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Safety is the treatment, but a moving target — and love is the answer

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The following is a brief review of some key concepts from Clinical Applications of the Polyvagal Theory (Stephen Porges & Deb Dana, Eds., Norton, 2018).

It is now well understood that until our trauma clients genuinely feel safe, no healing will take place. “Cues of safety are the treatment,” according to Dr. Stephen Porges. His Polyvagal Theory that has transformed how we understand the nervous system and now treat trauma emphasizes that “safety is defined by feeling safe and not simply by the removal of threat” (p. 61). It is not good enough to point out to a frightened client that there is nothing to fear in the therapy room with you, they must actually feel it to be so. And this is a moving target.

In the context of providing therapy to those who suffer from the effects of complex trauma, safety may need to be established again and again as younger parts of the self emerge to establish relationship. You may have established a great rapport with the person who shows up to therapy, the part of them that presents a brave and competent face to the world.  However, trauma survivors, and this represents all of us to some degree, can be exceptionally resilient and successful in some areas of their lives, while being chaotic and vulnerable in others. They can experience profound splits. The presenting self, the persona, is often very well put together, as this person may have had to put on a brave face over and over again and become very good at seeming reasonable and fine even when they were breaking inside.

The rapport you so carefully establish with your client is critical, but then when the relationship deepens, there will often be a whole new process of creating safety. As van der Kolk states in his chapter on Safety and Reciprocity, “Our most painful injuries are inflicted by people we love and depend on. That is the source of the deepest human grief, as well as of most psychiatric disturbances… [When] the very sources of comfort simultaneously are the sources of danger, this creates complex disturbances” (p. 31).

I have found that early establishing of safety with the presenting self in a complex trauma case can be relatively easy, but that as soon as the relationship deepens, we enter an entirely new and challenging terrain. Once we enter the client’s inner circle, we can suddenly be perceived as a threat because it was in the context of these very close relationships that the deepest trauma occurred. In session, the client can move from a sense of safety to one of threat in a heartbeat. The trigger can be something you can’t even see, perhaps something as seemingly-benign as an increased sense of closeness to you.

Van der Kolk said these problems will show up in two ways in our clients, both externally and internally, and the Polyvagal Theory makes sense of how this happens. Under real or perceived threat, the body will mount the series of defenses we are familiar with: fight/flight which can lead to “various degrees of unmanageable behavior”, and/or “withdrawn self-isolation” which moves the system into parasympathetic (dorsal-vagal) shutdown. According to van der Kolk, “Both adaptations interfere with play, formation of friendships, social awareness, emotional responsiveness and language development” (p. 31).

Pat Ogden explains, in her chapter on integrating Polyvagal Theory with her Sensorimotor Psychotherapy, that people can experience sympathetic arousal or parasympathetic slowdown in vastly different ways depending on whether or not fear is present. Arousal without fear is excitement (sport, dance, performance) and slowdown without fear is deep relaxation (meditation, yoga, daydreaming). Ogden said stimulating these states without fear may have inherent healing properties. “Perhaps their nervous system recalibrates as they learn to tolerate extremes of arousal… This recalibration leads to better social engagement because “when safety and choice are paramount, the evolutionarily newer ventral vagal branch of the parasympathetic system that regulates the heart, calms the viscera and governs the muscles of the face is activated, [this enables] positive social behavior” (p. 40).

Ogden wrote of her early days as a therapist, and how she moved clients through powerful, cathartic experiences of early trauma experiences, only to find that they became more dysregulated as a result. She tried various body-based exercises like grounding, centering and use of breath, and found attention on helping the body remain calm and present as the client made contact with early memories was slower going, but ultimately more effective. This attention the ‘window of tolerance’ is now standard practice in trauma therapy. Polyvagal theory gives us a clear sense of why such an approach is effective.

The concept of neuroception is key

Porges coined the phrase neuroception as our innate and automatic ability to detect threat or safety in our environment. Neuroception could also be seen as the internal communication system we come into direct contact with when we are focusing, an elegant practice that enables us to connect safely with our inner felt sense. Ogden notes that teaching clients about neuroception and how it can automatically trigger nervous system responses helps clients feel less shame and self-judgment about their behaviours. Cues of threat that go unnoticed consciously, can still trigger fight/flight and/or shutdown, and an understanding of how this works can clear confusion for the client about some of their challenging and automatic behaviours.

In therapy, the work then becomes in part learning to identify triggers, and in part learning to notice and manage the sensations and impulses that come up in response to these triggers. When a past trauma is “touched and awakened” (to use Bonnie Badenoch’s lovely phrase), the body will initiate defensive responses that are rarely under the person’s control. Focusing, the ability to pause and notice, ask inside with compassion and then assess whether the current environment is truly as unsafe as the body seems to think, is something that brings the client back a sense of self-control, understanding and relief.

