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The Significance of Dreams

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This book looks at dreams from a twenty-first century perspective. It takes its inspiration from Freud's insights, but pursues psychoanalytic interest into both neuroscience and the modern psychoanalytic consulting room. The book looks at laboratory research on dreaming alongside the modern clinical use of dreams and links together clinical and empirical research, integrating classical ideas with the plurality of psychoanalytic theoretical constructs available to modern researchers.Psychoanalysts writing about dreams have traditionally represented the cutting edge of clinical and theoretical development, and this book is no exception. Many of the contributions, as well as the epistemological position taken by the writers, represent a kind of radical openness to new ways of thinking about the clinical situation and about theory. In line with the ambition of the editors, this volume represents an integration of theories and disciplines, and a scientific context for modern psychoanalysis.The link between clinical research and extraclinical research via the royal road of dreaming is a theme that runs through all the contributions. These cover dreaming as it sheds light on clinical conditions such as depression and trauma, or dreams as they form a core aspect of clinical work; be that as a co-construction, or as shared play between therapist and patients. The book provides insight through dreams to understanding mental functions in all clinical situations and across all conditions.

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Chapter One - The Re-Awakening of Psychoanalytic Theories of Dreams and Dreaming



The re-awakening of psychoanalytic theories of dreams and dreaming

David Taylor

In 1908, Henri Poincaré (1854–1912), the French mathematician and philosopher of science, gave a celebrated series of lectures at the Société de Psychologie in Paris. One of his lectures had as its principal subject the psychology of mathematical discovery. The interest of his observations endures. They were published later that same year as chapter three of his widely read Science et Méthode. It was immediately translated into English and has been reprinted as recently as 2001. Poincaré's observations are based upon his own experiences. They carry weight because Poincaré, a mathematical genius, was responsible for some of the most important mathematical discoveries of his age. They made possible many significant recent advances in modern science. The importance of his theory about what are now known as automorphic functions is equal to that of the calculus (Ayoub, 2004; Weisstein, 1999; Birkhoff, 1920).1


Chapter Two - Dreams and Play in Child Analysis Today



Dreams and play in child analysis today

Margaret Rustin

To approach the topic of children's dreaming in a psychoanalytic context the links between dream and play have to be our starting point. While in adult analysis there can be continuing robust debate about the centrality of dreams for understanding unconscious life, we are working in a different register with children. Klein's early papers about analysing children (1932) record her recognition of the need to find a technique appropriate to the child's natural forms of communication and activity. Lying on a couch and free associating was not something one could meaningfully propose to any child, whereas an invitation to draw and play in the presence of an attentive adult who would take seriously what the child's imagination revealed seemed to Klein, and remains for us, the starting point for an analytic space to be created. Her initially experimental provision of a selection of small toys with which the child could construct personal scenarios demonstrated to her that it was possible to provide a setting for child analysis which had the necessary characteristics of simplicity, replicability, continuity over time, and recognisable difference from the child's everyday world. The available toys and other materials were to provide a vocabulary with which the child could convey what was on his mind, and were thus to be objects which did not determine the direction of the child's activity, but instead ones which could be used in many different ways, depending on what the child's imagination suggested. Thus, fundamentally, her technique proposed that playing of this particular sort was the child's equivalent of free association and provided the observing analyst with the necessary material.


Chapter Three - The Manifest Dream is the Real Dream: The Changing Relationship between Theory and Practice in the Interpretation of Dreams



The manifest dream is the real dream: the changing relationship between theory and practice in the interpretation of dreams1

