Dreams, Nightmares, and the Key to Successful Trauma Therapy By Leslie Ellis, PhD on 1/17/23 - 11:21 AM

A client of mine dreamt that she had sat so long in the bath that the water had turned cold. While I have heard thousands of client dreams, this one brought me to a realization about how dreams may be graphic depictions of client’s shifting autonomic states — images from and of the body. Far less filtered by our internal censor than waking thoughts, dreams are more image-based, visceral and fluid.

Spending time with my clients’ dream images in a calm and curious way has been inherently soothing for them, and of late, I am beginning to suspect why this is so. While many have offered opinions on the nature and purpose of dreams, this notion that they are images the body projects onto the dreamscape has become clinically compelling to me.

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Nightmares Can Be Most Useful Dreams

The late Ernest Hartmann, a celebrated dreamworker and researcher, famously said, “The nightmare is the most useful dream.” This is not meant to dismiss the real distress and terror that our worst dreams can bring. Nightmares are perhaps the most troubling symptom of post-traumatic stress injury and are prevalent in fully two-thirds of those with a mental health diagnosis. The benefit of nightmares is that they represent extreme emotional and physical states, and as such, ones that we can learn the most from.

I’ve spent the last few of years investigating the link between nightmares and the autonomic nervous system (ANS) through the lens of Porges’ polyvagal theory. Although I think the implications of this for nightmare formation and treatment are still largely unexplored, I started the ball rolling with the recent publication of an article with an optimistic title: Solving the Nightmare Mystery. In it, I imply that the role of the nervous system is a missing link in our understanding of how to treat nightmares.

I have been working clinically with those who experience deeply disturbing dreams for many years. One of the main things I do to help is facilitate the search for, and embodiment of, cues of safety that help alter the dreamer’s perception and experience of these dreams. Clients tell me that this embodied process of dreaming their dreams forward (called ‘rescripting’ in modern nightmare treatment literature), changes how they hold the dream in their body. Typically, the memory remains, but the emotional and physical “charge” dissipates.

For example, during the pandemic I dreamt of a woman falling to her death. She is a dear friend of mine with a highly compromised immune system, and it’s clear that the dream depicted my fear for her safety. I worked with this dream and found some hope in the athletic way she leaped onto the roof (before losing her balance). In dreaming it forward from there, she used that virtuosity to land safely. This dream session helped me feel better about the situation, and later she did indeed survive a nasty bout of COVID.

Nightmares as Lived Bodily Sensations

Nightmares are often quite dramatic depictions of current fear and/or past traumas. There is clear autonomic activation during sleep state shifts for those who experience them frequently. Nightmares are easily recalled, and their impact is tangibly felt, as is the relief one experiences when they begin to fade or shift into a more benign form. In a clinical setting, we can easily track clinical progress for those with intense dreams because when they shift toward more normal dreams, the change is welcome and obvious.

In a recent class I taught on the clinical use of dreams, I realized that all dreams might be expressions of our autonomic state, even the quieter ones. A student brought a dream with the central image of a still, dark woman in a tub. She had sat there for so long the water had gone cold. When I invited the dreamer to allow the dream to continue, her impulse was to turn on the hot water faucet, to bring some warmth to the bath and to the woman’s body.

At my invitation to enter the dream further, she took notice of the tub itself. It was older, more ornate and beautiful than the one in her bathroom, where the dream was set. I encouraged her to enjoy the details of this tub, and it began to feel like a precious heirloom. Details in dreams that depart from waking reality (called counterfactuals) warrant particular attention.

The dreamer’s demeanor changed in this process of warming the bath; her face coloring and smiling as she described making the bath a sanctuary, adding scent and oils, and dipping into the enjoyment of it. Later, she told me, “I continued to experience ‘mini shifts’ in the following days and was able to access and carry the felt sense of the warmth and beauty of the bath into many areas of my daily life. I noticed I feel more present when I bring a sense of aesthetics, a little beautifying and warming detail, to tackling some of the mundane daily tasks which have been weighing me down lately.”

The Critical Role of Polyvagal Theory

This entire dream process could be seen as an image of the autonomic nervous system (ANS) as described by the polyvagal theory. Porges’ theory updates the former conceptualization of the nervous system as paired opposites that shift between sympathetic arousal and parasympathetic relaxation/shutdown. Instead, the theory suggests that we automatically shift states in a specific order depending on our sense of threat: we move from safety and social engagement to activation in the face of threat (fight/flight), and lastly, to immobility if the threat is perceived as overwhelming. And the theory suggests we move out of these states in reverse order.

The woman in the dream followed these steps as she shifted from a cold, immobilized (dorsal vagal) state, into one of animation. The changes were clearly visible on her face. Her fellow classmates remarked on the change as the color returned to her cheeks, and her physiology demonstrated a clear shift into a state of social engagement and warmth (ventral vagal). This kind of shift is depicted in the imagery that arises in working with dreams. For example, the images from nightmares are clear representations of autonomic states. Activation or fight/flight – being chased or engaged in a battle are among the most prevalent nightmare themes.

What I am suggesting is that nightmares are the most obvious expression of what happens in all dreams. They are our bodies expressing, in image and sensation, our fluctuating internal state. They are a doorway into its expression, particularly valuable for those clients who have trouble hearing what’s going inside.

This brings me to another of Hartmann’s famous statements: that dreams are ‘picture-metaphors’ for our most salient emotional concerns. Sometimes our most pressing feelings are repressed, historic, or fleeting enough that we don’t think about them during the day. But our dreams have an uncanny way of picturing what matters most, even if we have repressed it. Our bodies carry the charge of feelings and memories that are unmetabolized, and these find expression in our dreams.

The True Purpose of Dreaming?

My sense, which is shared with many dreamworkers and researchers, is that the purpose of dreaming about emotion is not to upset us, but to help us process and shift such feelings. Sometimes, the dreams do this all on their own, like a nocturnal therapist, and sometimes it helps to have another person process the dreams with us. Sharing our dreams and bringing them into company and the light of day helps them do their job better. And increasingly, I’m beginning to think that a large part of their purpose is expressing and regulating the state of our nervous system.

However, I need to give the dreamer the last word here. In the example of the woman in the bathtub, the dreamer accepted that yes, the dream did depict welcome state changes. But there was more — an invitation to sink into the beauty and warmth of an elegant bathtub, and a new way of being with life’s mundane chores.

In other words, the shift in physiological state is welcome and accurate, but the invitation to appreciate beauty was compelling. And please forgive the very intended pun — to focus solely on physiology and ignore the depth and nuance of dream expression would be like throwing the baby out with the bathwater.

Questions for Thought

How does the author’s clinical use of the client’s dream fit with your own approach to dreamwork?

What might you have done differently with this client regarding her dream?

What is your own theoretical understanding of dreams and their “purpose?”


File under: The Art of Psychotherapy, Musings and Reflections