Dreams – again, start where you’re at.

In recent postings, I have been describing the importance and benefits of patients beginning sessions – when they can – by gently and honestly asking themselves where they’re at.  As we saw, some of the most productive sessions start this way.  By contrast, when patients try to talk about something “important” but their heart is not in it, it’s usually pointless and the session goes flat.  You shouldn’t talk about your mother just because you’re seeing and analytically oriented psychotherapist, unless that’s really where your heart is at the moment.  (Obviously there are cases when a person is resisting the important material, and then has to be coaxed/reminded to get back to talking serious – that’s a different situation and a topic for a whole other entry.)

The same thing is true when talking about dreams, as I’ve often noticed.  Laymen in particular are prone to asking me “what does it mean when you dream x, y, or z?”  Those of you who saw “Analyze This” may recall the maddening response the therapist gave his gangster-patient who asked the same thing.  He said “I don’t know; what does it mean to you?”

Annoying, perhaps, but correct.  It doesn’t matter what the dream means to the analyst.  The dream, or any element in it, might mean any one of 100 different things.  What matters is which of those hundred things is being symbolized in the dream for that dreamer – the only person who really knows that, ultimately, is the patient.  The therapist can guide.  The therapist may know which way to point the patient in considering what the dream or some element in it means.  But only the patient knows when we’ve hit the right answer.  The therapists job is – as my old mentor put it – to help clean off the glasses; I can tell you when you are resisting, distracting, avoiding, or simply lost, and I can point you in the direction of possible ways out.  It is only you who can tell us if we have found the right one.

Erwin is a good example of this.  He came to me with problems in his marriage, work, and relationships with his children.  He was frequently quite frustrated, felt powerless and spent much of his time enraged and unable to focus because of that feeling.  He came from an abusive childhood, had a father who was depressed and at one point suicidal, and who often made the boy feel very guilty for being such a burden (he wasn’t); Erwin recalls his father sadly talking about how much work it was to raise him, how he gave up so much to put him and his siblings through school.  Erwin also recalls his mother telling him that she hated him.  When his siblings were born – and he does not really remember this although it is clear from his recounting of the family history – he was replaced.  He had been the oldest, gotten all the attention, and suddenly these stressed and rather feckless parents turned all their focus on the new twin babies.

Psychology and psychoanalysis – as well as history and literature – teach us that what we don’t remember we are doomed to enact.  This unremembered sense of envy, the resultant scrambling to recover his honored place in the family and the attention and even minimal affection of his parents dogged Erwin the rest of his life and in our early sessions.  He wasted the first several months with me trying to control every aspect of our interaction, on the surface very polite but in fact quite demanding; in the midst of all that, of course, there was no room for us to actually engage and get anywhere; he had to establish his territory and all the ground rules before he could dare open up.  Eventually I was able to help him see his behavior and the feelings underneath, and our work could begin.

One day he came in with a nightmare:  His wife had set him up to take the fall for a crime so that she could be with another man, and she told him so in the dream.  My immediate thought was that the betrayal was what was so painful – not her leaving him.  That’s what the textbooks might tell us is the more powerful issue, the greater blow, and it may be what my own issues lead me to believe.

I have learned, however, never to assume.  I asked Erwin, as I ask all patients who bring in dreams, what was the most vivid element in the dream, the most vivid image, sound, moment, or feeling.  His answer was explicitly “that I’d been replaced; not that she set me up”.  Now that you know the history, I’m sure you can see the parallel between this and Erwin’s real life experience when he was a child.  Unless you’ve sat with this man and heard his stories at length, experienced his controlling behavior first-hand, and observed the pain he is in when he feels left out, you would not know what a perfect encapsulation of his life this dream and his particular response to it are.  And we might have missed it had I leaped to focus on the sense of horrific betrayal – nightmarish, I’d call it – that his wife not only left him for another man but had Erwin sent to prison, ruining his life and career as well as breaking his heart.

So again I remind all of us – patients and therapists – to shut off your brain, assumptions, and preconceptions as you proceed through a session.  Much better by far is to allow yourself to open up to the data:  Never mind what you think you know, what you think is “important” to discuss in therapy, never mind what you think the dream is about because you read a book, never mind what you are sure you feel because it is logical, reasonable, palatable – the latter is an especially strong draw for people and thus a frequent block to noticing what really is happening to you.

When Erwin and I did this during the session the result was a very useful discussion of his pattern of chasing acceptance and – most importantly – how he does not usually realize he is doing it; he reflected on how such behavior in fact drives others away (including potential clients and business contacts), and how painful it is for him to experience or perceive even the smallest sense of exclusion.  Most important, all that discussion left him calmer, more hopeful, sadder, yet much more able to focus and move forward with the day and his life.

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