Contemporary dream interpretation

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Contemporary dream interpretation was first modelled by Sigmund Freud in his landmark monograph The Interpretation of Dreams. His was the first comprehensive approach to understanding dreams. Freud emphasized the analysis of dreams as a means to unlocking the unconscious, and felt that dreams were fundamentally composed of repressed psychological material.

In contemporary psychoanalysis, the role of dream interpretation has been diminished somewhat, with analysts now focusing on other aspects of psychoanalysis. Nevertheless, dreams, and their interpretation, continue to provide a powerful therapeutic focus. Many studies have underlined the importance of dreams in psychoanalysis (and, indeed, therapeutic work in general.) Furthermore, a growing body of literature supports the continuity hypothesis of dreams, which states that the content of dreams is not remote from the waking reality, but, rather, portrays the most prominent feelings, interests and concerns of the individual.

Two dominant neurophysiological theories about dreams and their relationship with psychoanalysis have been developed: the activation-synthesis theory of Hobson and the most recently developed neuropsychoanalytic theory of Solms. These theories are undergoing active debate and, although they are different, they have areas of similarity. However, neither of these neurophysiological theories can be considered as fully accepted.

Freudian theory

Freud believed dreams represented a disguised fulfillment of a repressed wish. They are the easiest road to understanding of the unconscious activities of the mind (Freud, 1987 [Freud died in 1939, so how could this be published in '87?] as discussed in Cheniaux, 2004). His theories state that dreams have a manifest content (the conscious experience during sleep; the dream that we remember) and a latent content (considered unconscious). He proposed that the latent dream content is composed of three elements: the sensory impressions during the night; the residues of the previous day; and the id's instinctive drives (Pesant & Zadra, 2004). During sleep, the repression by the super-ego is weakened due to the absence of voluntary motor activity; this increases the possibility of instinctive impulses reaching consciousness. The dream is considered to be the "guardian" of sleep: dreams allow a partial gratification of the instinctual drives through a visual fantasy (manifest content), reducing the impact of these instinctive drives which might often cause the individual to wake in order to fulfill them, and thus allowing the continuation of sleep. The manifest content is not apparently comprehensive, as it consists of a distorted version of the latent content (Freud, 1987; Freud, 1975 as discussed in Domhoff, 2005).

At the beginning of the psychoanalytic movement, Freud and his followers considered dreams to be the primary tool of self analysis as well as a prominent part of the treatment (Freud, 1900; Lippman, 2000). Dream understanding and interpretation during that time was influenced by Freud's drive-conflict theory and was designed to reveal the "latent" content of the patient's repressed infantile sexuality and unconscious oedipal wishes (Ringel, 2002). To understand the dream the therapist had to explore and reveal the latent dream thoughts via the process of free association to the "manifest" content (Lane & Haris, 2002; Lane, Daniels & Barber, 1995).

Contemporary psychoanalytic approach

The developments in the field of classical psychoanalysis in which the ego psychology gradually replaced the id psychology affected greatly the clinical psychoanalytical practice (Elman, 2000). One of the main characteristics of the modern psychoanalytic approach is the change in the emphasis that Freud put in the oedipal phase and in the exploration of the unconscious, towards the investigation of ego, ego defenses and the pre-oedipal phases of developments (Ringel, 2002). This change is also reflected in the recent advances toward the understanding of dreams. Although modern analysts base their understanding of the dreams on many of Freud's discoveries, they believe that Freud, in focusing on oedipal conflicts, failed to pay adequate attention to the examination of the emotional experiences during the first three years of life. Furthermore, they conclude that these experiences often provide the impetus for the creation of a dream. The emphasis on the ego defenses and the degradation of the importance of the unconscious led to further consequences for the interpretation of dreams. The importance of the latent content of the dream in the clinical practice was shifted toward the manifest content of dreams (Lane, 1997; Lane & Haris 2000; Alperin, 2004; Pesant & Zadra, 2004).

In contrast to Freud's idea that the latent content of the dream can be revealed by the implementation of free association, contemporary analysts believe that the unconscious or hidden meaning of the dream is not discovered from the patient's associations to the dream material. According to them these associations are an additional defense, a disguise against the patient's primitive conflicts, and reveals only what the dreamer consciously feels or thinks about the dream (Lippman, 2000). Additionally, in modern psychoanalysis dreams are a valuable instrument for examining preverbal conflicts. Disagreeing with Freud's view that the true meaning of a dream derives from its latent content, contemporary analysts are convinced that "what one sees in the dream is the dream" (Spotnitz & Meadow, 1976, p. 99 as discussed in Alperin, 2004).

