Dream Interpretation in Clinical Practice: A Century After Freud

The therapeutic use of dreams was almost synonymous with the practice of psychotherapy in the twentieth century. Dream work was touted as the royal road to the unconscious and recommended as an effective vehicle for accessing hidden conflicts, enhancing the collaborative alliance, and facilitating important insights. More than a century after Freud's groundbreaking book, The Interpretation of Dreams, 1 some elements of his clinical theories and techniques have stood the test of time, including the use of free association, dream mechanisms (such as reversal, displacement, and condensation), and the idea that dreams reveal deeper feelings, unconscious conflicts, and past trauma. However, subsequent discoveries burst the boundaries of Freud's early wish fulfillment model. These breakthroughs included (1) the discovery of rapid eye movement (REM) in 1953, which identified the cyclic nature of dreams and allowed reliable laboratory collection of dreams; (2) more than a half century of using content analysis of dream narratives to study personality and psychopathology2; (3) expansion of knowledge about the functions of dreams3; and (4) the evolution of changes in dreaming patterns from childhood through the stages of adult development. 4 Finally, a century of case studies from various schools of psychology, such as psychoanalytic, Jungian, existential, cognitive, and humanistic, have tested innovative models and techniques with hundreds of thousands of psychotherapy patients. 5-7 This article discusses what has been learnt about how dreams can be used in psychotherapy and assessment and reviews practice guidelines for using dreams in a manner that is therapeutically effective, is within ethical guidelines, and is sensitive to cultural differences.