Love as the key to creating a therapeutic presence

Ron Kurtz, who developed the Hakomi method and was Ogden’s teacher, suggested a beautiful practice to help create the loving, therapeutic presence so necessary to our work as therapists. He suggests we simply discover and hold what we love about each client. “My first impulse is to find something to love, something to be inspired by, something heroic, something recognizable as the gift and the burden of the human condition, the pain and grace that’s there to find in everyone you meet” (Kurtz, 2010, from Readings in the Hakomi method, Hakomi.com).

Ogden concluded that “The felt sense comes to life in the science of the Polyvagal Theory which teaches us that the wisdom that we need is in our bodies and nervous systems and is deeper than cognitive explanations or mental assessments of danger and safety. Polyvagal Theory describes the drive for connection and intimacy as a nonconscious biological imperative situating any relationship, including the therapeutic relationship, in a new realm… At its core, Polyvagal Theory is about love and identifies the physiology behind it” (p. 48).

Embodying love to stay on target

This is a beautiful conclusion – that love is the key to providing safety in the therapy room. Badenoch underscores that this loving attention must come with “the ability to be present without agenda” (p. 79), something our culture does not teach us very well. In the challenge of doing deep trauma work, where the client’s neuroception of safety can be ephemeral, what the Polyvagal Theory tells us is to hold steady, and remain connected to the feelings of love, admiration and respect you hold for the client. This creates the environment they need to return to safety, social connection and the ability to heal due to the combined presence of your sustained loving support and their natural resilience.

Dr. Leslie Ellis teaches dreamwork, focusing and trauma treatment, and is author of A Clinician’s Guide to Dream Therapy.

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The lost art of listening

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I was asked recently to recommend some books for new therapists. I offered my favorites, Irvin Yalom’s The Gift of Therapy, Eugene Gendlin’s Focusing, and Jacquelyn Small’s Becoming Naturally Therapeutic. They were not really what the intern was asking for, which was specific techniques, solutions and more certainty about what to say in sessions.

I recall, from my early days as a therapist, that desire to say just the right thing, the need to help and to feel certain about what I was doing. After more than two decades in practice and years of training other therapists, I feel I know less in some ways than I did at the start. But that not-knowing is essential to really being present with someone. I realize now that the crucial skill for a new (or old) therapist is the simple, profound ability to listen. I think this is becoming a lost art.

What makes therapy so compelling? Why do people spend significant amounts of money and time to sit in the stew of their deepest concerns week after week? No small part of the attraction is the exquisite and unique experience of truly being listened to, of having the floor and someone’s compassionate undivided attention for almost an entire hour. Where else does that happen in life?

I count myself lucky to have a handful of friends and a partner who at times will sit still and attend to my dreams, my complaints, the vagaries of my current life story. And in a natural reciprocal rhythm, I gladly do the same for them. But even here, where some of my friends (also therapists) are exquisite listeners, there is a time limit, many other things pressing, a sense of how precious and rare it is to have moments where I can truly feel heard with spaciousness.

All of this makes me want to cultivate a deeper ability and commitment to the gift of listening. For inspiration, I have turned to Rob Foxcroft’s book, Feeling Heard, Hearing Others. He says we need patience to really listen:

“You have to slow down the pace of your listening, to be patient both inwardly and in your manner. Much of the time you will be silent – quiet and present, simply waiting and being with the person. Occasionally you will convey your empathy through your words or actions. It is helpful when you are not afraid. The more you are at peace with what is happening, the better it will be. And of course you may be afraid and far from peaceful. Well, so be it. We listen from where we are. There isn’t anywhere else to be, after all.”

Listen from where we are. That’s the trouble. We can be all over the map, thoughts flitting like hummingbirds, distracted by our phones, our thoughts, our impatience to have our own time to be heard. It becomes clear that presence is a prerequisite to good listening; cultivating the ability to simply be present in the moment creates the ability to truly be present with another.

These musings have led me to the idea that I could sprinkle this gift of listening more liberally and generously. Over the years, in my practice, I have cultivated the ability to drop into a quality of presence that is tangible and comforting, or so I like to think. I wonder what would happen if I did more of this… and, to think bigger, what if more of us stopped and really listened to each other? September 19 is the International Day of Listening. On this day, people around the world are asked to take some extra time to truly listen to others around them. The theme this year, in this era of polarization, is to find common ground and respectfully explore differences. I wonder, why not do this every day?