Modern analysts use the manifest content to understand the patient's unconscious. They attempt to understand the symbolism of the manifest content of the dream in relation to the total content of the session. During a session in which a patient describes a dream, everything that patient says and does after entering the therapist's office is considered an association to the dream and is used to untie its manifest content. The representatives of the modern psychoanalytic school are convinced that the patient's genetic history and unresolved conflicts are revealed in the transference and are symbolized in the patient's dreams. Because the patient is reporting the dream to the analyst, analysts believe that it is an indirect communication to the analyst about a major transference feeling (Alperin, 2004; Foshage, 2000; Lippman, 1996). The modern psychoanalytic view underlined the importance of dreams in the analysis of transference and counter-transference. Dreams are viewed as representations of the psychoanalytic relationship and reflect transference counter-transference issues. This feature is very prominent in the approach adopted from the interpersonal school of psychology (Levenson, 2000; Ellman, 2000).

In conclusion, modern analysts reckon the dream as a result of the whole personality and believe that it reveals much about the patient's entire personality structure. Rather than apply dreams, as Freud had, to discover what the patient is hiding, modern analysts should use dreams to understand why the patient is hiding and "why he is using these various methods to hide." If these character resistances are effectively analyzed, then the basic quality of the patient's dreams should alter significantly; they should become clearer and less disguised (Alperin, 2004).

Content and continuity

According to Domhoff (2005) dreaming is defined as "a sequence of perceptions, thoughts and emotions during sleep that is experienced as a series of actual events. The nature of these events, the dream content, can be known to the interviewers only in the form of a verbal or written report."

Dream content seems to be evolved simultaneously with cognitive and emotional development during childhood. However, when adulthood is reached, only few differences emerge concerning the dream content. The most apparent variability in dream content seems to deal with the emergence of aggression, which additionally diverges greatly due to age, as it has been demonstrated through a majority of studies. Despite the originality and creativity that is exhibited in the cognitive construction of dreams, and even given the aspects of dream content that are not understood, most dreams are more realistic and based on everyday life than is proposed by previous traditional dream theories. Furthermore, much dream content seems more evident than might be expected when reviewing clinical theories which emphasize disguise and/or symbolism in understanding dreams (Domhoff, 2005).

Ernest Hartmann (1998) was one of the theorists that envisioned dreams as contextualizing the dominant emotion, expressing it through a pictorial representation. This pattern is found most clearly in dreams of people that are experiencing an intense emotion (such as in general stressful situations) and not major traumas. Even if there is no dominant emotion, and several lower intensity emotions are present, such pattern, although less clear, is still present. Thus, Hartmann and his collaborators have published numerous studies demonstrating the importance of emotion in dreams, and demonstrating that the power of the central image of the dream is related to the power of the underlying emotion (Cheniaux, 2006; Hartmann, 1998).

More recent developments suggest that dreams are more similar than different because they dramatize people's conceptions and concerns in relation to personal issues, which probably does not vary much from country to country as culture does. In particular, the continuity hypothesis postulates that the content of everyday dreams reflects the dreamer's waking states and concerns. In other words, elements from people's dreams can be related to corresponding waking or psychological variables (Domhoff, 2005). Research findings have revealed that the occurrence of recurrent dreams, nightmares and unpleasant everyday dreams is related to one's psychological well-being (Blagrove, Farmer, & Williams, 2004; Zadra & Donderi, 2000). Further data demonstrate that the dream reports of people suffering from certain psychopathologies can differ from those of normal control subjects (Kramer, 2000; Schredl & Engelhardt, 2001), and that certain personality dimensions such as extroversion (Bernstein & Roberts, 1995), neuroticism (Schredl, Landgraf, & Zeiler, 2003), and psychological boundaries (Schredl, Schäfer, Hofmann,& Jacob, 1999) are extensively associated to dream content.

In addition, dreams have considerable consistency across time and countries because they express personal interests, worries and emotional preoccupations about family, friends, social life, recreational interests, and relationships at work (Domhoff, Meyer-Gomes, & Schredl, 2006; Schredl, 2003). Within the context of the emphasis on personal concerns, there are sometimes distortions in settings, sudden scene changes, or unusual aspects to familiar characters, but dreams are in general a reasonable stimulation of the dreamer's conception of his waking reality in terms of characters, social interactions, activities and settings (Domhoff, 2005).

In conclusion, the continuity between dream content and waking concerns, when combined with other parallels between dreaming and waking cognition, can be used to develop a cognitive theory of dreams (Domhoff, Meyer-Gomes, & Schredl, 2006). The focus of the cognitive theory is on the fact that thinking, imagining and dreaming develop as part of a conceptual system, or system of schemas and scripts, which is the organizational basis for all human knowledge, beliefs and actions (Domhoff, Meyer-Gomes, & Schredl, 2006; Klinger, 1999).

