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Dream-Work in Therapy

Even after centuries of advancements in science, we still know so little about how our mind draws on memory to create images, stories, and experiences in our dreams. Sigmund Freud, the founder of psychoanalysis, laid the groundwork for dream-work therapy. Neuroscience's findings in sleep and dreams have resulted in exciting modern-day discoveries that allow for a greater understanding of cognitive processes and disorders like generalized anxiety disorder, and PTSD.

Psychodynamic therapy put dreams on center stage for psychologists in the early 1900s. This form of therapy, an alternative to traditional psychoanalysis, consists of a psychological interpretation of our emotional and mental processes. Spurred by Freud, psychodynamic therapy is the main reason that dreamwork plays such a central role in neuroscience today. Indeed, had it not been for Freud’s contributions (and, in particular, his foundational belief that dreams are “the royal road to the unconscious”), dreamwork might not have been relevant in our time. Dreams can be seen as the “carriers of unconscious meaning and are interpreted as they arise” (Hepple et al., 2002), and are important to the Freudian analytic technique in the modern-day–especially to “dream therapists.” In psychodynamic therapy, a dream therapist first asks a patient to recall her latest dream and interpret it herself, by forming her own meaning. Next, the therapist interprets her patient's personal association to the dream, rather than the dream itself.

Of course, it took some trial and error to arrive at the streamlined technique practiced today. Psychiatry of Freud's time was largely based on two prominent disorders: depression and dementia. Over many decades of research, new medications, such as “anti-dementia” drugs and depression home remedies, came to market. These treatments have been particularly beneficial to the elderly, as they have “justifiably encouraged a belief that physical treatments are able to 'cure' an increasing number of mentally ill older people” (Hepple et al., 2002). The aforementioned medical discoveries reduced the stigma around psychiatric medications in the 1900s and encouraged medication over traditional (and controversial) techniques, like blood-letting and lobotomy. Freud established that talking about your problems, including your dreams, was a much better remedy for mental illness than the traumatizing procedure of the lobotomy, whereby a doctor would sever connections in the brain's prefrontal cortex.

Though Freud’s work was key to establishing dreamwork, the technique has modern applications, extending beyond psychodynamic therapy. Used in cognitive behavioral therapy, dreamwork gives us a crucial look into our cognitive processes. That is to say, many experts today believe our dreams really do have meaning. Dreaming includes processes such as: “accumulating content in both semantic and autobiographical memory; representing these elements in a visual and auditory manner and in other modalities; combining the above representations into a dream scene; [and] creating a narrative sequence for the dream scene” (Skrzypińska & Szmigielska, 2017). These functions occur in our brain nearly every night, which makes dreaming relevant as a shared human experience.

In recent years, therapists have made exciting discoveries in working with dreams. There are many fascinating ways to use them, from the antiquated (such as in using Freudian theory to distinguish dreams as infantile, sexual, or aggressive wishes) to the cutting edge (as in understanding nightmares and insomnia in crime victims with PTSD). One prominent researcher, William Domhoff, has been building a “DreamBank,'' which includes records of more than 22,000 dreams, logged by people all over the world. Domhoff writes that, as of 2017, the bank now has “463 more recent dreams from the Vietnam Veteran who previously contributed 98 of his post-Vietnam nightmares and 32 additional dreams from 2015” (Domhoff, DreamBank, 2017).

Dream research like this could prove incredibly valuable in studying PTSD and its lifelong effects on dreaming. But it goes well beyond that. Domhoff makes the incredible claim that, as per his research, just seventy-five to one hundred dreams can provide a robust psychological portrait of an individual. And a thousand dreams, recorded over a couple of decades, can give us a profile of a person's mind almost as individualized and informative as their fingerprints (Domhoff, DreamBank, 2017). It should go without saying that this finding has important implications in identifying and treating psychological maladies.

Indeed, another particularly exciting discovery is the correlation between bad dream frequency in adults with Generalized Anxiety Disorder (GAD) and the effectiveness of cognitive behavioral therapy for anxiety. Nightmares have particular clinical relevance. A study conducted on older adults with GAD found that those participants had “significantly higher frequencies of bad dreams than older adults without a generalized anxiety disorder, and cognitive behavioral therapy for anxiety led to a significant reduction in bad dream frequencies” (Nardoff et al., 2014). This is a promising development in cognitive behavioral therapy, as it suggests that utilizing dreams in (this form) of talk therapy is a useful approach in treating bad dreams or nightmares. It is easy to underestimate the extent to which a bad nightmare can ruin a night of sleep, which makes treating bad dream occurrences quite relevant.

In summary, despite a current lack of research in dreamwork, as new research is conducted, the relevance of dreams may become more important than ever in studying PTSD, nightmares, and generalized anxiety disorder. In so being, the world of psychotherapy could soon see a monumental reexamination of Freudian ideas in therapists’ offices across the country.

Conducting dream research on individuals with mental illness could be the solution to truly understanding mental disorders and their effects. Whether dream research continues to progress or gives way to new forms of psychoanalysis, dreams will forever be a fascinating shared human experience that will, with any luck, one day be better understood.


Bad Dream Frequency in Older Adults With Generalized Anxiety Disorder: Prevalence,

Correlates, and Effect of Cognitive Behavioral Treatment for Anxiety. Behavioral Sleep Medicine, 12(1), 28–40.

Domhoff, W. G. (n.d.). DreamBank. Retrieved April 7, 2022, from

Hepple, J., Pearce, J., & Wilkinson, P. (2002). Psychological therapies with older people:

Developing treatments for effective practice. Brunner-Routledge.

Nadorff, Porter, B., Rhoades, H. M., Greisinger, A. J., Kunik, M. E., & Stanley, M. A. (2014).

Skrzypińska, D., & Szmigielska, B. (2017). Dreams in Cognitive-Behavioral Therapy. In Ö.

Şenormancı, & G. Şenormancı (Eds.), Cognitive Behavioral Therapy and Clinical Applications.

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