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Dream therapy works: Study shows diagnostic and transformative power of clinical work with dreams

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In Angela’s dreams, there was always a similar theme. In them, she was climbing a mountain, an impossibly-steep slope that seemed to tower ever-higher so that no matter how hard she tried, she could never get to the top. Sometimes she met obstacles, weather, darkness, various elements that hindered her journey. Then one day, the way opened up. It was wide and clear, she felt strong and capable, with an inner conviction she would make it to the summit. This dream heralded a dramatic shift: an increase in agency in her dreaming life that was paralleled in her waking life. Recent research has shown this correlation is not unique to Angela. In fact, the ongoing pattern of dream life of clients in psychotherapy provides important diagnostic and prognostic information.

Nightmare treatment brings predictable shifts in dreaming patterns

In my doctoral research, my qualitative study of the way dreams changed for refugees with PTSD nightmares following dream therapy unearthed a promising pattern across cases. In these harrowing recurrent nightmares, the dream ego’s plight was always dire, the dreamer felt helpless, and would typically wake up in the most frightening part of the dream, about to be killed, kidnapped or in some way deeply traumatized. In the dreamwork, we invited them to imagine a new dream ending, and after this, the dream ego in subsequent dreams showed progressively more agency. In the dreams, the dream ego moved in reverse order of the nervous system’s response to threat: from freeze to flight to fight. Coinciding with this was a significant reduction in PTSD symptoms.

Study identifies the four most common dream patterns

A recent study of dream patterns as related to the psychotherapy process confirms this general progression. The researchers found that dreams generally follow one of the four most common patterns. In the first, the dream ego is threatened; second, the dream ego is confronted with a task or performance requirement; third is a mobility dream depicting some kind of journey; and fourth is a social interaction dream. Any of these patterns can get stuck in a repetitive pattern that the researchers found would coincide with some form of pathology. When the dream begins to shift, so does the dreamer.

For the study led by Roesler (2018), researchers analysed 202 dreams of 15 patients in psychoanalytic therapy and found that their patterns of dreaming corresponded closely with their psychological problems. For example when the dream ego is continually threatened, this corresponds with a weak ego structure, and as both the course of therapy and dreaming progressed, there was a noticeable growth in ego strength in both dreaming and waking life. For example, instead of trying to escape the threat, the dream ego might confront the threatening figures or actively fight, and ultimately succeed, or the threat itself transforms into something less dangerous For example, “In Case 5, in the first half of the series, the dream ego is threatened by snakes. Then in the midst of the dream series, a golden snake appears which is not dangerous” (p. 313). The author noted that these patterns of transformation occurred only in the cases where the therapist reported improvement in both symptoms and personality structure.

As dream ego becomes stronger, so does the dreamer

The relationship between dream patterns and the dreamer’s psychological health tended to move forward in predictable ways, and the patterns themselves formed a kind of continuum: dreams of a threatened dream ego would shift toward more engaged and empowered patterns such as journeys or social interactions. In general, an active dream ego with the ability to solve problems and exhibit agency correlates with psychological health in waking life.

What does this mean for therapists? The study demonstrates two good reasons to track and work with client’s dreams. First, the dreams provide diagnostic information and can indicate clinical progress. Second, working with the dreams themselves may be able to bring about the very changes the client seeking therapy is needing.

Dreams provide honest feedback to therapists

Jenkins (2014) conceives of dreamwork as an intervention in the dream life of the client. If it is effective, the dream life changes for the better. He wrote that “the dream work can then be judged by its influence on the next dream.” This gives the dream worker immediate feedback that is unfiltered: “It allows for an independent assessment rather than relying in the self-assessment of the dreamer.”

To return to Angela’s dream, the sudden shift in the dramatic landscape to something far less daunting, and her corresponding increase in agency and confidence could be viewed as a sign of success not just in the dream, but in the therapy process and in her life. Dream work that invites experiential connection with the dream to foster such shifts may be helpful not only in dream life, but in life in general, and the subsequent dreams can provide proof of success. If Angela next dreams of leading a successful expedition to the Everest summit, we know she is going to be just fine.

 

Jenkins, D. (2014). Assessing dream work: Conceptualizing dream work as an intervention in dream life. International Journal of Dream Research, 7(2), 121-128.

Roesler, C. (2018). Dream Content Corresponds with Dreamer’s Psychological Problems and Personality Structure and  with Improvement in Psychotherapy: A typology of Dream Patterns in Dream Series of Patients in Analytical Psychology. Dreaming, 28(4), 303-321.