Juan Pablo Jiménez


Some 110 years after the publication of The Interpretation of Dreams, a foundational text of our discipline, the theoretical and practical panorama of psychoanalysis is complex and variegated, not to say worrisome. Ever since Wallerstein (1988, 1990) declared over twenty years ago that the theoretical and technical diversity is the rule and that there is no unique theoretical truth or practical approach, various works have come out in succession alerting about the fragmentation of knowledge (Fonagy, 1999) and the chaotic appearance of contemporary psychoanalysis (Thomä, 2000). The problem is that beyond a welcome pluralism what really exists is a mere plurality or, even worse, a fragmentation that makes a theoretical and practical dialogue among colleagues increasingly difficult. What is lacking is a methodology which can be applied systematically to compare the various theories and technical approaches. Thus, the menace spills over the scientific discipline nature of psychoanalysis. Wilson (2000) warns us that today's “pluralism”, which has managed to remedy yesterday's authoritarian monism, “can easily evolve into tomorrow's nightmare, unless some guiding principles chart an ever evolving integrative course” (2000, p. 412). According to Charles Hanly, the standing president of the International Psychoanalytical Association (IPA), “At present, psychoanalysis has an abundance or even superabundance of theory and a paucity of theory-testing observations” (2010a). In order to tackle this problem, the IPA recently set up two work groups aimed at proposed strategies that would remedy the problems related to the theoretical and practical diversity in psychoanalysis. The task of a first such group consists in exploring means to define the so-called “clinical evidence”; in other words, “to explore how clinical observations are being used, how they can be used and how they can best be used to test interpretations and theories” (Hanly, 2010a). The task of a second such group is to search for methods to better integrate the psychoanalytical theoretical edifice. One of its purposes is “to clarify theoretical differences where logically irreconcilable differences exist and to explore directions in which their resolution might be found and to find and clarify real agreement, when it exists, despite apparent difference and even contradiction” (Hanly, 2010b). Whether or not these groups will make progress on any of these fronts is something that remains to be seen. The truth is that during the last decades many have attempted to clarify the complex relationship between theory and practice in psychoanalysis (Bernardi, 2003; Canestri, Bohleber, Denis & Fonagy, 2006; Fonagy, Kächele, Krause, Jones & Perron, 1999; Jiménez, 2006, 2008, 2009; Kächele, Schachter & Thomä, 2009; Strenger, 1991; Thomä & Kächele, 1975).


Chapter Four - Changes in Dreams—from a Psychoanalysis with a Traumatised, Chronic Depressed Patient



Changes in dreams—from a psychoanalysis with a traumatised, chronic depressed patient

Marianne Leuzinger-Bohleber

“It is like a deeply engraved, though entirely irrational program: that alone and without protection, love and security I am unable to survive in this world…”

(Mr W)

Preliminary remarks

Established by Freud, the psychoanalytic extended case report continues to be one of the most important forms of communication in international psychoanalysis, albeit in more recent years such reports have rarely been published in international journals of psychoanalysis. Among others, the partial disappearance of this erstwhile tradition in psychoanalysis as “clinical science” may be linked to the heated controversies in which various authors have questioned the very validity for science of such case reports (cf. e.g., Thomä & Kächele, 1987). A discussion of these controversies would exceed the constraints of the present contribution (cf. also, Leuzinger-Bohleber, 2007, 2010; Leuzinger-Bohleber, Rüger, Stuhr & Beutel, 2002, 2003). I myself contend that, to date, no credible alternative to the case reports has been developed for adequately and “legibly” presenting the “narrative truths”,1 as acquired over the course of lengthy psychoanalysis, to the psychoanalytic and non-psychoanalytic communities. Indeed, while precise reports of sessions (either verbatim, or else based on analysts’ notes) may be indispensable for many clinical and conceptual discussions, they nevertheless remain insufficient for conveying the total impression of a treatment and the results thereof. By contrast—and naturally as best exemplified in Freud's own literary extended case studies—the comprehensive case report succeeds in conveying both to students and to a broad public “what psychoanalysis is”, the goals it pursues, and the types of transformations it effectuates within patients etc. Hence, as empirical psychoanalytical researcher and as clinician, I do not confine my admiration exclusively to the work and legacy of Freud: it also encompasses writers and poets as a whole to the extent that the latter succeed in giving masterful articulation to their insights in complex, psychic processes of transformation of the unconscious, and in mediating the results to their readers. For these reasons, I concur with leading narrative researchers who postulate that many “truths can only be told and not be measured”.


Chapter Five - Dreams as Subject of Psychoanalytical Treatment Research



Dreams as subject of psychoanalytical treatment research

Horst Kächele

An overview of the various functions of dreams distinguishes six (Strunz, 1989):

1.  Dream as by-product of the biological phenomenon of sleep

2.  Adaptive functions

3.  Creative functions

4.  Defensive functions

5.  “Negative functions”, e.g., in the repetition of a trauma in a nightmare, and

6.  So-called “demand functions”, e.g., dreams during a therapy.

This paper will focus on the last of the six functions and shall—by providing three empirical illustrations—point to the rather meagre attention given to dream reports in treatment research. When we speak about dreams in psychoanalytic therapy, we tend to think of a specific dream; rarely enough is it considered that the repeated communication of dreams belongs to the core features especially of psychoanalytic therapies. How else could one understand that an expert panel of North American psychoanalysts places this feature on the first rank of a list of features that discriminates a “psychoanalytic prototype” from prototypes of other psychotherapies (Ablon & Jones, 2005).


