Abstract
This very interesting clinical material gives us a welcome opportunity to reflect on the meaning of dreams in analysis and the ways we address and think of them—particularly when the patient is silent about them or is otherwise reluctant to engage directly with the analyst. The paper is offered as a commentary on the possibilities of dreams as a means of working through trauma. For me, though, what seems in play with these dreams is not so much trauma and its resolution, but rather how the dreams depict the psychoanalytic process itself. I think of the dreams as a reflection and commentary on the ongoing psychoanalytic process, representing the patient’s internal world as it plays out in the workings of the transference and countertransference. I think more of how the dream functions than of what it might “say.”
The analyst describes his sensitivity to his patient’s sense of fragility, a sensitivity that from the outset, I think, exerts a particular grip on the analysis. With that in mind I was particularly interested in the state of mind the dreams arouse in the analyst. For example, the analyst’s response might take the form of an overriding and inhibiting concern about trying to get it just right with his patient. The patient’s dreams, then, would not only depict her anxieties and fantasies, but would also transmit those anxieties to the analyst. The analyst may unwittingly enact these anxieties by taking an overly careful approach to the dream material.
I don’t accord dreams a privileged place in the analytic work. Once a dream is told, I think immediately of how both the dream and its telling are used by the patient. Does she allow the analyst room to think about the dream? Do interpretations excite her or shut her down? Does the analyst feel he has to fit in with the patient’s requirements? I don’t think we should treat dreams as unique modes of expression. Like everything said in analysis, we should attend to how they are told and how they are taken up—by the patient herself and by the analyst.
In “What is a Clinical Fact?” Edna O’Shaughnessy (1994) describes moments in analysis that both patient and analyst can characterize as “fact.” These are facts, not in the historical sense, but in the sense of having happened here and now in a way that is emotionally verifiable for both patient and analyst. The “fact,” then, is a clinical fact that both patient and analyst can recognize as such.
O’Shaughnessy, though she doesn’t reference Bion here, might be thinking a bit of his now famous admonition that the analyst approach the session “without memory or desire.” Bion’s elliptical admonishment refers to the openness of the analyst’s mind, an openness that is not predisposed to a particular direction or desire, but can be resolutely neutral to the patient’s communication. For Bion this state of mind is what he calls unsaturated—unsaturated with presupposition, with theoretical imposition, with any quest at all on the analyst’s part.
But often dreams do generate desires in the analyst: the desire to figure something out, to get to the bottom of it, to be helpful or good, to make sense—even before the patient can make the connections the analyst might want the patient to make. We see this in the material Levy presents—the analyst wanting to make sense of the dreams and pointing toward historical connections as a means of doing so. I think this is a common interpretive strategy.
Rather than drawing on the moments between patient and analyst, the here and now, the “clinical facts” of the situation, analysts often use dreams to make sense of the past. Of course dreams do help us conjure up the past of our patients—their histories and internal worlds—but for me the dream is first and foremost an opportunity to explore its meanings in the immediate moment of the analysis, between patient and analyst.
I pay particular attention to the way the dream is told—does the telling allow the analyst to work with it? Or does it seem that the patient is keeping hold of some of its contents, indirectly asserting a kind of precognition that forecloses the analyst’s participation? There are myriad possibilities as to how a dream can be told, and the analyst will certainly attend to these preconscious communications.
The analyst who wants interpretive answers (to a preexisting question about what the dream “means”) will have his mind already filled—by his own questions and concerns—that will necessarily make it harder to sense the immediate countertransference affects evoked by the patient’s dreams and by the mode in which the patient interacts with the analyst in relation to the dream’s contents.
First Dream
The first dream illustrates the process taking place between analyst and patient at a very early point in the treatment. The dream (which had awaken the patient in a fright) is as follows: I was climbing up a steep mountain . . . saw a lighthouse at the top . . . there was a man there . . . I reached the top . . . I don’t remember what he said to me. . . . Then I was going down . . . it was dark . . . I can’t remember the rest of the dream [p. 3].
