In a recent study (Jones & DeCicco, 2009) a colleague and I have found that people who were mild to moderately high in anxiety tended to have more scene changes. The participants in the study reported going from one scene to the next, where people high in depression did not. This finding implies that people who are anxious in their waking day bring thoughts and feelings into sleep time that may affect the images that are being created. That is, the images do not appear to finish out a scene entirely but rather, scenes are quickly changed with unfinished story lines. For example, a man may be running down a road in one dream scene and then suddenly, finds himself at a friend's house. These abrupt scene changes were correlated with waking day anxiety.
Another interesting finding from the study is that people high in waking day anxiety did not have as much "discovery" with dream interpretation. Perhaps it is the fact that the dreams are so abruptly changing scenes that it is difficult to relate this to any one waking day life with interpretation. Nevertheless, many scene changes in a dream may be altering us to the possibility of waking day anxiety. This could help in self-guided dream work and in professional practice since jumping scenes may be an important element of the dreaming landscape.
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In my experience as psychotherapist anxious patients very often feature this "jumping around" in dreams as well as in waking life behaviors (with, e.g., starting many things or getting involved in many relationships without really focusing, or finishing, or getting to completeness in one at least) and also in the therapeutic conversation. This latter gets sometime tiresome, because the patient ceaselessly goes beside the point, shows expectations of some magic solution that could bring about relief and appears to be scarcely prone to think, to focus on her/his own feelings etc. (all that gets the core of a psychotherapeutic work).
ReplyDeleteI'm used to consider this tendency to avoidance (absolutely common in anxiety) as a problem with the meaning of life. That is, the patient is really afraid of discovering, out of her/his experiences, some very negative meaning about her/his own person(like guilt, inadequacy, abandon, defeat etc.).
No surprise that, given these conditions, avoidance is shown also in her/his dreams.
It's many years that I work with patients suffering this way, and I found out that this subject is connected with the one of the last Teresa's post. The therapist must absolutely resist to the temptation of imposing "from outside" or "by authority" a meaning to the patient. In the best case that woulkd result useless and frustrating for both. A great patience and trust in the efficacy of time is needed, but meanings, discoveries and solutions have always to be found working and searching together. It obviously doesn't mean that the therapist should appear uncertain or insecure in proposing her/his own hypothesis, points of views etc..
Thank you Teresa for sharing the outcomes of researches like that. In my opinion matching research and clinic together is very, very useful!
Bye!
Massimo gives us a very nice bridge between the research on anxiety and the clinical application of dreams. Those of us who have worked in clinical practice often see this "jumping around" with ideas and solutions in patients with anxiety. When using dream therapy with these patients it can be very useful for guiding the clinician's approach but also, for the patient to see their own scattered thoughts and behaviour. As per the continuity hypothesis of dreaming, what we think and do in waking life is brought into dream life. It appears to be very clear when dealing with waking day anxiety and dreams.
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ReplyDeleteRicordo anni fa una donna che faceva dei sogni che mi sembravano racconti
ReplyDeletedi Garcia Marquez , tanti erano i cambiamenti di scena , i personaggi , le epopee …
Diversi di questi sogni parlavano di storie ( mai concluse ) di cavalieri medioevali…
Non sono mai riuscita a capire cosa volessero dire : mi sembravano costruzioni
un po’ artificiose ,e forse lo erano …
Forse , capisco dopo il tuo post , non c’era niente da capire e andava solo osservato
il cambiamento repentino di scena che riportava all’ansia della donna ;
e forse si trattava solo di aspettare con pazienza che la donna desse una fine alle sue storie….:
la conclusione della storia , se il setting terapeutico avesse funzionato , sarebbe probabilmente stata positiva per la sua vita .
Concordo pienamente con ciò che Massimo dice riguardo alla pazienza e alla fiducia che il terapeuta dovrebbe avere riguardo alla possibilità di soluzione , che devono vedere soprattutto attiva la persona , il “paziente” .