Chapter Six - The Work at The Gate—Discussion of the Papers of Juan Pablo Jimenez and Horst Kächele



The work at the gate—discussion of the papers of Juan Pablo Jimenez and Horst Kächele

Rudi Vermote

Juan Pablo Jimenez's paper is a beautiful illustration of dealing with and thinking about dreams in psychoanalysis. The psychoanalytic research by Horst Kächele shows how the use of a strict methodology and statistical analysis of the data of a long-term analysis can offer new and thought provoking findings, which are not visible from within the sessions.

The common points between both papers are striking. Both papers focus on the manifest dream. In the research of Kächele and colleagues, this is the story of the dream; to Jimenez it is the narration of the dream and the associations that go with it.

Both authors further focus on the divergence between dream content and what happens in life at a conscious level. From this divergence, we might gain the impression that they are two separate worlds. This is challenging because most psychoanalytic models on dreams are based on a link between dreams and actual experiences: the Freudian approach linking dreams to inner conflicts and wish-fulfilment, the Kleinian interpretation linking dreams to the transference-countertransference in the here and now of the session, and the Bionian interpretation where dreams are seen as a processing of thoughts and feelings by the dream work alpha, which comes close to what Mauro Mancia hypothesises from a neuroscientific approach.


Chapter Seven - When Theories Touch: An Attempted Integration and Reformulation of Dream Theory



When theories touch: an attempted integration and reformulation of dream theory

Steven J. Ellman and Lissa Weinstein

Although Freud initially presented a complex model of dreaming, the emphasis of this model was on the wish. The wish, to paraphrase Freud, is the capital needed to fuel the dream, and Freud and those who followed him have focused heavily on the capital in the business of dreaming. Freud maintained that dreams are instigated by unconscious wishes. After making this assertion Freud (1900), in Chapter Seven of The Interpretation of Dreams, frequently reminds us of Socrates helping his listeners search for the meaning of the good and the beautiful. The sceptic might ask whether all dreams are instigated by a wish; what about anxiety dreams or dreams that feel horrific and typically are called nightmares? Freud answers these queries and his answers lead him to consider a realm of experience that up to that point in time had been largely unexplored, the earliest and deepest recesses of human experience. He defines an unconscious wish as a pleasure that has its source in early childhood. It is a pleasure that if activated shows the mind in conflict since what is pleasurable at one level (unconscious) will cause anxiety on another level (preconscious-conscious). This conflict is mediated by the censorship (which serves a defensive function) and these two levels of awareness are primarily governed by different modes of cognition (primary vs. secondary process).


Chapter Eight - “It's only a Dream”: Physiological and Developmental Contributions to the Feeling of Reality



“It's only a dream”: physiological and developmental contributions to the feeling of reality

Lissa Weinstein and Steven J. Ellman

In his story, “The Night Face Up”, Julio Cortazar describes a young man who finds himself in a hospital after a motorcycle accident. The protagonist's day, ordinary until he is surprised by a careless pedestrian, is transformed as he moves in and out of a dream while he lies in traction. In the dream, he is a Motecan Indian fleeing Aztec hunters trying to capture him for a mass sacrifice. Elements of the hospital are incorporated into the dream as he struggles against a rising fever: the surgeon's knife transformed into the priest's sharp stone, the odours of the operating room now interpreted as the smell of woods, swamp, and death. For most of the story, the protagonist is sure that he is the man injured in the hospital, but at the last minute, as he lies on an altar awaiting the cut of the priest's obsidian knife, “He knew that he was not going to wake up, that he was awake, that the marvelous dream had been the other, absurd as all dreams are—a dream in which he was going through the strange avenues of an astonishing city, with green and red lights that burned without fire or smoke…In the infinite lie of the dream, they had also picked him up off the ground, someone had approached him also with a knife in his hand, approached him who was lying face up, face up with his eyes closed between the bonfires on the steps” (Cortazar, 1968).


