The powerful “magic” of dream interpretation and narrative

Back in 2020, I and Dr. Jessica Reis published a paper on the importance of teaching psychiatric residents dream interpretation, and you can email me if you want a copy of that paper, but turns out there is a lot of literature on how important dream work really is–and yet despite that, most institutions don’t have a dedicated course in it. Why is that? And what is the problem here? Let’s get into it!

Why Don't We Teach More About Dreams?

So, with only a few exceptions, why don’t we teach psychiatric residents dream interpretation? Well, the reasons are complicated, but long story short, CBT–a good therapy when used properly–is extremely popular, but it classically does not deal with dreams, and many seem to think it’s more “evidence based” than other types of therapy. But, as you can find is such works as the book “The Great Psychotherapy Debate” by Wampold and Imel, that’s not really true. In fact, it’s not even remotely true. In fact, fifty years of psychotherapy research has told us only a few things–one, that therapy works and is highly effective, and two, it doesn’t seem to matter much what kind of therapy is used. 

The Medical Model

The problem is the so-called “medical model” of therapy, which was adopted early in the last century based on the models of treatment using medications. In the medical model, you envision that there is some kind of problem in the body, and then, based on the mechanism involved with that problem, you develop an intervention for it. You apply the intervention, whether it is a procedure, or a medication, and this leads to a good outcome. That’s the medical model. This model, which seems reasonable enough, was applied to psychotherapy theories, once psychology began to slowly break away from psychoanalytic models that were developed in the early 20th century. Now, of course, that doesn’t mean those models were abandoned–psychoanalysis of all kinds has developed ever since then, matured, and become much more sophisticated over the last 100 years, but nevertheless, its prominence waned, as therapies like CBT became more prevalent.

CBT is manualized, and the idea is that you can look at a person’s suffering, and analyze it using the medical model, as disordered and distorted cognitions causing their pain. You apply the CBT treatment, repair those cognitive patterns, and viola! The person is now better. Now, according to the medical model, that should be that. CBT works, which means the mechanism it uses to explain illness and recovery are correct, and other types of therapy should be inerior. 

Except they aren’t. And this is where Wampold and Imel get into the nitty gritty, reviewing hundreds of studies on psychotherapy. I’ll give you just one example: CBT vs. EMDR for PTSD. In all the head to head studies of therapy for PTSD, both of these kinds of therapy work well for PTSD. Ok. But, according to the medical model, suffering in PTSD is caused by some kind of dysfunctional mechanism in the mind, and all one need do is apply a technique that fixes the dysfunction, to lead to healing. Notice how, in the medical model, a whole lot of stuff is ignored. Like, it doesn’t matter who the therapist is, they just need to apply the technique adequately. In theory a computer could do it (and don’t get me started on AI therapists). The patient doesn’t even matter, either. They have disorder X, and you just use treatment Y for X, and that’s that. And it’s curious to me that so few people take pause with this–I mean, shouldn’t the patient’s overall experience make a difference? Shouldn’t the therapist make a difference? No? Is that really borne out by the studies?

The Medical Model is Inadequate to Account for the Evidence

Well that’s the problem. It isn’t. And if we’re going to be actually “evidence based” we need to get ok with that and start working on why this is. EMDR, see, also works for PTSD, only the proposed mechanism is extremely different from CBT. Now a lot of times, people just chalk up the equal results (called the Dodo Bird effect for reasons too silly to get into here), to “common factors” in all kinds of therapy, like positive regard, attentive listening, and so forth. But if that’s all that’s doing it, why aren’t we seeing any superior results from one therapy from another? The upshot, is that the medical model is the problem. In the book, they propose something they call a ‘contextual model’, which would take me too far afield to get into in detail today, but let me know in the comments if you want to hear more about that. 

Anyway, the reason I’m bringing this all up is that I want you to be a little bit skeptical when people start waving around the “evidence based” flag, because the fact of the matter is that CBT does not have “better evidence” than other types of therapy. It has good evidence of effectiveness, it just doesn’t seem to have any clear, consistent, and pervasive evidence of superiority over any other kind of true therapy. So to really explore the evidence, you have to go beyond simple head-to-head therapy trials, because they are mostly based on the medical model, and look for what ELSE might provide us with a guide to good therapy.

Why We Should Pay Attention to Dreams

Which brings me to dream interpretation. In the above paper I mentioned, Reis and I review all the evidence for why working with dreams is a good idea, to include not just outcome measures, but patient satisfaction, rapport building, and some of the more so-called ‘intangible’ qualities of therapy. I’ve been using dream interpretation for years, and I can say without equivocation that it does work well, especially when it comes to recurrent, disturbing nightmares. And I did do a short video on this last week, but I wanted to get into more depth here. Over the years I’ve had many cases where a person had chronic, recurrent nightmares, to the point that they were afraid to go to sleep, even. It was THAT distressing to them. These dreams would ruin their day, make them feel horrible, and just haunt them generally for months to some times years on end. 

