Symposium: Eclectic uses of metaphor in psychotherapy

The present paper deals with the use of dreams and the associated images in the context of cognitive behavioral therapy. Dreams have historically been an important part of the psychotherapeutic process. The therapist trained in cognitive behavioral therapy is frequently not trained or prepared to work with dreams in psychotherapy and may lose valuable opportunities to tap the richness of imagery offered in dreams. The cognitive model sees the dreamer as idiosyncratic and the dream as a dramatization of the patient's view of self, world, and future, subject to the same cognitive distortions as the waking state. The following guidelines can be set for C-B dream work: (1) The dream needs to be understood in thematic rather than symbolic terms. (2) The thematic content of the dream is idiosyncratic to the dreamer and must be viewed within the context of the dreamer's life. (3) The specific language and images of the dream are important. (4) The affective responses to the dreams can be seen as similar to the dreamer's affective response in waking situations. (5) The particular length of the dream is of lesser import than the content. (6) The dream is a product of, and the responsibility of the dreamer. (7) Dream material is amenable to the same cognitive restructuring as any automatic thoughts. (8) Dreams can be used when the patient appears 'stuck' in therapy. (9) Dreams cannot become the sole focus of the session and need to be dealt with as part of the agenda. (10) Imagery, associated with the dreams can be quite useful in the therapeutic work. The cognitive therapist can enrich his or her armamentarium by including dreams and imagery as part of the psychotherapeutic collaborative process. They offer an opportunity for the patient to understand his or her cognitions as played out on the stage of the imagination and to challenge or dispute those depressogenic thoughts, with a resultant positive affect shift. The dream would not then necessarily be the royal road to the unconscious, but rather the more commonly traveled route toward the individual's conscious understandings of personal, family, cultural, religious, and gender-related schema.