Chapter Nine - Discussion of Steven J. Ellman's and Lissa Weinstein's Chapters



Discussion of Steven J. Ellman's and Lissa Weinstein's chapters

Peter Fonagy

I am pleased to discuss two superb chapters. Fortunately for me as discussant, both chapters were closely linked in terms of intellectual stance and theoretical framework. They reflect an attempt at integration at a number of levels: (1) the integration of psychoanalytic theory and experimental science; (2) the integration of object relations and drive theories; and (3) the integration of clinical work with complex high level theoretical accounts. Again, fortunately for this discussant, the integration succeeds at all these levels.

At the core of both chapters is the notion of endogenous stimulation which is truly a new “drive” theory. Although the theory is not equivalent to any of Freud's views of drives, it explores a number of theoretical oppositions or paradoxes which psychoanalytic theoreticians have learned to embrace over the years. For example, as we shall see, accepting the notion of endogenous stimulations we can no longer debate whether people are pleasure or object seeking. In some ways this is reminiscent of the resolution of the contradictions surrounding the particle and wave theories of light. Understanding the physical, bodily experience that appears to underpin the experience of dreams helps us unpack many complex psychoanalytic ideas.


Chapter Ten - Changes in Dreams of Chronic Depressed Patients: The Frankfurt fMRI/EEG Study (FRED)



Changes in dreams of chronic depressed patients: the Frankfurt fMRI/EEG study (FRED)

Tamara Fischmann, Michael Russ, Tobias Baehr, Aglaja Stirn, and Marianne Leuzinger-Bohleber

Introductory remarks

In this chapter we are summarising changes in dreams in a patient investigated in the on-going FRED study. With this single case we would like to illustrate our attempt to combine clinical and extraclinical (experimental) research in the large on-going LAC depression study.1 Marianne Leuzinger-Bohleber has reported the changes of dreams as one indicator for therapeutic changes from a clinical perspective in Chapter Five. The same patient, part of a sub-sample of the 380 chronic depressed patients2 recruited in the LAC depression study, was willing to spend the necessary two nights in the sleep laboratory of the Sigmund-Freud-Institute because investigating his severe sleeping disturbances was of clinical importance. His severe sleeping problem, shared with many of the patients, is one of his most burdening symptoms and indeed the EEG data elicited showed pathological sleep patterns such that he had to be referred to a medical expert for sleep disturbances, who prescribed him the necessary medications to improve his sleeping behaviour. We are thus investigating several patients of the LAC study also by EEG and fMRI and will publish additional single case studies as well as the results of the group comparisons between the changes in dreams of these patients and a non-clinical control group.


Chapter Eleven - Traumatic Dreams: Symbolisation gone Astray



Traumatic dreams: symbolisation gone astray

Sverre Varvin, Tamara Fischmann, Vladimir Jovic, Bent Rosenbaum, and Stephan Hau


An underlying claim in the research to be presented in this chapter is that formal laboratory based dream research may inspire clinical work with dreams in psychoanalysis and psychoanalytic psychotherapy and possibly change theory. A dream dreamt in a laboratory setting and a dream dreamt during a psychoanalytic process do not, however, necessarily express the same underlying process. The last will to a large extent be determined by the specific and actual transference-countertransference situation, in contrast to a laboratory setting where transference reactions are usually not accounted for or may be seen as a disturbance. In our research it became apparent, however, that those volunteering to participate in laboratory dream research did have expectations and transferences that were displayed in relation to the setting and the interviewers. A wish for security was obvious in many cases but many had also “unfinished business” that in one way or another appeared as themes in dreams and associations to the dream. This was especially visible in individuals with chronic post-traumatic states who often struggled with long-standing guilt and problems with aggression.


Chapter Twelve - Communicative Functions of Dream Telling



Communicative functions of dream telling

Hanspeter Mathys


Why do people share their dreams? What motivates patients in therapy to communicate their dreams to their therapists and analysts? What expectations are connected with telling dreams?

In psychoanalysis we assume that the analyst is the expert in the interpretation of dreams; analysands tell the analyst their dreams to learn something about themselves (Boothe, 2006). In the favourable case, analysands are able to examine and analyse their dream contents, and in the even more favourable case there is appropriation and reconciliation with portions of their personality that are alien to them and not very welcome. Bartels (1979) emphasises that the motivation to communicate dreams lies in the irritating experience of the mysterious, the enigmatic: we know what we dreamed, but we do not know why and what for (see Freud, 1916/1917, p. 94). It is this break between dream and waking life that provokes the wish for an explanation, for interpretation (Bartels, 1979, p. 102, freely translated here). This was the starting point for the single case study of the dream dialogue between “Amalie X” and her analyst presented in the following.1