Importance in therapy

Through clinical observation has been revealed the importance of using dream interpretation in psychotherapy, no matter its orientation. In particular, three types of gains are described as a result of dream interpretation (Peasant & Zadra, 2004). Insight is the first asset gained by the clinical use of dreams for both the therapist and the client (Hill, 1996, 2003). In particular research (Elliot et al., 1994) is conceptualized insight as containing four elements:

• metaphorical vision with the intention of seeing oneself in a totally new perspective,
• connection with the aim of linking different aspects of one's experience,
• suddenness, which is described as an affect display of surprise, and
• newness, which means the profound exploration of one's psychic world.

Another type of gain is the increased involvement of the client in the therapeutic process. Dream work can facilitate and provide access to client's most essential issues (Derr & Zimpfer, 1996). Therefore, dream interpretation can be proved most beneficial in building a therapeutic relationship, even in the most distrustful patients. Building such a trustful relationship with the client can enhance his/her active involvement in the therapeutic process (Derr & Zimpfer, 1996). At length, a better understanding of the client's dynamics and clinical progress is one of the most essential gains that have been revealed in many clinical reports (Peasant & Zadra, 2004). Through dream work has been showed that clinicians have a better access to their client's cognitive schemas. Alternatively, dream content reflects the evolution of the client’s self-concept, defense mechanisms, core conflicts and at last transfer reactions (Glucksman, 1988).

Importance of the use of the dreams in therapy has been tested throughout the years by some empirical studies. For instance, it has been found that understanding a disturbing persistent dream can reduce its occurrence and its associated distress (Webb & Fagan, 1993). An additional interesting research revealed that clients who were at risk for early therapy dropout were more likely to continue their therapy and benefit most of it, if they pay attention to their dreams. Therefore, it was suggested that encouraging clients to pay attention to their dreams and work collaboratively with their therapist, augment their commitment to therapy (Cartwright, Tipton & Wicklund, 1980). Alternatively, several studies state that dream interpretation, when considered active during psychotherapy, brings unique benefits to clients, that may not be obtained by using some other therapeutic interventions. Although, there are some other studies, which were unable to replicate and extend the above connotation, dream interpretation appears to constitute an effective therapeutic tool, which can only contribute some exceptional components to the therapeutic relationship per se (Hill et al., 2000; Diemer et al., 1996). In addition, we must take into account that the therapist's crucial role contributes a lot in dream work's efficacy. In other words, the therapist's supportive and facilitating presence contributes both to the client's involvement in therapy and insight. Although the therapist's empathically listening is still considered of greater importance than dream interpretation, several studies suggest that even if clients can highly benefit from self-help dream work sessions, the therapist's compassionate and facilitative presence can result in even greater benefits (Hill et al., 2003).

As a final point, it has been shown that dreams' pleasant or unpleasant content has a vital function in gaining from dream interpretation. Empirical studies suggest that dream pleasantness leads to higher levels of hope and openness towards conflict resolution, whereas unpleasant dreams have a negative impact on clients' progress, as remind to the dreamer the unresolved conflicts or impeding threats (Hill et al., 2001).

Dream theories and psychoanalysis

According to Mancia (1999), neuroscientists are interested in the study of the brain structures and functions involved in the production of the dream, whereas psychoanalysts are interested in its meaning. However, according to Reiser (2001), the psychoanalytic and neuroscientific models for dreams, although quite different, should not be seen as antagonistic, but as complementary and mutually enriching. Nevertheless, the debate between activation-synthesis theorist Hobson and psychoanalytic theorist Solms about the nature of dreaming and dream content shows no signs of reconciliation (Cheniaux, 2006; Domhoff, 2005).

Hobson & McCarley's activation-synthesis theory was the first neuropsychological theory of dreaming that strongly criticized Freud (Cheniaux, 2006). According to this theory, during REM sleep there is a reduction in aminergic activity, and an increase in cholinergic activity, particularly in the brainstem. As a result, during REM sleep the ponto-geniculo-occipital (PGO) spikes periodically generated, which are considered to be the main stimuli of dreams. Their origin is in the brainstem. They are reproduced in the lateral geniculate body of the thalamus and reaching the visual cortex (occipital), they activate it. Thus, the images of the dream are generated based on stored visual memory traits. This cortical activation takes place randomly. Thus, chaotic images are formed, which subsequently undergo a process of synthesis, building a sequential narrative. Therefore, dreams are generated in the brainstem without any meaning, reflecting clearly the brain activity (Hobson, 1999; Hobson & McCarley, 1977; McCarley, 1998).

Contrary to Hobson, Solms is one of the leading researchers in the area of neuropsychoanalysis. He claims that REM sleep is controlled by the cholinergic activity of the brainstem, whereas the dream is controlled by the dopaminergic circuits of the anterior brain. Thus, as distinct states, one might occur without the other. Fibers of the dopaminergic mesolimbic-mesocortical system pass through the ventromedial area of the frontal lobe in the forebrain, which is responsible for the generation of dreams. The mesolimbic-mesocortical system is also related to motivational states, which prompt behaviors that aim to satisfy biological needs. Furthermore, the involvement of the dopaminergic mesolimbic-mesocortical system in the generation of dreams is clearly related to what psychoanalysts call instinctual drives, supporting Freud's hypothesis that dreams are motivated by desires (Solms, 2000, 1995).

