D S P P  B U L L E T I N

Review of September Meeting

Robert Aberg, Ph.D.

On Wednesday, September 19th, Dr. John Herman inaugurated DSPP's 2001-2 series of monthly meetings with his presentation, "Contemporary Dream Interpretation, Freud and his Aftermath; what we have learned from psychoanalytic theory and neurobiology about the use of dreams in psychotherapy." After noting the debt that practically all dynamic psychotherapies owe to Freud for formulating such basic clinical constructs as the unconscious, the subconscious, psychic conflict, infantile sexuality, and acting out, Dr. Herman noted that contemporary psychoanalytic thought and neurobiological research had called into question one of Freud's basic assumptions regarding the interpretation of dreams, i.e., that all dreams should ultimately be understood as some variant of wish-fulfillment. That Freud's rather rigid stance in this regard can, at best, be regarded as incomplete, is strongly suggested by the fact that neurobiological research has established that there are different types of dream physiology (e.g., REM and non-REM (NREM) dreams) with corresponding differences in dream phenomenology. For example, REM dreams tend to be elaborately narrative whereas NREM dreams are typically static images without plot development. The mechanisms that Freud identified as disguising the latent content of the dream (e.g., representation, condensation, displacement, symbolization, secondary revision) to produce the manifest dream content seem to, at the least, require further development given the finding that certain areas of the brain are either aroused or shut down depending on what phase of the sleep cycle the dreamer is in. For example, it would seem reasonable to expect that different "mechanisms" would be employed depending upon which areas of the brain were more or less active.

Dr. Herman used two examples of NREM dreams to explore different ways in which dreams may be understood and used in psychotherapy. First, he reviewed Freud's own report of a dream, "the dream of the botanical monograph," originally recounted in The Interpretation of Dreams. Dr. Herman reviewed how Freud used the technique of free association to the manifest dream contents to arrive at an interpretation of the latent content of the dream and its underlying unconscious infantile wish. Dr. Herman pointed to Freud's process as an example of the unparalleled wealth of unconscious material that the dream could provide given the skillful use of the method of free association. He noted that, "The pure gold of significant associations he (Freud) mined from the fragment of breccia stands as a benchmark against which each of us may measure our powers of dream interpretation."

Dr. Herman recounted Freud's train of associations through memory traces from the previous day to anecdotes and discussions with colleagues to other recollections and thoughts, thus providing an example of the classical process of dream interpretation. Ironically, Dr. Herman noted that the ultimate "message" or interpretation of the dream material gleaned by Freud was, to say the least, open to debate. However, Dr. Herman maintained that the particular "answer" Freud derived from the use of the method of free association was of much lesser importance than the demonstration of the process of free association itself. Dr Herman noted that,

The collection of associations to the dream...appears of far greater psychic import than the wish-fulfillment meaning he assigns it. It is clear that the real work of Freud's self-analysis in his examination of this dream resides in his painstaking construction of a network of associations dealing with current and past thoughts, conflicts, and wishes. His memories of forgetting his wife's favorite flowers, misdiagnosing his beloved father's glaucoma, of not publishing further on cocaine are poignant and moving; his wish-fulfillment interpretation is empty by comparison.

Dr. Herman continued by noting a number of suggestions for how to use and interpret dream material in ongoing psychotherapy. He began by identifying several "rules for dream interpretation" originally proposed by Freud in "The employment of dream-interpretation in psychoanalysis," 1912. Interestingly, the weight of these rules seems to be on the side of cautioning the therapist not to overvalue the dream material to the extent that an overproduction of dreams or too great concern with regard to particular dream contents can, in effect, serve the purpose of resistance by preventing the emergence of other material or otherwise impeding the patient's process of free association. And, as always, Freud advises that "...analyzing resistance always takes precedence over dream interpretation." For example, these "rules" call for the patient and therapist not to continue with a particular dream interpretation beyond a single psychotherapy session and to "guard against displaying too special an interest in dream meaning to guard against the patient believing that ceasing to offer dreams might interrupt the treatment's progress."

Dr. Herman also cited recommendations from Steven Levy's text, Principles of Interpretation (Aronson, 1990) for clinical use of dreams. Levy drew attention to the fact that many patients feel that dreams contain hidden meanings and that, by bringing dream material into the therapy, they are "...taking a risk, which although it may be based upon certain distorted and unnecessary fears, nonetheless indicates a degree of trust and willingness to explore new material." A corollary to this is that a therapist's failure to respond to dream material "...gives the patient a powerful indirect message about avoidance or unacceptability of unconscious material."

Levy advises that dreams not be viewed as psychic puzzlers, each with its own unique answer. Rather, he suggests that dreams may have multi-layered meanings and whatever inferences are drawn regarding the possible meaning of the dream be integrated with observations and associations from other sources. The goal is not to discover the specific meaning of the dream but to assist the patient in understanding and appreciating previously unconscious mechanisms, thoughts and the "...many different trends within himself, some more ego syntonic than others."