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Whether and how to work with traumatic nightmares: An example from Auschwitz

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Many therapists I am teaching to work with dreams have expressed hesitation in working directly with their clients’ most challenging nightmares. They express a concern that talking about these highly disturbing dreams will stir up their client’s fears, possibly reinforce them and generally make matters worse. In a recent blog post, I presented some evidence that almost anything you try will be helpful; nightmares are treatable and should be addressed promptly and directly.

Philosopher Eugene Gendlin offered this piece of wisdom from his book, Focusing:  “What is true is already so. Owning up to it doesn’t make it worse. Not being open about it doesn’t make it go away… People can stand what is true, for they are already enduring it.”

Those who suffer from frequent, recurrent nightmares are already enduring them, so as Gendlin suggests, talking about them does not make them worse, but in fact tends to help. This idea was supported by a recent study looking at the dreams of those who suffered what is arguably the worst possible trauma: participants were all former prisoners of Auschwitz. Polish researcher Wojciech Owczarski analyzed more than 500 dreams of 127 former inmates and concluded that most of their dreams were adaptive on their own or had “therapeutic potential.”

Only 10 percent of the dreams were recurrent, repetitive dreams that replayed actual trauma memories; most had begun to weave in present experiences with the past, or were metaphors for the experience. Both of these kinds of dreams can be viewed as signs of potential recovery from the trauma. For example, one former inmate’s dreams of the concentration camp began to include his young wife, and he wrote, “There’s more confidence that both myself and my wife will survive.”

This research refutes an earlier study (Lavie and Kaminer, 1991) which suggested that in cases of severe traumatic experiences like the Holocaust, those who repressed their memories and did not examine their nightmares fared better. Owczarski found that while not all of the dreams of the Auschwitz survivors had therapeutic effects by themselves, “all of them seem useful and healing in psychotherapy, so suggesting patients repress their dreams would turn out to be a serious mistake.”

How to work with nightmares

So if even the most horrific dreams warrant attention in therapy, the next question is how to do this in a way that does not re-traumatize the client. In this, it can be helpful to take the lead from the dreams themselves as they are an indication of how far along the path to healing the dreamer has come. The man who dreams that his young wife is at Auschwitz with him has clearly come a long way towards recovery from his traumatic experience and would be able to discuss these dreams with relative ease.

In other dreams, you would have to be more tactful and resourceful to use the nightmare’s therapeutic potential. Recurrent dreams that replicate the trauma exactly demonstrate the least amount of progress toward healing – although they can be seen as a form of inner exposure therapy, a repeated calling for the dreamer to attend to the trauma. In these cases, forms of imagery therapy that invite the dreamer to continue the dream, and allow it to play forward have been shown to help.

Help manage fear responses

I believe that the key to working with highly charged material is to help the dreamer to manage their physiological responses, to learn to keep calm in the face of recalled trauma. This process involves establishing and safe and supportive connection with the client, teaching skills that help the client learn to cultivate calm and keep a safe distance from the material. For example, clients can be encouraged titrate: to work with the dream images one little piece at a time. They can also learn how to build an ‘observer self’ that is able to watch the trauma dream play out without the sense that they are reliving the experience.

There is more to this way of working than I can offer in detail here. The main point is that even with the worst nightmares, there is therapeutic potential and to avoid the discussion may well be a mistake. Chances are you won’t make it worse because your client is “already enduring it.” In fact, having someone accompany them into their darkest places demonstrates the danger has past and the trauma can be talked about constructively and healed.

 

If you are interested in learning more about nightmares and their treatment, sign up for my short, focused online course. Because I feel this material is important to disseminate, the course is always open, is self-paced, and currently discounted during the virus crisis. Please ask your clients if they have nightmares, and let them know they are treatable. CLICK HERE for a free PDF for clients: What You Can Do About Your Nightmares. Or check out our Short Focused Course on Nightmare Treatment using THIS LINK. 

 

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Do we benefit from dreams whether we work them or not?

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There are varying schools of thought about whether we can benefit from dreams even if we don’t work with them.  At one end of the spectrum is the notion that dreams don’t do anything for us at all. At the other end is the idea that dreams are a piece of unfinished process that moves us forward only when we revisit the dream. The middle road is the notion that dreams are useful in and of themselves (and there are many theories about why and how they are useful), but they are more beneficial if you work with them. If you don’t have a dream therapist, simply writing your dreams down, telling someone, and allowing dreams to send your musings down an unfamiliar path can spark new ideas and insights.

I fall into the middle ground somewhere, but personally have found dreams to be most beneficial for myself and my clients when I spend time with them and actively try to align myself in the direction they send my attention and intention.