Hobson and Solms

Hobson's and Solms' first major empirical difference concerns the neurophysiological origins of dreaming (Domhoff, 2005). According to Hobson, dreaming has its origins in the region of the pons that generates REM sleep. This region produces chaotic signals that activate the forebrain and force it to make a synthesis of the noisy input it is receiving from the ponto-geniculo-occipital (PGO) spikes (Hobson, 1999; Hobson & McCarley, 1977; McCarley, 1998). According to Jones (2000), the brainstem signals are not as noisy as Hobson believed. In contrast, they are generated in a repetitive, rhythmic, and highly predictable manner. Hobson has also underestimated the degree of cortical control over the brainstem activity of dreams. Present evidence suggests a dynamic interaction between the forebrain and pons in molding the structure and timing of PGO spikes during REM sleep (Siegel, 2000). On the other hand, Solms has claimed that dreaming is possible without REM, rejecting the strong relationship between REM and dreaming originally emphasized by Hobson. According to him, the origins of dreaming are in the ventral tegmental area of the midbrain (Solms, 2000).

According to Hobson, the lower levels of serotonin and norepinephrine during REM, when combined with high levels of acetylcholine, make the dreaming state very different from waking, providing it with several distinctive characteristics, such as bizarreness (Domhoff, 2005). For Solms, the dopaminergic system, originating in the ventral tegmental area, is the neurochemical basis for dreaming, being also the basis for the seeking system (Solms & Turnbull, 2002). Gottesmann (2002) concluded that Hobson is incorrect about the nature of neurotransmitters involved during REM sleep. The absence of serotonin, norepinephrine, and histamine is important, along with high levels of both acetylcholine and dopamine, with the dopamine having more impact as its inhibitors are at low levels. Moreover, the role of gamma-aminobutyric acid has been found to be important (Siegel, 2000).

For Hobson, the regularity of REM, the alteration between REM and NREM, and the brainstem basis for the REM-NREM cycle, demonstrate that the Freudian emphasis on wishes, censorship, and the dream work was wrong. In contrast, Solms supported the Freudian theory and provided the basis for an invigorating next step in psychoanalytic thinking that he has called neuropsychoanalysis (Domhoff, 2005). According to him, the seeking system is the basis for Freud's libido concept, which means that dreams are motivated by sexual energy, just as Freud claimed (Solms & Turnbull, 2002).

Despite the above differences, these theories also have several similarities. To begin with, they share the idea that dreaming is a form of psychosis, either delirium (Hobson) or schizophrenia (Solms). The extreme characterization of dreaming as a psychotic state led them to give emphasis on the nature of dream content as bizarre and highly emotional. But, the coherent nature of most dreams contradicts their beliefs. Secondly, their conclusions about dream content have been derived from neurophysiological assumptions, while ignoring the need to study dreaming and dream content at a cognitive level. They both claim that Freud was wrong about the psychological concept of censorship, due to the deactivation of the dorsolateral prefrontal cortex during sleep, which is important for higher-order cognition. Thus, they ignored that other regions of the prefrontal cortex that remain activated contribute to complex cognitions (Domhoff, 2005).

When Hobson and McCarley proposed their activation-synthesis model of dreaming nearly 30 years ago, it was seen as a major challenge to the Freudian model. For Freud, the mind/brain starts with the threatening drive expression that is then transformed through the dream work. In the activation-synthesis model, the mind/brain starts with a random stimulus, generated from the pons, which is then transformed into a more-or-less coherent narrative. Ironically, whether the transformation is for the purposes of defense and disguise, or merely, as Hobson and McCarley put it, "making the best of a bad job," the process of transformation reflects the dreamer's psychodynamics. Activation-synthesis is like the brain administering a Rorschach or thematic apperception test (TAT) to itself. An image that could be interpreted in many ways is elaborated into a meaningful narrative. McCarley acknowledged that the activation-synthesis hypothesis did not pose a threat to the psychological understanding of dreams. It was primarily a theory of the neural instigation of dreams, and he argued that the final dream integrates "the brain stem-induced motor and sensory activation with the particular memories and personality characteristics of the dreamer."

Taking all the above into consideration, we can conclude that if there is to be a synthesis of dream findings with neurophysiological results, it cannot be based on Hobson's cognitively impoverished approach or Solms' attempt to revive psychoanalysis as neuropsychoanalysis. Future research is needed to incorporate the features of dreaming and dream content into a new neurocognitive theory of dreams (Domhoff, 2005).

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