Nearly a third of the human life is spent sleeping. Sleep usually follows a pattern or cycle during the course of the night that includes REM and non-REM sleep. The beginning of REM sleep also marks the beginning of dreaming (Myers, 2007). A dream is traditionally viewed as a series of images, pictures, feelings and thoughts that pass through the sleeping individuals mind. This could be accompanied by sounds as well and usually takes a story-like quality (Hobson & Stickgold, 1994).
Dreams have not only been recorded but have also been considered important since the beginning of time. They were considered to be divine messages from God, omens and prophecies that extended their mystery into waking life. The first known recorded dream dates back to 2500 BCE in Mesopotamia. Because of their supreme importance, dream interpretation held immense value in Ancient Greece and Egypt. Interpretation of dreams had significance as healing, medicinal, social, prophetic and religious antidotes and were, indeed, used for diagnosis, prognosis as well as in the formulation of treatment. The most important ancient book of dream analysis, Artemidorus, was in fact referred by Sigmund Freud during the course of his famous work on dreams. Despite the popularity of dream interpretation in the ancient world it was Freud’s ‘interpretation of dreams’ that brought the enigma of studying dreams to the world stage. Freud’s belief, that dreams were the royal road to the unconscious, established them as the foundation for psychoanalysis (Blum, 2000). He found wish fulfilment to be the central tenet of what dreams express and emphasized unfulfilled desires portrayed by them. Jung’s believed dreams arose out of the collective unconscious (Domhoff, 2000).
Today the scientific exploration of dreams has come a long way from this early conceptualization and analysis put forth by Freud and Jung. The identification of REM and the development of electrophysiological measures to study brain activity wave patterns has allowed for the phenomenon of dreams to be studied as it occurs biologically. Brain activity occurs during all stages of dream and dreams are recorded during all the different physiological stages of sleep. However a majority of the people tend to remember dreams that occur in REM sleep (Occhionero, 2004).
Questions regarding the meaning of dreams are often raised while studying them. The general notion of studying dreams rests with the belief that dreams disclose people’s ideas and understanding, their concerns and interests. These in turn become important factors that need to be studied because they form the origin or basis for actions as well as in determining where people will spend their energy (Hall, 1947, 1953a).
Dreams are also considered an extension or another part on the continuum of consciousness, the first part being waking life. Hence there exists a link between the two parts (Dohoff, 1996) and proof of this has been most prominently advocated through extensive studies carried out by Hall and his colleagues (1972 cited in Domhoff, 2000). The documentation of this repeated consistency between waking life and dreams also gave rise to the adoption of ‘continuity hypothesis’ by Hall to define this phenomenon (Domhoff, 2000). The ideas expressed in dreams are part of what is present is waking life. The same is true for concerns and interests. This reproduction of personal apprehensions is untouched by defences and cultures and is therefore pure in its depiction and processing within the mind. The resolution of what may be on the mind may also be reflected in dreams (Domhoff, 1996). Dreams provide an inside look into the visual thinking of a person as it relates to their emotional life and emotional concerns (Schredl, 2000). At the core of the construction of dreams is the transformation of abstract thoughts, feelings and sensations into concrete images, which can then be inspected by analyzing dreams. Dreams allow for the understanding of how the dreamer represents their self and their world (Kramer, 1991). Interpreting dreams then is an exercise in uncovering how the individual thinks and conceives the world, other people and the self, as well as impulses and conflicts (Hall, 1953). Thus as a cognitive process, dreams recreate the real world from memory and as part of the psychological process have their meanings embedded in the ideas, concerns, interests and aspirations of the people (Domhoff, 2000).
Due to the wealth of information that can be extracted from dreams, they are often found to be useful in psychotherapy. Working with dreams in psychotherapy has been shown to be effective and worthwhile (Cogar & Hill, 1992; Diemer, Lobell, Vivino, & Hill, 1996; Falk & Hill, 1995; Heaton, Hill, Petersen, Rochlen, & Zack, 1998; Hill, Diemer, & Heaton, 1997; Hill, Diemer, Hess, Hillyer, & Seeman, 1993; Hill et aI., 2001; Hill, Nakayama, & Wonnell, 1998; Rochlen, Ligiero, Hill, & Heaton, 1999; Shuttleworth-Jordan & Saayman, 1989; Webb & Fagan, 1993; Won nell & Hill, 2000; Zack & Hill, 1998 as cited in Crook & Hill, 2003).
