Review of The Significance of Dreams by Fonagy et al.

The Significance of Dreams: Bridging Clinical and Extra-clinical Research in Psychoanalysis, P. Fonagy, H. Kächele, M. Leuzinger-Bohleber, D. Taylor (eds.), London, UK, Karnac Books, 2012

Review by  Leticia Castrechini-Franieck, PhD^[1]

‘The Interpretation of Dreams’ (Freud, 1900) is Freud’s legendary work. Chapter 7, ‘The psychology of the dream processes’ attempts to explain the dream process – how the mind works in producing dreams.  While Freud significantly revised  other conceptual frameworks of the psychoanalytic theory over years, the theory of dreams process was not revised, except in the essay ‘A Metapsychological Supplement to the Theory of Dreams’ (Freud, 1917).  There, Freud makes small additions in his concepts of dream process. Even later psychoanalytic writers that extended Freud’s work have focused their attention on dealing with dream interpretation and its use in psychoanalysis without addressing the mechanism of the dream process (Hawkins, 2011(1966)).

But changes in the contemporary clinical practice has refocused psychoanalytic therapy from revealing impulses and desires suppressed in the unconscious to a substantial interest in object relationship (and attachment) and strengthening the adaptive function of the ego (in the Anglo-German approaches). The importance of the analytic relationship has shifted the attention from latent to manifest dream content (Lempen & Midgley, 2006).  Although Erikson suggested complementing the manifest to the latent in his “Dream Specimen” paper (Erikson, 1954; Szajnberg, 2011).

The Significance of Dreams, reviewed here, is a part of Karnac’s ‘Developments in Psychoanalysis Series’ to communicate the intellectual excitement about psychoanalytical ideas, in order to make them accessible to a larger group (e.g. students, scholar, and practitioners). Most of the essays collected in this volume  were presented at the 12^th Joseph Sandler Research Conference in March 2011 (recorded presentations are available on http://internationalpsychoanalysis.net/2012/07/29/horst-kachele-dreams-as-a-subject-of-psychoanalytical-research-at-the-joseph-sandler-conference-2012/ ), prior to  the 47° IPA Mexico Congress 2011, where the concept of dreams was a key topic. In the introduction, the editors discuss four papers presented at a panel in Mexico (available on http://internationalpsychoanalysis.net/2011/08/06/ipa-2011-mexico-congress-panel-on-dreams/ ) to illustrate ‘a number of threads running through current clinical theory about dreams’ (page xxiv).  Before launching into their viewpoint, the editors discuss central concerns about dreams in psychoanalysis (mostly derived from the 47° IPA Mexico Congress 2011), raising question about interdisciplinary research and theoretical pluralism in contemporary psychoanalysis and a historical perspective on the relation between psychoanalysis, science and society (For a more complete overview, see (Makari, 2008) which is reviewed here  http://internationalpsychoanalysis.net/2012/02/20/considerations-of-george-makaris-revloution-in-mind/ ).

The Significance of Dreams’ fifteen chapters covering  clinical research on dreams; extra-clinical research on dreams; conceptual integrations including dreams in modern literature.

In the clinical research section presents diverse psychoanalysts’ approaches to interpretation.  David Taylor compares the relation between Freud’s original theory of dreams to present clinical approaches like that the between Newton’s theories on physics to modern physics.   Taylor proposes a new understanding of clinical research by connecting the three components of the process of mathematical discovery (from Poincaré, a French mathematician/social philosopher) with the understanding of dreaming function. Juan Pablo Jimenez suggests abandoning dream symbol interpretation, or interpreting patients’ association; rather he suggests creating ‘co-construction’ within the context of transference-counter transference. Marianne Leuzinger-Bohleber illustrates how traumatic experiences may be rendered in dreams so that analytical work on dreams may promote the symbolization and mentalization of the trauma. Finally, Margret Rustin presents the overlap between playing and dreaming and draws attention to ‘changes in contemporary childhood’ reflect on the present-day symbolic activity in children.

In the extra-clinical research on dreams, Horst Kächele highlights the ‘demand functions’ of the dream. Kächele asserts that while single dreams are important, repeated communication of dreams must not escape clinicians’ attention, such as: ‘Patients’ dreams and the theory of therapist’; ‘Relationship patterns in dreams’ and ‘Dream series analysis as a measure of process’. Rudi Vermote compares clinical and empirical research to introduce conceptual research.  To illustrate his point, he touches on Jimenez’s & Kächele papers, underlining that both authors not only muse on an open and creative understanding of dreams, but also have the same focus – the manifest dreams.  He asks whether the psychoanalysts’ task is to understand the context of the dreams or to facilitate the dreams function – drawing mainly on Bion’s work.