A dream that prevented suicide

There are many examples of dreams that do their work by themselves, needing no interpretation or further exploration. An entire book,  Dreams That Change Our Lives, a publication by the International Association for the Study of Dreams (IASD), is devoted to the topic and filled with examples of transformational dreams. In one striking example, a woman who was planning suicide had a dream that she was at a friend’s funeral and Jesus angrily told her she had to give the eulogy. As she did this, she deeply felt the sorrow of all the friends and family attending, and forever changed her mind about killing herself.

For me, the transformation from a dream has mostly come in the context of therapy or working with through it with a friend or dreamwork partner. In a recent example, I dreamt I was trapped on a cliff, had run up a ridge with my sister and was trying to get down to the water via the rocky canyon on the other side that led to a small, rugged beach. We were on an island that was beautiful but with incredibly steep shores. My sister jumped down into the canyon where there was a brown leather couch – still a ways from the water, and I could not see any realistic way back out of there. But neither could I get back to where I had come from. I was perched in a small hollow that was sloped down toward the cliffs, and it felt like now that I had stopped my momentum, any little movement could affect my balance enough for me to fall to my death. That’s kind of where the dream left me – if I pushed myself back against the rock, as close into the little hollow as possible, I could hang on, but there was no way to rest in it, no flat enough perch to take my entire weight. In a word, it was terrifying. And it felt like there was no way out.

Dreamwork provides the way forward

I had the chance to work with the dream a few days later with a fellow therapist as part of a group exercise. I realized from my own work with traumatic dreams is that fear often narrows our field of vision, and we are not aware of all that is possible. I was dimly aware I was in a dream when I had it, but not enough to attempt to defy gravity. But I did realize, in talking about the dream, that there was another way to get out of my predicament: I could jump! I goal was to get into the water anyway – this would be the most direct route. The danger was in falling too close to the cliffs and landing on the rocks below, but it felt as though I could use momentum to run down the ridge and with momentum, launch myself up, out and away from danger.

Making the leap!

I told my friend how for most people, the prospect would be scary, but for me, jumping from a cliff would be fine because I spent my university years competing for the diving team. I wasn’t afraid of jumping from great height into deep water. She repeated back to me my sentiment about this: you know what you’re doing. The felt sense I got from this was, yes, be bold. Make the leap. So I imagined myself in the dream again and instead of cowering against the rock, I ran down the slope to get some speed and then launched myself into a swan dive, fully expecting to drop like a stone. Instead I started to soar. It reminded me of the one time I went parasailing from the top of Grouse Mountain, the pilot and I launching ourselves by running down a steep slope and then lifting off. I love it when dreams surprise me, and I came away with a feeling of soaring, of lightness and of being lifted up. It was such a different feeling from the way the dream had ended, and I felt grateful to my dream partner, and so glad I had a chance to move forward from where I had been crouched in terror on the cliffs.

Does this resolve everything as tidily as that? I don’t think there is anything tidy about dream work. If a dream is indeed alive (which is how I experience it), it is always changing. And there is never just one way to interpret and dream. There is probably a place in my life where I can’t quite rest, a place that feels precarious. There is also a part of me that feels the confidence of mastery, a sense of being called to do something again that I had once dedicated many hours over many years to achieve mastery. I am not talking literally about diving of course, my middle-aged body would have something to say about that. But writing is also a skill I acquired, and then honed, in my ten years as a professional writer and editor. Now I am writing again after a 20-year hiatus where my focus was on the practice of psychotherapy.

I feel like I did when jumping off that dream cliff – a sense that this is a familiar activity, a sense of knowing what I’m doing. It feels as if the dream is asking me to be bold and to be brave, implying I won’t drop like a stone, but will soar. I don’t know if dreaming the dream on and having such a splendid ending is truly a prediction of the future. But I can say that it gave me a lift, and implies I will be propelled forward by forces greater than my own if I boldly move forward, which feels both motivating and true. The feeling of soaring was a pleasure in the moment, one I can still feel when I sense inside, especially in my chest and shoulders. If that is all the dreamwork brings, it will have been worth the exercise. It made me want to sit down and write.

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Personal dreamwork example: Evolution dream

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In the last couple of posts, I wrote some suggestions about working with your own dreams, and now I’m going to give you a personal example of what I’ve done with an impactful dream I’ve been carrying around with me for the past month or so. Other dreams have come and gone, but this one has stayed with me. It feels like a big dream, the kind of dream worthy of extended time and attention.