Almost 50 – 90 % therapists work with dreams in psychotherapy (Keller et. al., 1995; Schredl, Bohusch, Kahl, Mader, and Somesan, 2000). In fact, Schredl and his colleagues (2000) report that therapist’s credit working with dreams as being a substantial contributor to efficacious treatment and outcome. Working with dreams is reported to be beneficial and a good number of clients themselves bring up their dream in the therapeutic settings. Therapist from an assortment of schools in psychotherapy such as psychoanalytic, existentialist, cognitive, Gestalt, CBT, family therapy, group therapy, and person-centered therapy use dreams in treatment (Pesant & Zadra, 2004) and dreams are even used in diagnosis (Barrett, 2002). Dreams have been studied within therapy in the context of drug abuse (e.g., Reid & Simeon, 2001 as cited in Pesant & Zadra, 2004), eating disorders (e.g., Brink & Allan, 1992 as cited in Pesant & Zadra, 2004), bereavement (e.g., Moss, 2002 as cited in Pesant & Zadra, 2004), couple and family therapy (e.g., Sanders, 1994 as cited in Pesant & Zadra, 2004) and the use of spiritual context in dreams (e.g., Gilbert, 2002 as cited in Pesant & Zadra, 2004).
Another population with which dreams prove to be useful in therapy are survivors of trauma. Dreams of people who have undergone trauma begin by reflecting the incident and the victim’s emotional state. Dreams also depict a manifestation of guilt and remorse often experienced by the victim. Self -blame may also become a part of the dreams in this process. Often they expand to assimilate similar memories from the past. When the trauma starts being integrated by the victim the dream content begins to lean towards normalcy. This change is what demarcates progress from staying stagnant (Hartmann, 1995).
The content analysis of dreams can inform therapy and clinical practice by revealing insightful information. Not only this, change in the content of dreams can also be an indicator of progress in therapy. The use of dreams in therapy leads to more involvement of the client in the therapeutic process; it helps bring to light distressing issues that the client is unwilling to discuss openly. Victims and survivors of trauma, in particular, are receptive to the use of dreams in comparison to following direct psychotherapeutic techniques (Pesant & Zadra, 2004). Victims of trauma are usually guarded when discussing the traumatic event. The fear and terror is often not conveyed with the same gravity at which it is being experienced. And exploring these feelings becomes difficult because of the sheltered thoughts of the victims. In such cases dreams provide an entrance into the feelings that are at the core of their trauma. Not only do dreams bring to light these feelings, they also make it easier to discuss these feelings and deal with them. The belief that dreams are not as real as their experience allows victims to distance themselves from it consequently resulting in acknowledgement and acceptance of the feelings (Cohen, 1999; Hartmann, 1995). Therefore, dreams provide a way of understanding the client and what he or she may be going through when the presence of a trauma such as abuse makes it difficult for the client to speak about it. In fact, clients themselves report the use of dreams as helpful in the process of therapy (Crook-Lyon & Hill, 2004).
This study is hence, being conducted with aim of analysing the dreams of victims of trauma, in particular, victims of physical and sexual abuse.
While several definitions of dreams exist to convey a similar experience, the definition of dream by Hall (1953) incorporates all aspects of dreaming into a comprehensive definition. He defines it as follows:
“A dream is a succession of images, predominantly visual in quality, which are experienced during sleep. A dream commonly has one or more scenes, several characters in addition to the dreamer, and a sequence of actions and interactions usually involving the dreamer. It resembles a motion picture or dramatic production in which the dreamer is a participant-observer. Although a dream is an hallucination, the dreamer experiences it as he does any perceptual phenomenon. Scenes, people, objects, and actions are experienced as though they were impressing themselves on the senses from the external world. The world of dreams, it goes without saying, is a world of pure projection.”
