The Use of Dreams for Diagnosis and Prognosis
Each individual’s level of psychological health is a decisive factor in couple counseling. The degree of the psychological disturbance and also the psychological reserves in each partner helps the counselor plan the sessions.
There are many psychological tests that can give us information. However, I prefer to use dreams in diagnosing the psychological condition of the partners. Dreams answer the questions I pose to myself: “Who are these two people? Am I dealing with neurosis or psychosis? Or is this basically a psychologically healthy couple only needing some clarification
and help for a short period?” Depending on what I find in the dreams, I design the kind of treatment that seems most appropriate.
Sometimes it is advisable to take one or both partners into individual therapy for a certain time. Often it is also possible to begin therapy with both right away. Whenever possible my colleague John and I carry out the counseling together. Frequently this kind of cooperation works well because the husband feels supported by the presence of a male therapist.
A man who is having problems with his wife may assume at first that a female therapist would be on the wife’s side, and this heightens his resistance to the therapy. Sometimes, however, the opposite is the case, for instance when the man feels inferior to other men. He might be embarrassed to talk about these difficulties with another man, and feel more
comfortable with an older, somewhat maternal woman like myself.
Whatever the case, he hopes that I will accept him like a good mother, with kindness and understanding.
Then again, we have the situation where a couples group offers the best chance of success, especially when the partners feel socially isolated and think they’re the only ones with problems. Some people will listen to another member of a group rather than a marriage counselor, because they think: “Maybe you can take this kind of attitude (of the spouse), but,
after all, I’m not a psychologist . . . .”
However, participation in a group is no guaranty of success. The kind of counseling is not the decisive factor. What makes the difference is that the partners feel that they are in good hands, that they have confidence in the counselors, and, if they are in a group, that the other members understand them.
Three cases follow. I worked by myself without my colleague in the first case. It became evident in the first session that a joint approach would not be possible. The reason for this will become apparent. Herman and Mary were over fifty years old and had been married for more than twenty-five years. Both their children were also married. Herman did illustrations for books and taught art in high school. Mary ran the household and helped her children, friends and neighbors with cooking and baking. She had recently entered the menopause.
Since then she had started to complain not only about the present condition of her marriage, but also about everything that had gone wrong in the last ten years. This was astonishing because up to now these two people had had a quiet and harmonious relationship. Now they argued so often that their oldest daughter, who was a social worker, advised them to seek marriage counseling.
In the first session Mary talked about issues that were completely new to her husband. For example, she complained that he was passive and never helped her with housework. She described him as increasingly slow and impractical. Her anxiety about getting older, something she had never felt before, made her look at his limitations in a very critical light.
He barely understood what she was talking about. “But I have always been this way,” he said. It sounded like an apology.
In all the years of their marriage, Mary had admired her husband as the artist he was, but now she was increasingly disappointed in his work.
His illustrations looked strange to her and they had much less success than before. Every day he went to his studio earlier. However, he now needed a whole week rather than a weekend to come up with a sketch for a new illustration, and even then he didn’t produce anything really good. He wasn’t really conscious of these facts and had no explanation for
them, which only made his wife more frightened.
The husband gave the impression of being a calm, somewhat passive and withdrawn person. He looked older than he was, but didn’t seem to be in a bad psychological situation. He accepted the observations of his wife concerning his slowness, but didn’t feel that he could do much to change it. He was somewhat anxious himself about producing so little art
in the last few years, but he tried to rationalize it.
I asked about his dreams. He said that he dreamed every night, usually terrifying nightmares. His wife confirmed that he often groaned while dreaming and also cried out loudly for help. Whenever she woke him up, he would tell her about the frightening situations that had tormented him in the dreams.
The first dream he told me had occurred just a few nights before: I’m going into a deserted factory. I haven’t been there for twelve or fourteen years. No one had been in the factory during the last twelve years and everything had slowly fallen apart. No one had come to repair anything. I walk through the factory. It is a bleak sight; all of the machines are on the
first floor, just as they used to be.
They were good, strong and durable machines that were driven by big wheels from the ground floor. However, all of the transmission belts driving the wheels were cut and the machines could no longer be repaired. Not only were the wheels rusty, they were completely demolished and broken into small pieces by vandals. An auxiliary engine, which had kept the large machines running for some time, was also ruined and no one knew how to repair it. It was a scene of complete destruction.
Associations to the dream revealed that this man had been brutally mistreated by an alcoholic father from earliest childhood. He recalled that he was twelve years old when his father had almost killed him with a butcher knife. The police came just in time to take the wounded boy to the hospital. After that he had failed at school and felt inwardly destroyed.
