Psychotherapy Bulletin

Psychotherapy Bulletin

2022 President’s Column 57(1)

Dreams in Psychotherapy

Many therapists tell me that they never learned how to do dream work and don’t feel comfortable addressing them in therapy. How sad because they are then missing out on potentially valuable aspects of clients’ lives. After all, if the average person spends two hours in REM sleep per night, that adds up to 51,000 hours or six years of dreams if they live to 70 years of age (and that does not even count the non-REM dreams). We should not ignore anything that is such a big part of one’s life.

And beyond that, dreams are often quite fascinating. They reveal aspects of our inner lives that we might not experience in waking life. We go on fantastic voyages, meet interesting creatures, have incredible adventures, and do things we might not do in waking life. How interesting to learn about a person’s inner world.

On the other hand, we often have horrifying nightmares and replay recurrent problems. Often times these nightmares wake the dreamer and keep them awake so that they cannot function the next day. People who have had traumatic experiences are likely to replay these experiences over and over in their nightmares. As therapists, we should definitely know about these nightmares because they provide a window into how the client is processing (or more often not processing) trauma.

Although we do not know the reason for all dreams, it seems likely that dreams help us process events in our waking lives. Something happens in waking life, and we connect it during dreams with our memories of past events. Hence, dreams are incredibly personal, and we cannot use dream dictionaries to interpret them.

Of course, not all clients remember their dreams, and not all want to talk about their dreams in therapy. In a survey (Hill et al., 2008), psychoanalytic therapists reported that about half of their clients brought in dreams. Similarly, in a study of clients in our clinic (Hill et al., 2013), we found that of 46 clients who had attended at least eight sessions of psychodynamic therapy (all with doctoral student therapists who had been trained in dream work), half presented at least one dream during therapy but only six discussed dreams in three or more sessions. When those who did not talk about dreams were asked why not, they said that they did not remember their dreams or that other things were more important to talk about.

Some clients do not know that it is acceptable to talk about dreams in therapy. So, one idea is to let them know at the beginning of therapy that you like to work with dreams. And later in therapy, if clients are stuck or having a hard time getting to deeper levels, you can suggest that they bring in their dreams. Of course, be open to the possibility that they do not want to work with dreams, but at least if you educate them about dreams, they know that you’re open to discussing them if they so choose.

What can you do if they do bring in their dreams?  If nothing else, just as you would ask about their experience of any other event in their lives that they wanted to understand, you can listen and ask them about their experience of the dream. 

The next thing you can do is ask them to pick an image and tell you more about it. Ask them to describe the image (something in the dream or a part of the dream) in detail . . . to paint the picture so that you can see, hear, and feel it. Ask them about their feelings as they describe it and encourage them to experience their feelings in the moment. Ask them to associate to the image: What’s the first thing that comes to mind, what are their memories? Then ask them about what might have triggered the image in their waking life. You can repeat this with as many images as you have time for in the session (or you can continue with the dream in additional sessions). We have found that this exploration stage takes the most time, and it’s more important to go into depth on a few images than to cover every image in the dream superficially. 

If you have more time, ask what they think the dream means. How would they interpret it? Ask questions about their interpretation: What did they focus on? What did they leave out? If their interpretation was about the experience itself, waking life, past events, or existential concerns, ask about other possible ways of interpreting it. Think about how their interpretation fits with what you know about the client. There’s no need for you to have an interpretation of their dream, but if you do you might share it very tentatively and ask how that fits for them. But be careful to let them be the one who interprets the dream since it’s theirs. You might finish this segment by asking them to summarize what they learned about themselves in the dream work. 

If there has been some new understanding, you can move on to action. Do they want to change something in their waking life? If so, you can help them with behavioral techniques. Is the dream more metaphorical? If so, you could help them think of a ritual to help them remember what they learned. To finish this segment, you might ask them to summarize what they learned about themselves through the dream work, and then to give a title to the dream.

Obviously, you won’t complete all these stages in a single session unless you have very extended sessions (we have found that a thorough dream interpretation takes about 90 minutes). But you can come back to the same dream in subsequent sessions. And you can ask what thoughts the client had about the dream between sessions.

I suggest you try the model working with your own dreams. Experiential learning can allow you to personally see what can be gained by working with dreams. And I highly recommend dream groups.

You can learn more about this model for working with dreams in Hill (2004) and Hill & Spangler (2016). A quick summary of the findings on about 25+ studies we have done on this model of dream work (see reviews in Hill, 2004; Hill, 2019; Hill & Knox, 2010; Spangler & Hill, 2015): we know that dream work is effective in terms of client ratings of session quality, gains in insight, gains in action, improvements in target problems, and increased attitudes toward dreams. I should note, however, that we have not compared this approach with other dream approaches, so we have no evidence that this approach is better than other approaches (but I would note that there is a paucity of research on other approaches).

An additional interesting thing is when clients dream about their therapists and therapists dream about their clients (Hill et al., 2014; Spangler et al., 2009). Usually, it is indicative of something going on, so good to pay attention to. 

Good luck working with dreams!  Dream on!

Cite This Article

Hill, C. (2022). 2022 president’s column 57(1): Dreams in psychotherapy. Psychotherapy Bulletin, 57(1), 2-4.


Hill, C. E. (Ed.) (2004). Dream work in therapy: Facilitating exploration, insight, and action. Washington DC: American Psychological Association.

Hill, C. E., & Knox, S. (2010). The use of dreams in modern psychotherapy. In A Clow & P. McNamara (Eds.), International Review of Neurobiology (Vol 92, pp. 291-317). Academic Press. 

Hill, C. E., & Spangler, P. T. (2016). Hill cognitive-experiential method. In J. E. Lewis & S. Krippner (Eds.) Working with dreams and PTSD nightmares: 14 approaches for psychotherapists and counselors (pp. 133-142). Santa Barbara, CA: Praeger.

Hill, C. E. (2019). Benefits of dreamwork in psychotherapy. In K. Valli & R. J. Hoss (Eds.), Dreams: Understanding biology, psychology, and culture, Vol. 2 (pp. 461-465). Santa Barbara, CA: Greenwood. 

Hill, C. E., Gelso, C. J., Gerstenblith, J., Chui, H., Pudasaini, S., Burgard, J., Baumann, E., & Huang, T. (2013). The dreamscape of psychodynamic psychotherapy: Dreams, dreamers, dream work, consequences, and cases. Dreaming, 23, 1-45.

Hill, C. E., Knox, S., Crook-Lyon, R. E., Hess, S. A., Miles, J., Spangler, P., & Pudasaini, S. (2014). Dreaming of you: Client and therapist dreams about each other during psychodynamic psychotherapy. Psychotherapy Research, 523-537.  doi:10.1080/10503307.2013.867461

Spangler, P., Hill, C. E., Mettus, C., Guo, A. H., & Heymsfield, L. (2009). Therapist perspectives on the dreams about clients: A qualitative investigation. Psychotherapy Research, 19, 81-95.  doi:10.1080/10503300802430665 


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