden, S. (2011). The science behind dreaming. Scientific American. Retrieved from https://www.scientificamerican.com/article/the-science-behind-dreaming