At fourteen he was apprenticed to an uncle who owned a small factory, but he wasn’t treated much better there than he had been by his father. He had to hand over to his father the little money he earned by his hard work; his father then spent it on drink. The boy felt deep hatred that he couldn’t express. When he was drafted into the army, he was happy
for the first time in his life.
After the war he met the woman who later became his wife. She showed a maternal interest in him. She wanted to make him happy, to give him what life had failed to provide. He was hired by a school and was still teaching there at the time of the counseling. In addition he worked as an illustrator for two publishing houses. Life with his wife was simple and quiet. Even when the children came along, nothing much changed for him.
He played and drew with the children in his calm way. His wife took care of the house and saw that the children had everything they needed. She made sure that Herman was not burdened with more than he could manage. She never complained. He was a kind person and grateful to her. She accepted her life and was well satisfied with her family.
The auxiliary motor that he mentioned in the dream, and that had kept his own machinery going through the years, was his wife. She had given him a great deal of psychological support, but now that she burdened him with her own fears, he felt that his total existence was endangered.
His artistic creativity suffered as a result. This dream and similar dreams that followed left no doubt in my mind that this man was chronically schizophrenic and that the poor little compensation, the auxiliary motor, couldn’t help any longer. The prognosis for him was not good. It seemed highly unlikely that he could regain his vitality and creative ability
through any kind of therapy. I therefore suggested that I speak to the wife alone. It turned out that she was a strong, intelligent and very healthy woman. With a heavy heart
she accepted the fact that her husband, a man who had been severely damaged from earliest childhood, would not become healthier with advancing age.
She admitted that she had suspected this for a long time, but had hoped something could be done. Nevertheless she was prepared to stay in the marriage and to take up the function of “auxiliary motor” again because she really loved her husband, who had many endearing qualities. Her momentary fears over aging were the result of a recent rejection by a man. She had fallen in love with him, but he had preferred a The Use of Dreams for Diagnosis and Prognosis 45 younger woman. This problem was worked out in a relatively short individual therapy.
Another diagnostic dream was much happier than the one just mentioned. A wealthy couple, Fred and Diane, came to see me because they had so many arguments. They had been married for six years. She reproached him for being egotistical. He said that she was driving him to despair with her desire for a career, which he thought would threaten his
social position.
John, with whom I shared this consultation, interrupted, “I know that feeling. I was just as old-fashioned at the beginning of my marriage.” Fred replied, “I’m not old-fashioned. Do you think that someone is necessarily old-fashioned if he doesn’t want his wife to work?”
“No,” answered John. “I only know that I resisted having my wife work because of the old-fashioned ideas of my father.” We didn’t want to pursue the argument on this point any further. I’m not quite sure how it came up, but somehow it was mentioned that Diane was in the habit of getting up two or three times a night to see if both her
children were well covered up.
Some women are afraid of thunderstorms,” Fred said, smiling. “My Diane is afraid of drafts.” “Yes, it’s really ridiculous,” Diane said, “but I think that drafts are very harmful. I read once . . .” We all had to laugh. “I feel she is really overdoing it,” said Fred in a slightly angry tone, “but that’s the way she is in everything.”
“If you weren’t so egotistical,” Diane replied, “you would get up and check to see if the children are covered up . . .”
Fred shrugged his shoulders indifferently, apparently used to this reproach. “I don’t understand this whole thing,” I said, turning to Diane. “Don’t you live in a warm climate where the nights are warm?” “Not only that,” said Fred, before Diane could answer, “we also have a highly paid nanny who sleeps with the children.”
“It isn’t abnormal that I should want to protect my children from 46 The Use of Dreams for Diagnosis and Prognosis drafts, colds and illness,” said Diane, piqued, and it was obvious that we would get nowhere if we stayed on the level of these animosities. I asked Diane if she remembered a dream. (When she called to make an appointment ten days before, I had told her to try to remember some dreams.)
“Yes,” she said, “the night after our phone call I had a dream that I wrote down and brought with me.” She read:
was with my girlfriend at the movies. After we had left the theater, I said to my friend a while later, “I forgot something in the cloak room of the theater, but I don’t know what.” The friend said, “You have forgotten your children there. You checked them at the cloakroom before we went into the movie.” I laughed and was completely unconcerned. “Oh, the
theater is closed by now; I’ll pick them up tomorrow.”
She added that a few days after that she had had a similar dream: I put the children in a compartment of the train and I went in another. When a few cars of the train were uncoupled, I forgot the children, and I never went back to find them.