The analyst’s intervention emphasizes the patient’s seeing a light—he underscores the hopeful quality in the dream. (Reading this, I, on the other hand, immediately wonder whether this interpretation refers to the analyst’s desire to have the analysis be an optimistic source of light for the patient, a patient who intermittently had been very depressed.) But the patient is angered when the analyst says this and falls silent. As in the dream where the patient doesn’t recall what was said, in the session she grows angry when the analyst speaks. The dream suggests a turning away from a good object (a good object is what her analyst wants and needs to be). Moreover, as the patient “goes down,” she succumbs, her mind stops functioning properly, she goes down into darkness, not only depression I think but also a darkness where she cannot think / can’t remember / can’t use what was offered. To me this is not so much a dream of trauma as a representation of the patient’s internal object world and her fears about her own mind and functioning, a depiction of the situation she now faces in her analysis. The man in the lighthouse signifies that she sees something positive in a figure (her analyst I imagine) but that she knows she cannot use it, cannot draw on it, cannot bring it with her. I think the patient is conveying her sense of the impossibility of having an object with her, someone who can thoughtfully or usefully observe and offer her something of use. She knows there is something hopeful but equally she knows that she cannot really approach it usefully, cannot take it with her or take it in. This is her anxiety, and it elicits a corresponding anxiety and response in the analyst. When she feels her analyst has missed this communication, has for whatever reason needed to emphasize the light, she cries inconsolably; when she feels alone as she has been in the dream, I immediately wonder if she is enacting something, getting her analyst to play the part of an object who cannot stand the difficult feelings she brings him.
For me this dream—though every early—depicts a central theme of the analysis. I think this often happens, even at such an early stage. I imagine that if one heard the dream in terms of the here and now, one might think of the man in the lighthouse as the analyst—offering something redeeming and hopeful that the dreamer cannot, does not, avail herself of—but, even more important, one might grasp the crucial sense of failure that is attributed to the analyst and to the dreamer, a sense that parallels the mood of the session and something of the tone of the analyst’s countertransference.
Levy and Finnegan emphasize the traumatic state of the patient’s life. It sounds as though she has indeed had a very difficult set of early relationships to navigate. I find myself wondering, though, about the utility of presupposing/imposing the notion of trauma rather than allowing one’s sense of the patient to develop along with the emergence of transference and countertransference. For the authors, the first dream is already evidence of the patient’s traumatic past. I would rather hear the dream as conveying the patient’s anxieties about the start of her analysis and her capacity to be accompanied/helped, and to properly engage her mind. The darkness—which may well be the patient’s hopelessness and depression, but may also have to do with the workings of her mind, her destructiveness—requires recognition, lest she feel overly reassured but not quite heard (as we are told she felt when her mother told her to “go buy a dress”). In other words, it seems to me that this first dream contains important transference elements that are active and available for interpretation.
What O’Shaughnessy calls a clinical fact can be obscured by having in mind a preexisting notion of what is in the patient’s mind—whether it is trauma, or particular aspects of the patient’s actual parents and reported history. A dream can tell us more about the patient’s internal object world in the moment, her unconscious fantasies of her object/analyst than a narrative historical description is able to do. So many questions can be present in the analyst’s mind in response to the patient’s communications—and when they are in the direction of the genetic past, searching for answers, rather than staying with what is evoked in the moment of the session, my sense is that a very crucial part of the communication is missed, particularly its present unconscious aspects. The first dream concludes with silence: the analyst says nothing, as he is presumably unsettled by the intensity of his patient’s response. In an aside, he tells the reader that more could be said about his countertransference (p. 16). For me, however, the countertransference would be central. The analyst’s careful scrutiny of what is evoked in him in the moment can yield important data about the nature of the patient’s communications and fantasies at an unconscious level.