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000) specifically defines a trauma as “direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2).” (p. 463) – Briere, 2006
For the purpose of this study trauma resulting out of physical and sexual abuse is being considered.
Statement of Problem
To explore the various elements that arise in the dreams of victims of physical and sexual abuse as well as to observe those elements which occur the most in their dreams.
Goals and Objectives
The goal of this study is to identify the main elements that arise in the dreams of survivors of physical and sexual abuse. The objectives of the research involve examining the major elements so as to inform therapeutic intervention processes.
Rationale and Significance
Surprisingly, despite the number of therapists who work with dreams no research has been done on the efficacy of using dreams in treatment for trauma survivors. This is especially relevant since research suggests that trauma victims generally report disturbed dreams and nightmares a majority of the time. Remarkably, no major studies have also been done that document the differentiation in the themes or content of dreams of trauma victims either (Crook & Hill, 2003). On the other hand, the few studies on the content of dreams of trauma victims have mainly focused on war trauma and its impact on children, adults as well as soldiers. Focus on the trauma that stems from abuse has hardly been studied. Since dreams document the process of integration as it occurs and are often the most feasible option to delve into deeper emotional conflicts that a victim of abuse may be facing, it is indeed imperative to begin to understand the main elements in the dreams of these survivors. A step towards understanding their underlying conflicts is likely to open new pathways in therapy that would allow these conflicts to be addressed and resolved successfully leading to positive outcomes. Documenting the major elements in their dreams in terms of categories would not just help in identifying the unique patterns in the dreams, it would also allow for the therapy to use these categories to construct goal directed, structured and time effective therapies that are able to aid the victims in a more effective manner.
Review of Literature
Traumatic dreams are often what are reported in abuse, rape or assault. While extremely distressing, they haven’t received much attention owing to their atypical occurrence (Domhoff, 1996). Traumatic dreams become more normal with time (Hartman, 1984), they reduce when the trauma is discussed in a group with those who suffer from similar trauma (Wilmer, 1982) or other kinds of trauma (Hartman, 1984), and they may also resurface with new stressors (Kramer, Schoen & Kinney, 1987). As the experience is integrated by the person, the dreams decrease or become more normal.
The intensification of dreams after trauma and loss has been reported through a number of studies (Kuiken, Dunn & Lo Verso, 2008). Hartmann’s (1998) study identified the prominent emotions that occur in dreams following trauma as terror which is usually succeeded by fear and then guilt or self-blame.
Dream studies on grief and traumatic loss have shown that dreams of people often imitate the different facets of their loss, and represent varied responses to grief (Belicki, Gulko, Ruzycki, & Aristotle, 2002-2003; Domhoff, 2007; Garfield, 1996). A study on Kurdish children traumatized by war found that the dreams of the children are usually unpleasant and disjointed. The authors were also able to establish the moderating effect of pleasant dreams on the trauma faced by the children (Punamaki, Jelal Ali, Ismahil, Nuutinen, 2005) a similar study on Palestinian children traumatized by war also found the same moderating effects (Punamaki, 1998)
Hartmann, Zborowski, Rosen and Grace (2001) studied the contextualizing images which is the central image in drams that is representative of the main emotion. They found this image to be intensified in those people who reported trauma. A direct comparison of dream series before and after trauma revealed the intensification of the image after the traumatic event. This was found to be very prominent in those who had reported abuse. They also found these images to be more negative specially with the individuals who had been abused. A similar study by Helminen and Punamaki (2008) on children undergoing the trauma of war also revealed that the contextualized images were more intense as compared to the non-trauma group. The results also showed the children’ dream images to have more negative emotions as well and those children whose dreams contained positive emotions also showed fewer post-traumatic symptoms, further strengthening the role of dreams in integrating the trauma.
Since traumatic nightmares form an important criteria in the diagnosis of Post-Traumatic Stress Disorder, Mellman, David, Bustamante, Torres and Fins (2005) concluded through their study that the main features of dreams indicate how the traumatic event is being processed and point towards maladaptive patterns that arise in the process. Indeed dream series and subsequent change in dream content can reflect the process of adjustment and integration (Hartmann et. al., 2001).