And often enough, it takes only one session of really sorting through the meaning of that dream to make a difference. Does it ALWAYS work? No, but nothing ever has 100% efficacy. But very often it works very well. And in the most dramatic instances, I have been able to work with a patient and completely stop the nightmares with only one session. Needless to say, when you do this, it is quite dramatic and it winds up making you look like some kind of dream wizard. Which is, of course, true. 

Why Does Dream Interpretation Work?

But what is happening here? What’s happening here is that I’m using what we are learning now are some very basic facts about how the brain organizes information daily. I’m utilizing some fairly straightforward facts about dreams as a part of this, to do this magic. The brain dreams, you see, because dreaming orders the mind. It’s a special kind of spontaneous thought focused on memory consolidation, identity formation, emotional regulation and future planning–and it does this by crafting metaphorical narratives. And it’s this part of the process–the construction of narratives–that is where the magic happens. Stories are magic spells, you see, they affect our minds in a very profound way. This is why children are obsessed with stories, they constantly tell them, love to hear their favorites over and over, it’s because children are natural magicians. And the way this magic works is that a symbolic narrative can pull together all those things I just mentioned–regulation, memory, planning, and identity, into a single coherent visuospatial sequence. This is powerful because this simple act actually makes life comprehensible. And it’s the metaphors that do the magic. Metaphors take things that are nebulous, difficult to comprehend, and overwhelming, and map them onto concrete visuospatial stories that are easy to understand. Hence, if I’m struggling with my feelings about my spouse, I might map this onto a conversation between myself, my spouse, and an “other” character who has a different opinion, where the other character is me, too. Or if I’m feeling like my life is out of control, my brain will map that onto being in a roller coaster. 

But what happens when the brain–which is of course imperfect–is struggling to make sense of my life in this way? What if my brain is gripped in an emotional complex so strong that all my attempts to make a symbolic story out of it, so that I can get on top of it and me–the ego–do something to try to fix my issues, are so stymied that I just can’t get it right? Well, in these instances, the brain goes into a kind of panic mode. The brain evolved, see, to make MEANING of our lives. It’s not there just to “calculate” things, and saying that the brain “processes information” is just another modern, empty description of something that is incredibly rich, messy, and full of emotion. Yes, it’s processing information, but this is how it does it, and emotions run the show. Emotions are extremely powerful and exist because they have survived millions of years of evolution, which is why they exist in almost all mammals. Nature doesn’t reinvent the wheel if She doesn’t have to. 

What if It Goes Wrong?

So when the brain struggles with this job, and can’t seem to craft a story that encapsulates the emotional issue that we are grappling with, it will keep hammering away at the same problem over and over. Hence the recurrent dream. And if the ego is clueless as to the meaning of the dream, it can’t help.

That is where WE come in: and I don’t mean just doctors and therapists, but we the ego, taking the dream seriously as a metaphor for our current emotional life situation (even if it goes back decades, it’s still current if you’re dreaming about it). This is where we have to interpret the dream correctly. And let me just say, interpreting a dream is not usually easy or simple. If it were easy, your brain wouldn’t need to encapsulate it in metaphors to make sense of it. Not only that, we don’t always know WHAT the brain is symbolizing with its symbols, so we have to backwards-engineer these spontaneous products to get at what they are truly about. It requires a close attention to context, details, and overall personality structure of the dreamer. It requires a trusting therapeutic relationship, too, and a humility. Jung said, learn everything you can about dream symbolism, but then forget it when you’re working with a patient. He said a lot of pithy things like this, but he was trying to highlight that you should never assume you know what the dream is really about until you get into all the details. Dreams are holistic products about the whole person–they are irreducible by definition. Now, that doesn’t mean that you can’t look at bits and pieces of it and figure out what they are probably about. Darkness is usually about danger and the unmanifest. Fire is usually about intense affect. Cold is usually about social isolation. Other characters, unless you know them personally, are usually abstract personifications of different elements of your own feelings. So it takes time and care to do it right–but then, all RPGers know that it takes time to learn your spells and cast them properly. 

Dream Interpretation is Effective "Magic"!

I get a lot of people sending me messages saying “Hey I’ve had a recurrent dream of pizza-shaped aliens trying to take over Altoona with crayon machine-gun space ships! What’s does that mean?” Don’t expect an instant cure or an easy answer. That said, you can check out my books and other resources on this at my website erikgoodwyn.com, including the paper I mentioned earlier, which I’d be glad to send anyone interested, and of course last but not least, you can check out my fantasy novel KOTFD, which uses all of this stuff to construct a symbolic and fantastical narrative just like an extended dream. What is it truly about? I’ll leave that to you to decide.

Keep Dreaming!

EG