Evolution Dream

I am driving my blue Audi (which often appears in my dreams) and nearing the peak of an ever-steepening mountaintop. I am almost at the crest and gun the engine but can feel steepness of the pitch is too much for my car. Just as gravity is about to pull the car back and down, I turn sharply to the left, like the perfect hammerhead turns my dad used to do with me in his little aerobatic biplane. I see a patch of grass about a mile down below me in the valley. I no sooner think this, when I am making a soft spongy landing on this bright green patch of grass. I have somewhere to get to, and ditch my car to start swimming toward a vague destination I imagine as a very exclusive cocktail party in a house perched on a cliff. My car follows dutifully along on the roadside, which is a gorgeous narrow European waterfront road with old stone retaining walls. I am swimming with a large, twisted stick that offers just a bit of flotation, and also slows me down, but I keep it with me because it will get me further in the long run. It’s getting dark and I still haven’t reached my destination, am resigned to get out, get in my car, and head back the other way, try again another day.

In the dreamwork with Robbyn, she suggests I don’t give up, but keep heading to my destination. Then I am Gollum, a small black lizard-like human emerging from the water at the base of the cliff on which the house is perched. I imagine starting to climb the cliff and as soon as I do, I am there, dressed up and standing in the cocktail party, surveying the view from the large front windows. There is a buzz of communication in all directions, many conversations at once. But then it dawns on me: no one is drinking. And no one is talking either. They are all telepathic and in the dream I think: I’ve found my people!

The dream gave me an expansive feeling, and I was content to carry that with me. This is what I mean by carrying a dream along in your body. At times I imagine swimming with the stick that takes me further though it’s cumbersome and wonder what that’s about. I consider the Gollum-figure as the earliest phase of evolution; I have an association to the idea that we evolved from the sea and at one point crawled up on land. Which makes me think the telepathic people represent the other polarity, a higher form of evolution.

I’ve worked with the dream for a good couple of hours with my dreamwork partner, and am very lucky to have someone so empathic, intuitive, highly trained and loving sit in the soup with me and my dreams. The process has stirred up such aliveness in this dream that I will keep working the material. I also recently attended the annual conference for the International Association for the Study of Dreams (IASD) and planned to don an aviator’s mask and scarf along with some webbed scuba gloves and a black hoodie to retell the dream as an enactment at the dream ball on the final night. I arrived late from dinner and the parade of dreamers had begun, so I chose to stay and watch rather than chase up to my room at the far corner of the 900-year-old Dutch abbey where the conference is held every few years. I did tell my dream to some friends at the ball, and again to my daughter. It seems that this is one of the purposes of having such dreams – to marvel at them, linger with them and then to share them, which immediately takes conversation to a deeper level of intimacy and connection.

In the future, I may paint the dream, continue to embody its most mysterious places, and possibly even talk about it in another dreamwork session. It’s clear I won’t be done with this dream for a long time, but it feels more like the dream is not done with me!

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Work with your own dreams using ‘bias control’

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In the last post, I introduced a few ways to work with your own dreams: by writing them down and journaling about your impressions and associations, by drawing them and by embodying the emotion the bring and letting it stay with you to mull over. There is another way that is so useful it deserves its own post. It’s a method called ‘bias control’ because it is intended to do just that: control for the inherent bias we bring to most of our own dreams. Although they always bring something new, we tend to see them in terms of what we already know and believe, so we are notoriously bad judges of our own dream worlds.

Bias control is an idea from Eugene Gendlin, who developed an experiential, body-oriented practice called focusing as a systematic way for people to sense into their body’s wisdom, and its responses to their current situation. He developed a method to let your body interpret your dreams, and suggested bias control for those wanting to work on their own dreams.

Dreams bring us back into balance

The practice is simple, but contrarian. It asks that you take the least-attractive, most aversive aspects of your dream, and experientially imagine being that way. This idea is in keeping with Carl Jung’s idea that dream are compensatory: whenever our view is too much one way, a dream will come that could help bring us back into balance. In his autobiography Memories, Dreams, Reflections, Jung gave an example of this. He dreamt his client was in a high tower, so tall that he had to crane his head back to look up at her. In fact, in his analytic work with her, he realized he had been looking down on her, and the dream helped set him straight.

In another example, a client dreamt about a good friend whom she thought was far too permissive with her dog, letting him run free in situations the dreamer deemed unsafe. In the dream, the dog is driving a car, doing a good job of it and having a lot of fun, but the dreamer was really anxious the dog will crash. She is annoyed at her friend’s nonchalance, so I asked her imagine having that more relaxed, permissive point of view, to feel what it might be like to have less worry. It was a good feeling to move a little in that direction, provided she didn’t take it too far.

Try being dream characters you don’t like

You can try this yourself any time you have a dream figure that you take exception to, and this tends to happen often. If you dream of an authoritarian prison guard, for example, you might consider where you could be more assertive or protective. If you dream of a meek, mousy little figure that makes you squirm with their obsequious nature, you might try out being a bit gentler and more humble. If there is an irresponsible crack addict in your dream, you might try on the idea of being less responsible, or where addiction plays a role in your life.