In the field of psychotherapy, dreams have been found to be useful by therapists as well as clients. Polusny & Follette (1996) conducted a national survey of psychologists to discover that they use dream interpretation to retrieve memories of childhood sexual abuse in therapy. A study by Crook-Lyon and Hill (2004) found that clients themselves report dreams to be helpful to them when utilized during therapy. This is especially true for victims of trauma (Cohen, 1999).
Several other therapists believe in the usefulness of dreams in eliciting information about trauma (Bonaparte, 1947; Renik, 1981; Terr, 1979, 1990; van der Kolk, Briz, Burr, Sherry, & Hartmann, 1984 as cited in Alpert, 1995)
Southern (2004) successfully used dreamwork with his client who had faced child sexual abuse and was addicted to alcohol. The use of dream helped her in gaining spiritual understanding and insight into her emotions enabling resolution of her internal conflicts.
Another example of dreams facilitating comprehension in the process of therapy is recorded by Bogart (1993). He put forth a series of dreams in his case study which enabled the client to resolve conflicts associated with his sexual abuse as child. Through these dreams he was able to identify conflicts within his self, his relationships and sexuality and clarify the same, thus bringing in positive change.
Several more studies have also recorded successful outcomes. This study is an exploratory study that is being carried out with the aim of uncovering the main elements in the dreams of victims of physical and sexual abuse.
The proposed study is an exploratory qualitative study being carried out to uncover the main elements that may exist in the dreams of victims of physical and sexual abuse.
The population of interest would be victims of physical and sexual abuse
The sample being studied would comprise of individuals above 18 years of age. The only inclusion criteria set for the study is the experience of abuse in the past one year. Exclusion criteria entails anyone who is not literate in English. Demographic details such as age, education, SES would also be documented for the purpose of the study.
Dream reports are analyzed through the method of content analysis. It is a systematic technique for grouping together words in the text, on the basis of explicitly defined codes or identifiable themes and trends (Berelson, 1952; Krippendorff, 1980; and Weber, 1990 cited in Stemler, 2001). A quantitative content analysis in dream studies usually involves coding elements into categories and calculating the frequency for each category. The Hall and Van de Castle coding system, refined for nearly 60 years now by Hall and his colleagues, is the coding system used most widely to analyze dreams. It has set rules for coding into 8 nominal categories that have been established by studying thousands of dream reports. It consists of ten categories: characters, social interactions, activities, striving: success and failure, misfortunes and good fortunes, emotions, physical surroundings: settings and objects, descriptive elements, food and eating and elements from the past. The coding system has been established as an objective, empirical and comprehensive coding system. The coding system has also demonstrated good inter-rater reliability. The coding system has been used successfully across age, gender and cultures effectively (Domhoff, 1999).
In order to collect dream reports NGO’s in Bangalore would be contacted. An initial visit to the organization would be set up to establish rapport. Once comfortable, informed consent would be taken from the participants. They would informed of the study being conducted and its purpose. Those willing to participate would be provided with a dream diary. They would also be made aware of techniques used for better dream recall. The diaries would be collected from the participants after 45 days. The dream reports obtained would then be transcribed and coded using the Hall and Van de Castle coding system.
The unit of analysis would be the dream report. Using the criteria proposed by Domhoff, those dream reports that contain a minimum of 50 words would be considered for analysis. After being coded using the Hall and Van de Castle coding system Schneider and Domhoff’s dream SAT tool would be used to calculate frequencies of the elements in the dream content that have been coded into the 10 categories. The tool also calculates male/female percent, animal percent and aggression.
Informed consent would be obtained from all participants involved. It will also be ensured that all those who participate in the study are aware of the purpose of the study and decide to do so willingly. The participants will also have the right to withdraw at any stage of the study. Because of the sensitive nature of the topic, confidentiality of all participants will be ensured. Debriefing will be carried out upon collection of the dream diaries and participants will also be informed of the results of the study. The participant’s right to privacy will be upheld and ensured at all times.
Timeline and Budget
The tentative timeline and budget is given in table 1