Therapist Dreams About Clients: a Qualitative Investigation of Themes, Exploration, and Use
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ABSTRACT Title of Document: THERAPIST DREAMS ABOUT CLIENTS: A QUALITATIVE INVESTIGATION OF THEMES, EXPLORATION, AND USE Patricia Spangler, Master of Arts, 2007 Directed By: Professor Clara E. Hill, Department of Psychology Although case studies have indicated that dreams about clients can have therapeutic utility, little empirical research has been conducted on such dreams. The purpose of the current study was to learn more about this phenomenon, with a focus on four specific areas: (1) themes that occur in dreams about clients, (2) the meaning therapists make of the dreams, (3) what methods therapists use for gaining understanding of these dreams, and (4) what uses therapists make of their understanding. The consensual qualitative research method was used to analyze transcripts of interviews with 8 experienced therapists. Results indicated that the dreams typically had primarily negative interpersonal patterns, deepened therapist awareness of a known issue; therapists used multiple methods to work with the dreams; and therapists used their understanding of the dream in deciding how to proceed with the case. Specific meaning of the dreams included signals of unmanaged countertransference and indications to make fundamental changes in the therapeutic relationship or the therapist’s life. THERAPIST DREAMS ABOUT CLIENTS: A QUALITATIVE INVESTIGATION OF THEMES, EXPLORATION, AND USE By Patricia Spangler Thesis submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Master of Arts 2007 Advisory Committee: Professor Clara E. Hill, Chair/Advisor Professor Mary Ann Hoffman Dr. Sharon Spiegel © Copyright by Patricia Spangler 2007 Acknowledgements My deepest gratitude goes to Clara Hill for her superb auditing, gentle encouragement, and tireless support; I could not dream of a better mentor. Special thanks to the generous therapists who shared their dreams and their time for this study. Thanks, too, to Mary Ann Hoffman and Sharon Spiegel for serving on my advisory committee. I also extend my appreciation to my dedicated research assistants, Sarah Carter, Jaime Easter, Rebecca Greenwell, Erica Schonberg, Kelsey Skjei, Tina Thomas, Geetanjali Chattopadhyay, and Taylor Zilbiger, with special thanks to Carol Mettus, Huajing Guo, and Linda Heymsfield for their efforts on this endeavor at critical stages. Finally, special thanks to my family, whose patience and good humor have helped see me through this project. ii Table of Contents Acknowledgements ii Table of Contents iii List of Tables v Chapter 1: Introduction 1 Chapter 2: Review of the Literature 5 Therapist Dreams about Clients 5 Self-Analyses, Case Studies, and Anecdotes 5 Empirical Studies 19 Client Dreams about the Therapist 36 Qualitative Research 45 Background 45 Consensual Qualitative Research 46 Chapter 3: Statement of the Problem 49 Research Questions 50 Chapter 4: Method 51 Design 51 Participants 51 Measures 55 Procedure 55 Qualitative Analysis 63 Chapter 5: Results 66 Dreams in General 68 Specific Dream about a Client 75 Participating in the Study 91 Case Examples 94 Chapter 6: Discussion 102 Research Question 1 102 Research Question 2 107 Research Question 3 114 Research Question 4 116 Other Findings 119 Limitations 121 Implications 123 Future Research 125 iii Appendices 127 Appendix A: Recruiting Email 127 Appendix B: Interview Protocol 1 129 Appendix C: Interview Protocol 2 130 Appendix D: Dream Summaries 133 Appendix E: Sample Core Idea Table 138 Appendix F: Sample Cross Analysis Table 139 References 140 iv List of Tables Table 1: Number of Dreams about Different Clients or Same Client Presented by Each Therapist 66 Table 2: Domains, Categories, and Frequencies Regarding Therapist Dreams about Clients 70 v Chapter 1 Introduction From the dawn of human cognition, dreams—alluring, terrifying, inscrutable— have been a common source of fascination. Our adventures in sleep are at once universal and unique; everyone dreams, but we dream alone. Perhaps it is this paradox that drives the need to share our dreams, to decipher them, ultimately, to make some use of them. As psychoanalytic science was in its infancy, Freud (1900/1913) recognized the singular power of dreams and seized upon them as the via regia to knowledge of the unconscious. Since that time, researchers and clinicians have sought a greater understanding of dreams—their intrapsychic functions, their neurological footprints, and their therapeutic utility—and have made dreams the topic of wide-ranging research efforts. The vast majority of studies on therapeutic uses of dreams have investigated clients’ dreams, with a strong concentration on dreams about the therapist, which have been