What happens when you take this contrarian path is that it leads out of your usual way of doing things. Gendlin said it doesn’t mean you need to become just like the figure in your dream that you despise, but that moving slightly in that direction might bring you something new that expands and changes you, and that this might be the dream’s very purpose.

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How to work with your own dreams: Stay engaged with them

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I’m feeling celebratory because yesterday I pressed ‘SEND’ on the very last step in writing my book on the clinical use of dreams. Happy and tired, like I’ve just given birth – which, in a way, I have. Now I want this long-term labour of love to be read widely, and to reach those it’s intended for. Hence, this blog, intended to help spread the word about the book, and to be a vehicle to continue sharing my expanding knowledge about how to work with dreams. I expect to be a student of dreams for a long time.

The question I was asked most often in the past year and a half, when I told people I was writing a book about dreams, is, will it help me interpret my own dreams? Can anyone read it, or is it just for professional therapists? Most seem to be wanting some dreamwork self-help, which got me thinking about what kinds of things might facilitate doing dreamwork on one’s own.

The first caveat is that I think it is always better to tell a dream to a partner or group because we can be amazingly obtuse about our own dreams. Dreams often refer to things we repress, and as we revisit them, the same biases are present in our attempt to make sense of our dreams. However, there are lots of situations where you might want to do some personal dreamwork: if you have no one else available, if you want to revisit a dream that is still reverberating with you, or if you have a backlog of dreams you can’t get to in your dream group or therapy session. Sometimes a dream just lingers, its striking images flashing through our minds during the day, and inviting some form of engagement with the dream.

Let the dream fill you up

There are many things that will open up the dream to you in spite of your inherent tendency to dismiss or overlook some key aspects of it. The first is to write it down in detail along with your impressions and associations to the dream. Then read the dream back and attempt to re-experience the dream, especially the emotion it brought with it. In sampling that emotion, perhaps ask yourself if this feeling is familiar or trying to tell you something, or maybe just linger in the feeling and don’t try to figure it out. If you let it fill you up, it will speak to you in some way that may not be predictable in advance. You can’t get the message by speculating about how you would feel if such a thing were to happen, but rather by having the experience in your bones, or your belly, or wherever it seems to live in your body.

You can draw a sketch of the dream. This also has the potential to quiet the analytic part of you that will prematurely try to decipher the dream as if it were a puzzle to be solved. Drawing a dream shifts you into the right hemisphere, the associative, experiential side of the brain that is better suited for dreamwork. As you draw, the image may speak to you more directly from the dream itself than from your written account, and surprise elements may creep into your drawing.

Both carrying the dream images and emotions with you, and making a drawing of the dream are ways to continue the engagement with your dream over time. The big, numinous, moving dreams we have are worthy of this level of engagement, and the process can shift and change, sometimes over a lifetime.

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Nightmares are easily treatable, though too few seek help

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Taken together, the nightmare studies presented at the recent (June 2019) conference for the International Association for the Study of Dreams (IASD) offer compelling reasons for those who suffer from nightmares to seek any kind of treatment, and as soon as possible. The studies suggest that virtually all nightmare treatments are effective, and that the earlier nightmare disorder is treated the better. Current nightmare research was presented at an international dream conference held in a 900-year-old abbey in Kerkrade, The Netherlands. In this post, I will summarize the nightmare studies of greatest clinical relevance.

Michael Schredl conducted a four-year longitudinal study on nightmares and stress and found that nightmare frequency is generally stable from childhood onwards. He thinks nightmares may be due to emotional regulation issues rather than genetics. He said what increases nightmare frequency and distress is a rise in current anxiety and stress levels (vs. trait stress). Frequent nightmares in the past also predict frequent nightmares in the future. In terms of clinical implications, Schredl suggested that for those who suffer from frequent distressing nightmares, the earlier they seek treatment the better.

Too few seek treatment

Sadly, very few people seek help for their nightmares. Kateřina Surovcová conducted a qualitative study of the experiences of social dream sharing of nightmares. She noted that only one in 8 people seek help for their nightmares despite their detrimental effects. People are reluctant to share nightmares for fear of being seen as crazy, and because they don’t want to burden others with the darkness of their dreams. Yet talking about nightmares can bring a welcome sense of relief.

Another recent study, a randomized controlled trial by Carolin Schmid which compared two established imagery-based treatments, showed that all treatments are effective at reducing nightmare frequency and distress, even the control condition! For the many people who leave their nightmares untreated, it might help to know that virtually all treatment options are likely to be effective.