Both dreams were in strong contrast to her exaggerated solicitude for the children at night. The dreams clarify why she had to show so much concern. Unconsciously she wished to be free of the obligation to the children. Although she consciously reproached her husband for being old-fashioned in not allowing her to work, it soon became clear that she was much more annoyed that the children stood in the way of fulfilling her life’s wishes. Still, a direct question like: “Do you feel your children are a burden?” or “Do they hinder the fulfillment of your own plans?” would only cause angry protests. Every therapist avoids that in the first session.
On the subjective level the children represent the young and childish part of Diane herself, the part that she tried to forget. In fact, she had already separated from this part of herself—like the cars on the train. I asked if she liked to play with her children sometimes, or play in other ways—golf, perhaps. She angrily rejected this notion. “I played enough as a child. My husband, though, can’t get enough— The Use of Dreams for Diagnosis and Prognosis 47 he’s always playing. Now he’s building toy gliders just like a teen-ager. My toy would be a boutique or something like that. That could really excite me.”
John very carefully tried to find out to what degree she was conscious of her real attitude toward her children. “For my wife,” he said, “the decision between children or a career was not easy. For a long time she felt that the children stood in the way, that they actually robbed her of her own life.” “Yes, I know that feeling,” Diane said spontaneously.
Fred interrupted, “And you call me egotistical!” Half apologetically he added, “You have no idea what it’s like in my profession. It just won’t do if my wife works. It would look as if I didn’t earn enough and would result in a loss of respect on the part of my colleagues.” “Really?” I asked in as neutral a manner as I could. Fred added, “I know it sounds odd, but I can explain it.”
John and I said that we were interested in the explanation but it would have to wait until the next session. After they had left, John and I talked about our diagnosis and the
prognosis. We were both quite optimistic. They were capable of expressing themselves. Both were psychologically healthy and willing to grapple with their problems comparatively openly
. The two dreams showed, however, bizarre behavior for a mother. That the loss of her children in the dreams caused no guilt feelings seemed strange to John. I agreed, but
added that under the circumstances—she wanted so badly to have a boutique and a career—perhaps this unconscious wish to be free of the children ought not be judged too negatively. Besides that I thought she had completely normal guilt feelings.
“She didn’t say anything about guilt,” said John. I replied, “I see her nightly visits to the children’s room to make sure that nothing has happened to them as an answer to her unconscious guilt and also as a kind of self-punishment.” “Yes,” said John, “to pull yourself out of sleep three times a night—that would sure be a punishment for me.”
“Somehow she hinted at that when she reproached her husband for be48
The Use of Dreams for Diagnosis and Prognosis ing too egotistical to get up, thereby seeming to say, ‘I’m not egotistical—I’m making sacrifices for my children.’ ” Granted, this was a neurotic way to deal with her wishes and guilt feelings. However, Diane seemed healthy enough for us to offer a good prognosis for the marriage counseling.
Couples almost never come to counseling with the real reason for their difficulties. As we have already seen, the real reason is usually unconscious or repressed, at times manifesting only as a symptom. In the following case, which John and I began together, this misunderstanding was in the foreground.
Nick was thirty-five years old and worked as a printer. His wife Pat was thirty, very intelligent and worked as a teacher. Irvin was their nineyear-old son. They came for family therapy on the advice of Irvin’s schoolteacher, who was Pat’s friend. They were seeking help for Irvin who had a reading problem.
“He reads so badly that his little sister is already almost better than he,” said his mother. “Is that true?” asked John, turning to the boy. “That’s crazy,” said Irvin. “Penny just turned six. She can hardly read at all—besides that, she stutters.” He said this with a kind of triumph. He was obviously tired of being made a scapegoat all the time, and rightfully
resented that. In this first session it became obvious that the parents believed that all the family problems would be solved it only Irvin would get over his inhibition in reading.
As they left John said, “I would like to work with Irvin alone; I used to tutor children like him when I was a college student. He’ll be reading soon, and he’ll have fun doing it.” I thought that was a good idea.
We both agreed that Irvin probably needed the treatment much less than his parents. We developed all kinds of hypotheses but had no material on which to base them. The situation seemed to suggest that the somewhat cool mother/teacher made too strong demands on her children, thus contributing to the boy’s reading problem as well as the stutter of
the young girl. We finally decided that careful observation of the three as well as a few dreams would show the way the therapy should go. And that’s the way it was.
In the second session the parents brought Penny along and something quite unexpected happened. When she turned on the television set, a children’s program came on in which a woman talked very fast to the children, some sort of unintelligible word salad that made the children laugh; however, Penny covered her ears, stamped her feet and broke into
tears. She stammered out, “I hate her! I hate her! She’s like Aunt Irene. I don’t want to stay here!”
