Academic journal article Journal of Mental Health Counseling

Using Control-Mastery and Jungian Theories to Treat Nightmare Disorder: A Case from Thailand

Academic journal article Journal of Mental Health Counseling

Using Control-Mastery and Jungian Theories to Treat Nightmare Disorder: A Case from Thailand

Article excerpt

This case example describes the use of Control-Mastery Theory and Jungian dream theory to interpret a Thai woman's dreams and treat her nightmare disorder. We posit that therapy enabled the client to identify and challenge unconscious beliefs that had been preventing her from pursuing romantic relationships and ultimately life goals. The case illustrates dream interpretation as a psychotherapeutic tool and highlights the importance of considering cultural context to help make sense of a client's dreams and waking-life beliefs, feelings, and behaviors. The quality and rigor of the case example were enhanced by the use of the Messer (2007) Pragmatic Case method.

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This case describes the use of Control-Mastery Theory (CMT; Weiss, 1993) and Jungian theory (Jung, 1945/1993) in interpreting a Thai woman's distressing dreams and treating her nightmare disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed., American Psychiatric Association [APA], 2013), this disorder is typified by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that involve threats to survival, security, or physical integrity. Resultant sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (APA, 2013). The woman sought brief psychotherapy to understand her nightmares and to be relieved of the distress they caused her.

Although dream interpretation can be a valuable component of psychotherapy (Hill, 2004), many therapists do not utilize it because they lack specific training (Hill & Knox, 2010) or have the notion that dream work is incompatible with their therapeutic approach (Marszalek & Myers, 2006). This case is presented to illustrate one way of using dreams in psychotherapy and to stimulate interest in their value as a therapeutic tool.

Few studies detail psychotherapy with non-Western clients. This case aims to contribute to the non-Western evidence base and offer mental health counselors insight into Thai culture and how it can influence case conceptualization.

Strategies outlined by Messer (2007) were used to enhance the quality and rigor of the case example. With the client's consent, all sessions were video-recorded so as not to rely on the therapist's memory or notes. In addition, a clinical team of two psychiatrists and a family doctor (the second, fourth, and fifth authors) observed all sessions through a one-way mirror and discussed their observations with the therapist (the first author, a psychiatrist and trained psychotherapist). The involvement of the clinical team ensured that data for analysis were not selected by the therapist alone. In addition, a clinical psychologist (the second author) acted as an independent research auditor and checked that the therapist's conclusions were supported by the data, as Fishman (2000) advised. These strategies helped to prevent the case material from being interpreted in terms of a "reigning theoretical orthodoxy" (Messer, 2007, p. 57).

THEORETICAL BACKGROUND

This case was conceptualized from a broad psychoanalytic perspective. As we learned more about the client's presentation, a Jungian view of dreams seemed fitting. CMT was considered useful for making sense of psychological conflicts.

A Psychoanalytic Perspective on Dreams

A psychoanalytic approach assumes that dreams reflect unconscious psychological conflicts (Freud, 1899/1970). Interestingly, findings from neuro-imaging studies have led to a contemporary psychobiologic understanding of dreams that conforms to psychoanalytic theory (Reiser, 2001). Invariably, Freud found that dream symbols were related to themes of sexuality or aggression, making no allowances for cultural variations in the meanings of dream symbols (Van de Castle, 1994). Therefore, a Freudian framework per se was deemed inadequate for the current case. …

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