Chapter Thirteen - ADHD—Illness or Symptomatic Indicator for Trauma? a Case Study from the Therapy Comparison Study on Hyperactive Children at the Sigmund Freud Institute, Frankfurt



ADHD—illness or symptomatic indicator for trauma? A case study from the therapy comparison study on hyperactive children at the Sigmund Freud Institute, Frankfurt

Katrin Luise Laezer, Birgit Gaertner, and Emil Branik

In the last fifteen years there is an increasing number of clinical and theoretical contributions regarding the so-called attention deficit hyperactivity disorder (ADHD) in psychoanalytical literature. For a long time the rapid growth in the number of children diagnosed with ADHD had been denied. The scientific and everyday scientific discourse used to be quite limited. Etiological considerations had been restricted to genetic and neurochemical factors (see, e.g., Hopf, 2000, p. 279). Even in the domains of child psychoanalysis and psychotherapy a psychodynamic treatment of ADH children was seen as contraindicated, and child psychiatrists exclusively conducted therapies.

Meanwhile, not only in the public dialogue, but also in the scientific community, critical and warning statements concerning the increasing and often uncritically applied diagnosis “ADHD” and the frequent pharmacological interventions have come up. In the last ten years many psychoanalysts have modified their conceptual view of ADHD, trying to understand children with this diagnosis as patients with neurotic impairments and thus treating them psychotherapeutically. They could no longer deny that the ADH diagnosis is at best a descriptive one, which subsumes and conceals various and in parts severe psychological disorders. Thus, in the last few years numerous individual clinical studies and theoretical conceptualisations concerning the ADH syndrome were published (see, for example, in Germany: Borowski et al., 2010; Bovensiepen, Hopf & Molitor, 2004; Dammasch, 2009; Heinemann & Hopf, 2006; Leuzinger-Bohleber, Brandl & Hüther, 2006; Leuzinger-Bohleber et al., 2011; Neraal & Wildermuth, 2008; Staufenberg, 2011; Warrlich & Reinke, 2007). The development of symptoms which are characterised by attention deficit hyperactivity disorder vary significantly: “…we observe many different levels of psychic structure in so-called ADHD-children” (Leuzinger-Bohleber, Brandl & Hüther, 2006, p. 27).


Chapter Fourteen - No Intermediate Space for Dreaming? Findings of the EVA Study with Children at Risk



No intermediate space for dreaming? Findings of the EVA study with children at risk

Nicole Pfenning-Meerkoetter, Katrin Luise Laezer, Brigitte Schiller, Lorena Katharina Hartmann, and Marianne Leuzinger-Bohleber1


OECD states in a recent report: “…only in a few countries in Europe have children with a migration background such a bad level of education as in Germany…” (Klingholz, 2010, p. 129, translation: the authors). Every fourth child with a migration background leaves German schools without a formal qualification. Many of them will follow the steps of their parents and end up in a life without work on the fringe of society. The differences between these children and those who are born in a privileged family have never been as large as in recent years in Germany. Early neglect, violence, and an increase of psychosomatic and psychic illnesses such as depressions and drug abuse are some of the well-known consequences.

Seventy per cent of violent adolescents have been physically abused as children. Twenty to thirty per cent of these children will turn into violent adults (see, e.g., Egle, Hoffmann & Joraschky, 2000).


Chapter Fifteen - Orders of the Imaginary—Freud's the Interpretation of Dreams and the Literature of Classical Modernity



Orders of the imaginary—Freud's The Interpretation of Dreams and the literature of classical modernity

Peter-André alt

Preliminary methodological and systematic considerations

Since Descartes, the dream has remained confined to the tenebrous zones of the incomprehensible, of the meaningless. The European Enlightenment all but imposed a ban on interpretation by declaring the dream to be the epitome of the absence of meaning. It fell to Freud's theory of dreams to release the dream from the stranglehold prompted by this designation. Psychoanalysis constitutes the first scientific system since the oneirocritic of classical antiquity purporting to construe the dream according to the idea of a strict inherent structure. With the notion of the unconscious there appeared a new framework of meaning, which attributed to the dream a distinct status of an alphabet of signs with meaningful denotation. Freud went on to evaluate his own scientific achievement in this connection when, borrowing one of Friedrich Hebbel's phrases, he declared in 1914 that with his theory of dreams he had the overpowering impression of having “disturbed the sleep of the world” (Freud, 1914d, p. 21).



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