Irene was the father’s sister, ten years younger than he, who had moved into their home in order to attend college in New York. She helped out with housework and was available to baby-sit in the evening. She was a nice girl but she talked so fast that Penny could hardly understand her. Attempting to talk as quickly as her aunt, Penny had started to
stutter, which made her very frustrated. Irvin confirmed that Irene talked fast but added, “She doesn’t make me nervous.” I was surprised at the word “nervous” from a nine year old. It sounded as if he had picked it up somewhere.
“What or who does make you nervous?” I asked. He hesitated and appeared slightly embarrassed. John encouraged him to say what was on his mind; no one would think badly of him. “Daddy . . .” said Irvin softly, “when he always walks back and forth . . . even if he doesn’t say anything.”
The wife agreed, “Yes, he makes me nervous too.” Gradually one piece after another was added to this mosaic, and we weren’t far from the diagnosis. I asked Nick if he had dreamt since our last meeting. He told the following dream:
I was at my parents’ house in a small overcrowded room, where three artificial Christmas trees stood. My wife and my sister were sitting down, and I was standing next to the trees. I said that I was very fond of trees, especially oak trees, but added that a harmful kind of beetle was crawling under the bark of the trees. The beetles spread a disease that would kill these trees and all the trees in the vicinity. Besides that, the disease would spread very fast.
In the discussion of this dream it became clear that what was getting “under the skin” of the husband was not the reading problem of his son, but a problem in the marriage. It was his wife who, as the expression goes, got under his skin. Her intelligence and superiority in many areas compromised his position in the household and was felt as a threat to his
masculinity. That was the disease. It was almost a repetition of the situation in his parents’ house—the much younger sister, who was constantly brought up as being more intelligent than he.
Since she had been living with them, Nick had felt pushed aside and ignored by both women. They were better educated than he and had many common intellectual interests
in which he did not take part. So he would get angry and pace back and forth without saying a word. He realized that this made his wife nervous, but he hadn’t realized that his son also reacted negatively.
Nick’s feeling of inferiority made him overly anxious in relation to Irvin. He put strong pressure on the boy to achieve, especially since Nick realized that Penny might possibly surpass her brother some day. He didn’t want Irvin to suffer from a younger sister the way he had. Since Irene had moved to their home, Nick had increased his demands on Irvin
considerably, and Irvin had reacted with a reading problem. “And Pat doesn’t help at all,” he said reproachfully.
Irvin added, “At least Mommy leaves me in peace—she says it’s not so bad; I’ll learn to read later on.” And what do you believe?” asked John. Irvin said thoughtfully, “I think she’s right.” So it wasn’t the cool mother-teacher who put pressure on Irvin, but the father with his feelings of inferiority. He considered his wife’s tolerant behavior a weakness.
Now there was still another decisive question. I asked Nick, “Do you ever get on your own nerves? Do you have traits that get under your own skin?”
“Oh, yes—sure.” The answer was very spontaneous. “Since my sister has come I feel completely impotent—weak and undermined. But even before, I felt that way toward my wife. I always feel inferior. She reads so much and goes to the theater and museums. Sometimes I go along and even enjoy it—but I’d rather go bowling or play cards with friends. She
doesn’t like that. She turns up her nose at those things.” John interrupted just as Pat was going to defend herself: “Nick, you were going to say what you don’t like about yourself—why you are weak . . .?”
“Yes, I’m always competing with her. I always want to prove something to her—and when I catch myself doing it, I’m angry with myself. Then I say to myself, ‘You are really dumb, Nick; they’re right, and on top of everything else you’re a weakling.’ ”
His wife looked at him very surprised. She was obviously not aware of what was going on in her husband. “Have you ever talked about these things together?” I asked.
Both shook their heads.
On the objective level it was his wife who seemed weak to Nick and who got under his skin, but on the subjective level it was the criticism of his own weakness. The fact that this plague—and what a plague it was to have to compete continually with your wife and to continually come out the loser! —could kill strong oak trees pointed out that the vital strength
of the man was seriously threatened. The unconscious was sending him a message: You have to end this situation as quickly as possible.
Now we could make a diagnosis. The couple should come to John and me for marriage counseling. John would work alone with Irvin to help him free himself from the pressure to succeed and to develop a healthier attitude toward his younger sister. I, myself, would like to get to know Irene in order to understand why she put herself under such pressure that
little Penny was afraid of her fast talking.