Second Dream
I was lying in bed and had a hose in my hand . . . and I was spraying shit all over the walls . . . it did not bother me at all. I was pleased to be doing it [p. 6].
This dream—which the authors say was surprising to patient and analyst alike—indeed seemed to me to be quite a communication. I found myself thinking of a paper by Sodré (2015) in which she takes on “the endlessly bewildering question of bad faith” (p. 216). As I heard the dream I was alert to a feeling of being manipulated, being played: the patient is lying in bed (the couch) and spraying shit with no bad feeling at all—in fact feeling quite pleased about it. I think I would have heard this “dream” as a communication about something going on, under my nose, as it were, in the analysis: a manic activity filled with excitement—not troublesome—void of any depressive feeling or concern, though certainly strange and estranging, primitive, perverse, paranoid, and alone. The patient’s shit-spraying activity, along with its lack of capacity for reflection or thought, falls into what Sodré, drawing on Flaubert, has described regarding hysteria: “the only way of tolerating existence for the hysteric is to lose himself in phantasy as in perpetual orgy”—where fantasy is much truer than any reality (p. 221). For me there is something annihilating about the dream: spraying shit is accompanied by an inability or unwillingness to think together with the analyst, the dream activity paralleling the equally meaningless production in the hour. Like the dream, the hour has turned up “shit” involving an element of the patient’s destructiveness that is not recognized.
Here again I think of the lighthouse—the lighthouse that might well stand for reality, reality that this patient turns back from, turning instead toward the darkness of her fantasy world. With this dream, there is once again a reassurance—as after the first dream, when it was the analyst underscoring the presence of light and hope. Here it is the patient who reassures—“I wouldn’t do it here”—and with that the clinical fact of the dream, its immediate impact, is vitiated, even lost. The fact (to my hearing) is that it is happening here. And it continues to happen when the analyst asks for associations and they go nowhere.
It is a luxury to think about this material outside the pressured and charged situation of the consulting room, where undoubtedly it is much more difficult to think freely—particularly because of this patient’s efforts to impact her analyst and exert control over his functioning. I believe I would not ask the patient to associate, for fear it would lead either to a kind of falseness—more shit—or lead nowhere. I would rather try to stay with the uncomfortable experience of being told this dream, and try to explore it via the emotional impact of the session, including the patient’s nearly immediate need to be reassuring. The analyst asks, “Did she . . . wish to spray me with shit?” (p. 19). I would not ask whether she wishes to, but would instead reflect that she is in fact doing precisely that: in the very moment of telling this dream, she is conveying a sadistic, demeaning, and deadening attitude toward the analyst and the analysis. She is not merely traumatized, but is also living in a closed-off, eroticized fantasy world where she is in charge (she has the hose); here what is supposed to clean, instead makes filthy—for me a counterpoint to the light vs. darkness of the first dream. When Levy says he felt something wasn’t working, and he goes looking for further sources of her traumatic past, I find myself feeling that the material he seeks is already there—in what the patient brings, including the disruptive impact of her emotional outbursts, her silences, and the hold (the hose?) that she wields over her analyst. The feeling that something is not working is itself an important countertransference experience—one that fits with the feeling of futility or helplessness that Sodré (2015) describes in her discussion of hysterical patients. Working with the dream in the here and now of the session—taking it as an expression of important transference trends, rather than shuttling to associations and historical references—allows the dream to be alive between patient and analyst in the active current of the session. My own countertransference with this patient might have led me to feel irrelevant and futile (e.g., Levy describes wondering if she will leave, asking can he hold her?). She inspires this sort of feeling in her objects (and her dreams convey this repeatedly and powerfully). To me this is a central dynamic—conveyed by the dreams—that needs to be understood.
There is of course much more to be said about each of the dreams and the very vivid and interesting material we have had the privilege of considering. I want to thank the authors for their generosity in opening up what I hope will be a fruitful discussion.
Footnotes
Faculty, New York Psychoanalytic Institute.