Dr. Herman noted a division within psychoanalytic thought regarding the importance of dream material and dream interpretation. In 1967 the New York Psychoanalytic Institute published the findings of a two-year study of the dream by the Kris Study Group under the chairmanship of Charles Brenner. Brenner's group concluded that the dream was, simply speaking, merely another communication in the course of an analysis. Dream material was not viewed as providing access to unconscious material that would not be otherwise available. They also concluded that Freud's theory that dreams were the outcome of "the interplay between primary and secondary process was not compatible with the structural theory and ought to be discarded." Ralph Greenson, however, published a paper titled "The exceptional place of the dream in psychoanalytic practice" (Psychoanalytic Quarterly, 1970, 39, 519-541). In it Greenson argued strongly for treating the dream material as a privileged, deeper kind of material. He noted that patient's defenses significantly constrict their free associations, slips of the tongue, and ability to examine their acting out behavior. Dreams, on the other hand, cannot be so routinely defended against or rationalized away. He writes that "...as bizarre and incomprehensible as the dream may appear, the patient recognizes the dream as his, he knows it is his creation.... (H)e is quite willing to work on dreams provided his analyst has demonstrated how working together on dreams is helpful in achieving greater awareness of the patient's unknown self." Thus, it is not only the dream material itself that is important, but also the opportunity afforded the therapist and patient to work together on material that is relatively less censored by the patient's ego defenses.

Dr. Herman then reviewed some results of neurobiological investigations of dreaming. Among other findings, it was noted that a) most dreams are "not accompanied by a recollected emotion, and in those in which some feeling tone is reported, a negative emotion is more common than a positive emotion, that b) nightmares "represent a failure of the capacity of the REM dream to allow the continuity of sleep," and that nightmare recallers typically score higher on all MMPI scales, that c) "Intense emotional experiences of the day and the thoughts one has before going to sleep appear in dream recall from awakenings of the subsequent night's sleep," that d) "one wakes up feeling more friendly and less unhappy than one felt before the night's sleep" and that, e) judges are able to sort dreams on the basis of 1) night dreamt and 2) dreamer, indicating that the thematic content of dreams differs from night to night, and that dreams of particular individuals are distinguishable from other's.

With regard to the physiology of dreaming, Dr. Herman noted the theory of Hobson and McCarley, who argue that "...all the properties of dreaming could be accounted for by assuming that cortical structures were attempting to integrate virtually random barrages of electrical excitation arriving from the brainstem." This "bottom-up" approach is in direct contrast to the psychoanalytic "top-down" explanation, which assumes the dream to be a product of the cortex. They believed this was more consistent with the fact that REM sleep is found to occur in utero and in all mammals, indicating that REM sleep could not be the complex process of "dream work" with mechanisms such as condensation, representation, and symbolization that Freud described. Dr. Herman noted, however, that Hobson had more recently acknowledged that the phenomenology of dreams might not be so purely random. He grants that dream material may well be the product of an interaction between the brain stem activating the cortex, which, in turn, influences the pattern of activity in the brain stem.

Studies of REM sleep also suggest that it is a time of consolidating procedural memories, suggesting that REM affords us an opportunity for a kind of rehearsal for procedural tasks. Other studies confirm changes in patterns of neurotransmitter levels and areas of brain activation as subjects' transition between REM and
NREM sleep. It appears clear that the brain is operating under different conditions at these points and that these conditions are reflected in different dream phenomenology. NREM sleep appears to be more conceptual and thought-like and coincides with more quiescent brain activity. REM sleep, which coincides with hyperactivity in certain areas of the brain (e.g., the limbic system, the occipital cortex, the hippocampus), appears more narrative and visual in structure. Dr. Herman likened the shift between NREM and REM states to the shift between secondary and primary process thinking.

Dr. Herman concluded his presentation by stating that Freud's technique of exploring latent meaning of dream imagery through free association has endured, though his wish fulfillment theory of dream interpretation has not. He noted that dream interpretation was rarely so dramatically useful in clinical settings so as to "make the unconscious conscious." Working on dreams does, however, present an extremely valuable opportunity for the therapist and patient to learn to work together to "establish connections between thoughts, fantasies, and emotions which had previously been disconnected, perhaps due to forces such as repression." Dreams are still viewed as providing relatively uncensored material for the patient/therapist dyad to work together to understand, thereby providing a model for other areas of analytic inquiry over the course of treatment.

Questions following Dr. Herman's presentation concerned the specific differences in brain physiology between REM and hypnogogic states. Dr. Herman noted that EEG studies had produced a fairly detailed picture of the brain during REM, but that other states were less well understood. For example, there is no neurobiological explanation for those occasions when a dreamer wakes in the midst of a narrative dream, only to resume the same dream upon re-falling asleep. Dr. Rathbun observed that perhaps the chief value of working on dream material in psychotherapy is that it gives the therapist and patient a "job," or task to share in common. The specific importance of dealing with transference dreams was also noted. Dr. Godby observed that working with dreams rarely, if ever, occurred in the course of couple's therapy, though working on dreams in ongoing group therapy (among strangers) was quite common. This seemed to point to the relatively greater sense of risk and exposure people feel when dealing with their dreams. There was some speculation that a more deliberate focus on working with dream material in couples therapy might deepen the level of understanding of their relationship.

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