I would like to have had a few sessions with Nick alone but that would have been very bad for him psychologically. His self-destructive feelings of inferiority would have led him to say to himself, “Of course I’m the sick one, I need the therapy, my wife is the superior one as always—she doesn’t need individual therapy!” I wanted to prevent that.
I was therefore reassured when Pat said to me on leaving, “I’m glad that we can come back again. I would really like to know what I can do to make my husband happier and have a better marriage.” “My wife is always such a good student,” said Nick, half admiringly,
half sarcastically. “You’ll have a harder time with me. I’m not that intelligent.” “You’re already competing again,” said John, laughing. “There are no good or bad grades given out here; everyone passes.”
In order to make the correct diagnosis, it is important to determine whether certain behavior patterns, in a dream or in reality, could be classified as neurotic or psychotic. In Nick’s dream about the plague, which could be destructive, a clear warning was given that points to a possible fatal destructiveness. However, in the dream neither the person nor the trees are dead; it’s only a warning. The weakness that is symbolized by the plague is of a neurotic kind.
In contrast to that, the dream cited earlier of the desolate ruined factory gives the picture of a completely destroyed person. One would have to describe his psychological condition as severely neurotic. One indication of a psychotic dream is the passive and threatened position of the ego: the wrecked machines in the factory, the auxiliary motor beyond
repair. When a healthy ego is not available to put insights into action, therapy can’t help much. One would have to try to build up and strengthen the ego in a long drawn-out process. With Nick it appeared to John and I that such an attempt could succeed.
As already mentioned, the body, the “I” in the dream, often symbolizes the ego. Just as it is impossible to do gymnastic exercises with a completely wrecked and weakened body, so it is also senseless to do therapy with a psychologically crippled person. In such cases one should only try to make life a little easier for the patient.
Of course, one always has to take the total situation of the dreamer into consideration. Nevertheless there are some symbols that point to a possible psychosis, particularly when the symbol often recurs. Tidal waves or other overpowering natural catastrophes point to the fact that a person’s consciousness is in danger of being inundated by the unrestrained
power of the unconscious. Here is an example:
I’m standing on the beach; a huge wave is coming toward me. I can’t move and I know that it’s the end.
This was the dream of a young girl the day before a psychotic episode that had been coming on for more than a year; however, the family had not wanted to see it. Upon admission to the mental hospital the girl said, “I feel as if I don’t exist anymore; everything is so far away—I’m sitting on the bottom of the ocean, overwhelmed by the weight of the water.”
We often think of dreams as being illogical, confused and absurd, when this is not at all the case. When we dream about a situation that would seem absurd or crazy in reality, the dream often really does reveal a “crazy” situation that is a problem to us at the moment. For example, a catatonic patient wrote down the following dream:
A street full of people. There is a man who is eight stories tall. He is winding up all the people. They run around like automatons. Then they stand still until the man winds them up again. Another situation:
I’m beating a dog like crazy. He’s been dead a long time, but I keep on beating him over and over again. If we were to come upon this latter situation either in reality or in a
dream, we would consider it disturbed.
A less dramatic but equally significant form of psychosis is the apathetic withdrawal from reality. What we observe in the patient is expressed even more strongly in dreams that bring shocking images of people dismembered in auto accidents and the like, without the dreamer, either in the dream or upon waking, showing an appropriate reaction. In most of the dreams mentioned so far, there was no sign of psychosis. In the dream of the extraverted and introverted couple, the fear of wild animals is inappropriate. Had there really been wild animals in the pasture, the dreamer’s flight up into the tower would have been an appropriate eaction.
One could not even call the dream of the woman neurotic. It only shows that she is too dependent on status symbols. A clear example of a neurotic dream is that of the woman who compulsively has to make sure through the night that her children were covered up. The inner detached 54 The Use of Dreams for Diagnosis and Prognosis attitude to the children, the indifference that she feels toward them in reality and in the dream borders on the psychotic, but is still in the realm of the neurotic because she is able to relate to what is happening there.
A normal person with problems grapples with dreams that are unmistakably different from dreams that represent neuroses and psychoses. Dreams bring up unconscious material that should become conscious in order to be integrated. The dream’s attempt to establish an inner balance (the homeostatic function of the dream) is a part of the normal growth process and is not neurotic.
In dreams as well as in reality, one can separate the “normal” or psychologically healthy person from the neurotic or psychologically ill person by the attitude to the dreamed or actual life situations. Does the person view them as catastrophes or as problems to be solved? If the latter, there is hope. ~Carl Jung, CW 16, The Practical Use of Dream Analysis, Page 85-105
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