Dreams and their Interpretation in Psychotherapy: an Introduction

Dreams and their interpretation in psychotherapy have adopted different characteristics from model to model and, on the whole, have lost their meaning and centrality inside the therapeutic work as the “royal road to a knowledge of the unconscious activities of the mind” (Freud, 1900).
Freud’s statement, that opened the 20th century with such a bewildering proposition and that changed completely the approach to mental health, is everywhere in psychoanalytic literature but often differently interpreted: what does it mean really today concerning dreams?
Even if we are in the psychoanalytic domain, nonetheless I assume that we are talking of psychotherapy because nothing can warn away us from the statement that we are treating something of our patient. The natural consequence of the oneness-integrity-whole body and mind is that as we cure the first we can do the same for the second.
Therapy implies the fact of an organ/structure initially healthy that in a certain period starts to operate incorrectly, in other words to fall ill, and the intervention is addressed to find again the original functional unity.

Unfortunately we well know that today there aren’t full treatments for some biological diseases yet, withal the focus of research and clinical investigation is to find the path to eradicate fully these illnesses, starting from the basic statement that the organ/structure was born healthy and remained as is for a certain period and it can be redeveloped in its function.
The few situations in which the human being since birth has a dysfunctional organ/structure come under the inherited illnesses of the body and of the mind (mind considered as cerebral and not psychic activity).
Only for these situations, therapy, intended as restoration of the original functioning, is not possible because from the beginning the physiologic activity failed therefore the treatment is of a palliative kind.
I mentioned a simply dimension of pathological origin and development that could appear ordinary and organic but it’s so much neglected in mental health that seems like a global annihilation of the fact.
Today we are more addressed to speak about “client” instead of patient, “discomfort” instead of disease, “improvement” instead of treatment etc.: isn’t it stigmatization?

The paradox seems to be a growing interest in fighting stigma against mental disease and all surrounding it that insults, devalues and devastates the human being but at the same time the people who cares for mental health can’t call things with their names anymore.
I don’t want to go too far from the topic of my communication concerning dreams but the premise was necessary: in psychotherapy the work is to treat having in mind the unavoidable vision that the patient at the time of birth was sane, later in his/her physiological development something didn’t work, as the integration of psychiatry and psychotherapy with neurosciences widely accepts.
When I present this brief and easy introduction to conferences, or journals or debates with colleagues the answers are generally two: 1. You are talking about such obvious things; 2. You present an old medical, organic/mechanistic thought.
Concerning the first group I’m happy to say that I’m in a confortable space where my position is shared (as an “obvious” position) but then it’s hard for me to understand how these basic apparently shared statements of human development can be integrated with the treatment thence how, for them, the restoration of the original functioning (the physiology) happens in the psychotherapeutic process.

For the second group I can only answer that they have to decide: if we agree about the whole mind/body we have to consider them as the result of human physiology and there is just one physiology and it can’t be split in two different ones the organic one (medical) and the mind’s one (psychological).
It’s necessary at this time another short premise: to treat in psychotherapy for me means to have found some human, emotional/affective, physiological and psychopathological characteristics of the specific personal and historical moment of the patient I have in front of me thanks to whom I’m able to begin a psychotherapeutic work.
As a matter of fact there are general conditions of the patient in the specific moment (that can change over time) that suggest that is not indicated to start a psychotherapy and this is a frequent experience for every therapist but this doesn’t mean that is not possible to treat that patient as it is often believed.
The impossibility is dynamic and not static: the common position is to infer that a certain disease can’t be treated in psychotherapy but there is no psychopathology that can’t be treated by contrast there are specific moments of the patient that don’t allow the therapeutic process. These are the situations for example in which there’s a long time since pathology occurred and different pharmacological/psychological approaches failed in the years or a rigidity of the self that can’t allow an access to the insight etc. that I repeat are due to the moment and not to the pathology.

To treat in psychotherapy one of the tools widely recognized is the dream: for my experience it is not “A” tool but “THE” tool.
The other numerous factors of the therapeutic relationship are extremely important and they were super analyzed by literature: I think that they are all necessary but at the same time secondary if at the core of the therapeutic work is not posted the dream because the dream contains them all and present them in their more genuine and true shape.
If the dream is considered as “one” of the tools, I think that to call the other features of psychotherapy as “unconscious” is a too much generalization and the risk is that the differences with other approaches are not so far.
The attention given to the non-verbal emerged, to the relation, to associations, to spatial and temporal setting and also to dreams (not interpreted but used if the patient want or need to tell them), are placed in the here and now of the therapeutic relationship in quite all the relational psychotherapeutic approaches.

The question is: is the psychoanalytic/psychodynamic model different from others just because the name given to relational features of the therapy are: transfert, projective identification, unconscious, reverie etc.? This for me is a severe risk that is happening today and the problem is not to protect and split a model from the other but the alienation from the sense and meaning given to the unconscious.
The real difference between models is made by the dream, the consideration of its centrality in the therapeutic process, the relevance of its content as a treatment tool via its interpretation.
Nonetheless, inside psychotherapy there can’t be the relationship with the dream, we can call it either interpretation nor emersion of latent senses or whatever you want, if we ignore the emotional gear between psychotherapist and patient.

The floating emotions during the telling of a dream has nothing to do with the concept of empathy that for me has more the meaning to go inside an identification process or even in a fusion with the patient to avoid the cold detachment and the impersonality of the therapist so much criticized nowadays in classic psychoanalysis.
The absence of relationship offered by the uninvolved psychotherapist has been replaced by his/her full disposition to make his/her emotions available.
But rather this often means to include into the relationship the subjective and personal emotions, historical memories of the therapist together with the emersion of dreams and experiences of the patient.
Therefore the same psychotherapist gives him/herself away allowing the possibility to communicate his/her feelings concerning facts of his/her life.
I think that this could be a risk because the overflow of therapist’s subjectivity as his/her personal experiences doesn’t enable a well-defined separation between patient’s ones and their commixture confuses the therapeutic process.

At the same time separation doesn’t mean alienation or affective detachment on the contrary specifically talking of the listen of dream but there is completely an emotional movement.
When I have in front of me the patient with who I’m in a relationship, consciously represented by the psychotherapeutic session, the telling of the dream determines the progressive and continuous emerging of an image in my mind until the end of the narration.
Thanks to the image I comprehend the sense, not necessary clear, prompt and defined, included sometimes the non-sense, of the content of the dream therefore of what the patient wants to tell me.
It’s hardly possible to sense the image and the meaning of a dream totally because I could never be all “in” the dream otherwise I would be “in” the patient as the result of a psychotic fusion.

The word I use to explain my feelings in this situation is free-floating that is not to doubt but to remain open to the research, to remain unconsciously active: I’m not directing myself to a rational/conscious answer to the dream and I’m not trying to find an suitable/intelligent interpretation.
Only now I realize that I’m in front of the sense of the image that exists just because it contains inside my relationship with the patient until that moment, namely his/her narration’s mood, the expressing self, his/her painting the dreams.
I will explain the meaning of “formation of the image” of the dream inside the therapist… (to be continued).

Michele Battuello