Academic journal article American Journal of Psychotherapy

Working with Dreams in a Clinical Setting

Academic journal article American Journal of Psychotherapy

Working with Dreams in a Clinical Setting

Article excerpt

A disturbed sleep pattern, nightmares, and anxiety-filled dreams form a cluster of symptoms belonging to the DSM- IV diagnosis of Post-traumatic Stress Disorder. A psychotherapeutic group approach aimed at reducing these symptoms was undertaken in the form of a workshop. The workshop was not a regular part of the treatment program, but an experimental endeavor, offered to the patients during special occasions in the year (around holidays). The therapist was primarily interested in investigating possibilities for improving the quality of sleep and influencing the patterns of recurring anxiety-filled dreams and nightmares. The method has both structured and psychodynamic elements. The work carried out during the dream group was embedded in the total treatment program. This was crucial to allow personal themes to be continued in the regular treatment program.

INTRODUCTION

A disturbed sleep pattern, nightmares, and anxiety-filled dreams form a cluster of symptoms belonging to the DSM-IV (APA, 1994) diagnosis of Post Traumatic Stress Disorder (PTSD). These symptoms are difficult to influence and throughout a patient's lifetime, often return after temporary improvement or seem resistant to change altogether. Patients tend to use avoidance techniques to postpone going to sleep at night or they avoid talking about their traumatic experiences, fearing they will stir up bad dreams.

A psychotherapeutic group approach in the form of a workshop was undertaken to stimulate patients from our in-patient clinic to approach their dreams in a new, more active and creative way. The workshop was intended to help patients change the haunting themes of their nightmares and anxiety-filled dreams. The workshop was not a regular part of the treatment program, but an experimental endeavor offered to the patients during special occasions in the year (around holidays). The clinic offers programs on a 24-hour schedule from Sunday evening to Friday afternoon. The staff consists of sociotherapists on the ward, a social worker, a nurse, a creative therapist, a psychomotor therapist, and three individual-and group psychotherapists, one of whom is a psychiatrist and the head of the clinic. This article is not meant to describe this treatment in total. It focuses on an experimental and new initiative. It may be of interest to note that the therapists who facilitated the dream workshops are also the clinic's regular psychotherapists, only working in a different role during the workshop. While the work itself was instigated and carried out by the author, helped by one other psychotherapist in the actual carrying out of the workshop, the clinic's other team members had to deal with the material instigated, as one therapy always flows over into the others in a clinic.

The principal motivation in working with dreams in this way was based on psychoanalytic interest; the activation of the creative unconscious in helping patients overcome rigidity in their self-perception. Rigid conceptualisation and repetition phenomena, in persisting nightmares and anxiety dreams can be considered an aspect of fixation in the flow of ongoing development throughout a lifetime.

The patient population of the CENTRUM '45, Dutch national centre for the treatment of war-related traumas, is heterogeneous: first- and second-generation traumatized victims of World War II (WWII) and veterans of WWII and more recent wars. Some patients, such as journalists or professional health care workers, were traumatized through their work in war circumstances. The age range of the population falls between thirty and eighty years. Those in the so called second generation have not been in war-related life circumstances, but have grown up in a family with parents and/or older siblings who were traumatized, became seriously ill, or had died because of the war.

This heterogeneity of our patients requires that we offer a type of psychotherapy that is not typical for the treatment of specific symptoms. …

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