Just one treatment is effective

In the study, Schmid compared three different imagery-based methods. The first is imagery rehearsal therapy (IRT) which asks the client to imagine a new ending to their distressing dream and then rehearse it. The second is exposure therapy, in which the client is repeatedly exposed to their nightmare imagery. The third, an active rather than waitlist control, guides clients to imagine a safe place. Interestingly, all three methods worked equally well, and all worked with just one treatment session. So, in treating nightmares, it really is true that any treatment is better than no treatment, and the resulting decrease in nightmare frequency and distress occurs after just one treatment.

Schredl noted that in nightmare studies and clinical treatment, the distress caused by the nightmare is the most important variable, and the frequency is of secondary importance. He said people’s attitudes toward their nightmares matters. This is another area where clinical intervention can be very helpful. I can offer a personal example from my practice, an approach useful to any therapist wondering how to approach a challenging nightmare.

Improving attitudes toward nightmares

The images in nightmares can be gruesome and upsetting. However it helps to suggest to those who experience such dreams that the images are not meant to be taken literally, and that they may even be refer to something dramatically positive. Popular dreamworker Jeremy Taylor saw dream images of death, for example, as indicating a major transformation such as the cessation of an addiction. A client of mine dreamt of dismembering a woman, and this image lost its disturbing quality once she considered the ways she felt profoundly divided in her own life  and could see the image as an apt metaphor for this.

In my practice, I aim to encourage people who have nightmares to explore them with open curiosity, and in the course of experiential exploration, to befriend the dream images as much as possible. This shifts the dreamer’s attitude toward their nightmares, and as a result, they can often find them less distressing. This is one way to work with nightmares; what the research suggests is that almost anything works. So as a clinician, there is no need to shy away from dreamwork with clients who have nightmares, and in fact, good reasons to forge ahead.

 

If you are interested in learning more about nightmares and their treatment, sign up for my short, focused online course. Because I feel this material is important to disseminate, the course is always open, is self-paced, and currently discounted during the virus crisis. Please ask your clients if they have nightmares, and let them know they are treatable. CLICK HERE for a free PDF for clients: What You Can Do About Your Nightmares. Or check out our Short Focused Course on Nightmare Treatment using THIS LINK. 

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Dreams: Mysteries solved and unresolved

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Welcome to Demystifying Dreams! I will begin by stating that to resolve most questions about dreams is an impossible task. Although we understand more now than ever before, some key aspects of

Dr. Leslie Ellis headshot drleslieellis.comdreams remain a subject of considerable debate. For example, there is no consensus on the purpose of dreaming, or even if they have a purpose, and a wide-ranging set of ideas about their source and what they might mean. Their ongoing mystery is part of what makes them so alluring.

What I can do is provide clear and concise information about what we do know about dreams with an aim to helping those who work with dreams professionally proceed with greater skill and confidence. This blog will also appeal to those who want to know more about dreams in general: how to remember them and what to make of them.

I started this blog because I have just written a book on the topic of how to understand and work with dreams. The book is primarily for therapists who want some clear and simple tools to help their clients constructively explore their dreams. However, since I aim to keep the writing concise and accessible, it will also be of interest to anyone with curiosity about dreams. I welcome and will address your questions and comments.

A sampling of future topics

How to recall your dreams. Often the first thing people say when I tell them I’m working on a book about dreams is that they don’t dream, or don’t remember their dreams. The fact is, everybody dreams about two hours every night. When deprived of dreaming, we will spend a greater amount of our sleep time dreaming until we make up for the lost dream time. Our bodies treats dreaming as essential. So it isn’t that you don’t dream, but rather, don’t recall your dreams. There are physiological reasons for this and ways to improve dream recall – I will explain these in an upcoming instalment.

Why we dream. This is a question that has no hard and fast answer, and likely there is more than one answer. There are a few plausible theories that have been increasingly supported by research. A popular notion is that dreams help consolidate memory, sifting through the elements of our daily experience, making associative links to the past and enabling us to retain what is important.  Another well-supported idea is that dreams help regulate emotion, which could explain why most of us feel better in the morning than when we went to bed.

Why work with dreams? The main reason is that dreams can facilitate more efficient therapy by bringing the conversation right to the heart of matters that concern our clients most deeply. They open up challenging topics that clients find hard to bring up otherwise. They are unfiltered honest pictures of our client’s inner worlds, and once we understand a few simple things about the metaphorical language of dreaming, we can easily help our clients tap into this valuable resource that too often gets ignored. (For a fuller treatment of this topic, see the next blog entry.)