shown to be useful in elucidating client perspectives of the therapeutic relationship. More specifically, studies of clients’ dreams about their therapists have shown how frequently these dreams occur, their common themes, how they change during the course of therapy, and their utility as indicators of unconscious client issues or of difficult points in therapy (Carlson, 1986; Eyre, 1988; Feldman, 1945; Geffner, 2004; Gillman, 1993; Harris, 1962; Oremland, 1973; Rohde, Geller, & Farber, 1992; Sirois, 1994). In contrast, few empirical studies have been conducted on psychotherapists’ dreams about their clients. The body of research to date comprises mainly case studies or therapists’ reports of their own dreams, although four empirical studies have produced some inroads to understanding the nature of these dreams. These studies include Lester, Jodoin, and Robertson’s (1989) survey of psychoanalysts and candidates on dreams about patients, which indicated that the dreams occurred at a difficult point in analysis and that candidates and less experienced analysts do not dream about patients any more frequently than do more experienced analysts. Included in the study was an analysis of 41 dreams about patients provided by respondents, from which the researchers classified six relational themes. In the first of three qualitative studies reviewed here, Karcher (1999) examined the supervisory uses of dreams about clients in addressing countertransference in graduate student trainees. Results showed that most of the trainees’ dreams contained countertransferential material and that trainees perceived some benefit in supervisory use of the dreams. Degani (2001) showed that therapist dreams about patients occurred during challenging periods during therapy; that they involved difficult patients; that they functioned as a mode to fulfill wishes, work through relationship problems, and purge unpleasant emotions; and that insight gained from dream interpretation could elicit therapeutic breakthrough. Kron and Avny (2003) examined Jungian and relational perspectives of therapists’ countertransference dreams and identified nine interpersonal themes, some similar to themes identified in previous studies, and found three types of dream functions: prognostic, diagnostic, and compensatory. Although these studies have deepened our understanding of the phenomenon of therapist dreams about clients, the only approach taken thus far is psychodynamic, with a focus mainly on countertransference. In addition, for some of the studies, supervisor feedback was a key component (Karcher, 1999) or at least a consideration (Degani, 2001), but little attention was given to other measures therapists might take to help them understand their dreams about clients. Finally, most of the therapists in these studies were 2 graduate student trainees, which again, limits generalizability of the findings to that population. To broaden the knowledge base of this rich but underexplored resource, the current study examined dreams about clients from a very different sample: experienced therapists of various theoretical orientations. If dreams about clients serve the purposes of signaling unmanaged countertransference and providing clues about difficulties in the therapeutic relationship for therapist trainees, it was worthwhile to investigate the dreams of experienced therapists for these and other potential uses. In addition, results on the supervisory uses of dreams about clients have been mixed, and given that few experienced therapists are in regular supervision, it was useful to explore what other methods therapists have for working with these dreams and what uses they ultimately find for them. The existing literature indicates that therapist trainees tend to have negative dreams about challenging clients and that they occur during difficult times in therapy, suggesting that these dreams reflect young therapists’ state of unease regarding their professional development. Another goal of this study was to expand the investigation to the dream content and therapy environment pertaining to experienced therapists’ dreams about clients. In addition, the current study utilized a more rigorous methodology, consensual qualitative research (CQR), than has been applied in previous studies on this topic. Finally, this investigation had several implications for practice and training. Results of our investigation showed various methods being used to explore and understand dreams about clients. Elucidating the methods found in the current study can provide some guideposts to other therapists for working with their own dreams, 3 expanding their dream work repertoire, and potentially enabling them to gain a fuller understanding of their dreams. A richer, more complex picture of therapists’ unconscious