Category: Clinical Practice

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Treating Complex Trauma: Straddling Two Worlds

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A brief review of Trauma and the Soul: A psycho-spiritual approach to human development and its interruption by Donald Kalsched (Routledge, 2013)

In his book Trauma and the Soul, Kalsched (2013) asks us to stand between two worlds – with our embodied sense of all the trauma that is present in ourselves and in the world, but also with the richness that is our personal, immediate and infinite current existence. He poses the question, “How do we manage to live a full life between these two worlds?” (p. 2).

Kalsched believes that any complete view of the personal self “must include its infinite reach and spiritual potential as well as its finite limitations.” In fact, in working with the deep ravages of complex trauma, it is the depth of connection with one’s soul that is often the saving grace and the “ultimate source of transformation in psychotherapy.”

He notes that many of those who experienced early childhood trauma describe “a blurring of the boundaries between ordinary and non-ordinary reality… that is inaccessible to better adapted people” (p. 3). But one of Kalsched’s primary messages is that these inner protectors from the spirit realm often turn into inner persecutors. How to overcome this phenomenon, not often talked about, is the focus of Trauma and the Soul.

The archetypal world is there to catch trauma survivors when they fall

It is well understood that when a difficult situation exceeds a person’s ability to cope with it, they split off a part of themselves as a form of protection, and in doing so, often step into a vast transpersonal world. Dissociation drops the trauma survivor into a mysterious world that Kalsched argues is not simply the result of ‘splitting’ but is also a doorway into an archetypal world that is “already there to catch them” (p. 4).

To view these extraordinary experiences as metaphor for personal experience collapses the two worlds… “between which our lives are normally suspended.” To assume it is all bounded by personal experience is to lose something essential, and in the case of survivors of extreme trauma, to discount their personal experience as merely imagination. This does not mean that we should overvalue the magical world many trauma survivors inhabit as they often need to be “talked down from their celestial scaffolding… and reconnected to life.” But Kalsched stresses that “often the early story of the trauma survivor is a mythological story before it is a personal one.”

What current neuroscience of infancy shows is that dissociation due to trauma or neglect will fragment experience, storing it in implicit memory only. Kalsched suggests these fragments gather up archetypal images from the collective unconscious because there has not yet been a developmental step that differentiates into a personal self. So early trauma survivors find access to and expression of their story more easily through myth, dreams and metaphor.

The body is the access point for this material, and focusing remains one of the best ways I know to gain access to this metaphysical layer. Focusing is an inner process that gently opens a person up to their embodied, implicit knowledge. The process of accessing, and expressing what a trauma survivor embodies can move the material from the transpersonal to be woven into their personal story. To pathologize this process and label it as a form of psychosis is unhelpful, possibly harmful – though the ultimate goal is to enable the client to straddle both worlds while remaining in solid contact with what is real and present… at times a tricky balancing act.

Kalsched makes a careful distinction here. He states that “the spiritual world is real, and following trauma it is recruited for defensive purposes” (p. 5). He believe that the angels and demons that help or haunt survivors are not only the derivatives of a defensive process, something that would not exist otherwise.

In viewing the archetypal realm as its own form of reality, Kalsched does not dismiss the visible world or the importance of our new understanding of the role of attachment and early relationship. He said these developments keep trauma work “relevant and grounded. In fact, they even hold out the possibility of restoring the embodied soul to our field” (p. 8). I suspect the reason he devotes more attention to the invisible world is that it is too often ignored, and in trauma work, this is an oversight. He writes that the infinite and eternal world of spirit “is often potentiated by early trauma and so a complete story of trauma must include its perspective.”

Trauma is defined as anything we are unable to bear consciously. Children are especially vulnerable because they have not yet developed any way to metabolize abuse or neglect, and so their nascent sense of self would be shattered if it were not for our ability to split or dissociate to “save a part of the child’s innocence and aliveness, preserving it in the unconscious… and surrounding it with an implicit narrative that is eventually made explicit in dreams” (p. 11).

Newfound hope that healing is possible

Kalsched found that such dreams contained a pattern, a dyad of child or animal and its protector, often a diabolical figure that would appear just as the client was making progress in therapy – getting close enough to relational feelings to trigger a defensive response. In 1996, Kalsched wrote about this ‘self-care’ system without much hope, but he has since incorporated techniques informed by attachment and neuroscience (ie Schore, Badenoch, Bromberg). “As a result, I have been able to witness how the seemingly-intractable resistances of the self-care system can transform, and the defensive system can even release its prisoners” (p. 13). This work is not easy and involves the full relational participation of the therapist to bring about “the co-creation of an entirely new inter-subjective reality.”

Kalsched was fascinated with what is preserved when a traumatized child splits off and hides away an essential part of themselves. He originally called it the “imperishable personal spirit” and now calls it simply the soul. He called the “main epiphany” of Jung’s work the discovery of “the divine child, patiently awaiting his conscious realization” (1912, para 510). Kalsched points out that there is a sacred dimension we can discern from “the psyche’s symbolic process – if we learn how to attend to it in our dreams” (p. 15).

Kalsched echoes the popular sentiment that early trauma is relational trauma and this can only be healed in relationship. He stresses that such a healing relationship must be of a particular kind that looks both outward and inward. It can bridge dissociated self-states in a manner not unlike the ‘good-enough’ infant-mother dyad made famous by Winnicott. It can weather “the stormy affects that are generated as the soul re-enters the body, until re-connections are made between affect and images, between the present and the past, between the inner child and its caretakers. Such a relationship holds the hope that both inner and outer transitional space may open once again, that connections in the brain can slowly be re-wired, and that archetypal defenses will release us into human inter-subjectivity and ensouled living” (p. 21).

He adds that “therapy for the soul comes in many forms” in addition to therapy or parent-child relationship, including encounters with animals, art, ideas, music… there is no formula or system that applies universally. “This theory can never be systematic or scientific because the soul and spirit are mercurial realities, quixotic, ineffable and can never be pinned down… If we were wise, we would probably keep silent about the soul and learn to listen” (p. 22).

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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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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.