This introduces the contributions of neurobiological and experimental research into the function of rapid eye movement (REM).  Ellman, for instance, draws on the results of research on REM as a model for theoretical exploration within the clinical and early development contexts, emphasizing the interactions with infant’s biological predispositions, its environment and the social environment that encloses the mother-infant pair.   Lissa Weinstein explores REM deprivations to illustrate how differences in quality and quantity of mental activities among dreamers may exist. She relates this to the reflective self representation in dreams. She proposes a model of development of self perception, which takes the bidirectional relationship of the physiological patterning of REM sleep and maternal sensitiveness   relating this to the attachment.  Ellman’s and Weinstein’s chapters integrate object relations (attachment) and drive theories based on the experimental science and psychoanalytic theory cohesion.  Fonagy discusses Ellman’s and Weinstein’s chapters.

The third section introduces five novel studies: 1) ‘Changes in dreams of chronic depressed patients’ – a single case illustrates the study.  The patient reports dreams in a sleep laboratory to investigate changes in the manifest dreams. The Moser and v. Zeppelin coding system assesses the changes. 2)’Traumatic dreams: symbolization gone astray’ uses the same research setting – sleep laboratory, to study 50 males, divided into two groups –those with or without PTSD. 3) ‘Communicative functions of dream telling’ reports an entirely taped-recorded single case study of dream dialogue between patient-analyst pair, in which the introduction of the dream in this dialogue triggers a triadic communication. 4) ‘ADHD – illness or symptomatic indicator for trauma?’ and 5) ‘No intermediate space for dreaming? Findings of the EVA Study with Children at Risk’ are ongoing studies that have been conducted by the Sigmund Freud Institute’s team in Frankfurt in collaboration with other research teams & organizations. Single cases illustrate each of both studies, and following Rustin’s essay, they touch on the overlap between playing and dreaming.

‘Dreams in modern literature’ moves the significance of dreams from research and conceptualization to the creativity and aesthetic events of the literature. In this final chapter the reader will be introduced to the work of three writers, Hugo von Hofmannsthal, Arthur Schnitzler and Franz Kafka, all contemporaneous of Freud. The essay examines the influence of ‘The Interpretation of Dreams’ on their work.

This book reminds me of Shapiro & Emde’s Research in psychoanalysis (1995). For instance, there, Kernberg refers to the existence of two generations of researchers: researchers focused mainly on outcome – the scientific evaluation of the effectiveness of psychoanalytic treatment – and researchers focused mostly on process – the importance of the analytic relationship. The book embodies both generations. Besides, mostly essays presented keep their attention on dealing with dream discourse and its use in psychoanalysis; despite their alternative way.  Like a dream, The Significance of Dreamsis thought-provoking.

 

Erikson, E.H. (1954). The Dream Specimen of Psychoanalysis. J. Amer. Psychoanal. Assn., 2:5-56.

Freud, S. (1900a). The Interpretation of Dreams. S.E., 4&5. London: Horgarth

Freud, S.(1917d). A Metapsychological Supplement to the Theory of Dreams. S.E 14, London: Horgarth

Hawkins, D. R. [2011(1966)]: A review of psychoanalytic dream theory in the light of recent psychi-physiological studies of sleep and dreaming.Bri. J. Med. Psychol. (1966), 39,85.

Lansky, M. R. (1992). The legacy of the interpretation of dreams. In M.R. Lansky (Ed.), Essential Papers on Dreams, (pp. 3-31). New York: New York University Press.

Lempen, O. & Midgley, N. (2006). Exploring the Role of Children’s Dreams in Psychoanalytic Practice Today: a Pilot Study. Psychoanalytic Study of the Child, 61.

Makari, G. (2008). Revolution in Mind: the Creation of Psychoanalysis. London: Duckworth.

Shapiro, T. & Emde, R. N. Ed (1995). Research in psychoanalysis: Process, development, outcome. Madison, CT: International University Press.

Szajnberg, NM. (2011). Dream Interpretations: Functions of Developmental Phase of Life and Analysis. Psychoanalytic Review