ReplyDeletePerò , come te giustamente dici Massimo , è molto difficile portare avanti questo , specie per quelli di noi che lavorano in ambito privato . Ci sarebbe bisogno che l’ambito pubblico aiutasse moltissimo questa professione .
L’atteggiamento di ATTESA e FIDUCIA (sostegno) ecc., fondamentale in questa professione, rischia di essere scambiato per INCERTEZZA , in una società che , come la nostra , ci impone
come modello di “curante” colui che sa sempre cosa fare e ha sempre le risposte giuste
per tutto.
E’ forse per questo , perché nel nostro bagaglio portiamo la pazienza e l’attesa…che la nostra professione non è così vincente , né può esserlo , nella nostra società.
Perhaps then we can talk about our own approaches to anxiety dreams in practice. I myself use them as a cue that might lead me to see if in fact the person having the dreams is anxious. If the jumping around dreams matches the jumping around behaviour in practice or waking life then I begin working with the anxiety. I personally try to implement a "relaxation program" before and after each session. This technique is known to be effective with anxiety as per the research, so it is a very good starting point. The practice is continued between sessions. By continuing to follow the dreams they will reveal if the anxiety level is decreasing since there will be fewer scene changes. The dream then act as a guide for the clinican but insight likely will not occur for the dreamer until the anxiety level has decreased.
ReplyDeleteThe issues brought about by Donatella are important; anxious patient want to experience at least a slight improvement rapidly; further, since we get paid society has expectations on us but not always the real difficulties of our work are known and and taken in account; I would add that very often at least a significant person around the patient (i.e. a spouse, a parent, a friend, other relatives or works colleagues etc.) doesn't trust in psychotherapy. So the contextual frame of a psychotherapy where anziety problems are treated may be not so much propitious.
ReplyDeleteIt's many years that I keep to the following guidelines. From a theoprical point of view, physicist and scholars in the topic of complexity have shown us that when a system is near to chaos, in order to start a development of organization and complexity, it needs to receive simple inputs of low order. These might be able to trigger a process of increasing complexity; it's useless too introduce complexity beforehand.
This principle, put in practice, means that meanwhile we have to be patient about the rising of insight, elaboration and all the common outcomes of a psychotherapy, we are requested of doing right away something simple and effective.
In some cases, I behave like Teresa, starting very simple relaxation programs based on breathing exercises. In other, mostly if the patient is not an adult individual, but a whole family or a baby child, I give very simple pedagogical or strathegic instructions. Finally, when it's convenient, I refer the patient to a good physician to get medical support.
Obviously it doesn't work always. I have my percent of drop out as any other therapist, but generally, by working this way, I have satisfactory results, because patients start getting better, and the time to let a working alliance grow up, as well as a mutual trust, is granted.
Bye!
M
Il sogno per la persona che soffre d’ansia e per chi si occupa di psicoterapia con soggetti ansiosi
ReplyDelete( quindi pressoché tutti i terapeuti ) credo che sia importantissimo , centrale …
Penso che basti chiedere di descrivere quello che la persona ha sognato per vedere cambiare lo stato d’animo e il funzionamento della persona modificarsi . La persona comincia senz’altro ad alterare lo stato di coscienza . Questo è ben visibile perché la persona modifica il ritmo respiratorio , che rallenta come durante una seduta di ipnosi.
Tutto questo senza minimamente toccare il significato del sogno , semplicemente concentrandosi su immagini interne anziché esterne .
Questo è solo uno dei grossi regali che ci fa il sogno . la grossa possibilità di essere concentrati più sull’interno che sull’esterno .
Credo che questa capacità di “stare” più con immagini interne che esterne sia la cosa più
grossa che possa far decadere l’ansia a livelli minimi .
Mi succede quindi , durante la terapia con soggetti ansiosi , che , se anche non afferro per diverse sedute la problematica della persona , chiedo alla persona stessa di descrivere minuziosamente il suo sogno .
La comprensione del sogno e il suo ”utilizzo” vengono dopo….