How to Work with Traumatic Nightmares

Many therapists I am teaching to work with dreams have expressed hesitation in working directly with their clients’ most challenging nightmares. Their concern is that talking about these highly disturbing dreams will stir up their client’s fears, possibly reinforce them, and generally make matters worse. However, recent research shows some evidence that almost anything you try will be helpful. Nightmares are treatable and should be addressed promptly and directly.

Philosopher Eugene Gendlin offered this piece of wisdom from his book, Focusing:
“What is true is already so. Owning up to it doesn’t make it worse. Not being open about it doesn’t make it go away… People can stand what is true, for they are already enduring it.”

Those who suffer from frequent, recurrent nightmares are already enduring them, so as Gendlin suggests, talking about them does not make them worse, but in fact, tends to help. This idea was supported by a recent study looking at the dreams of those who suffered what is arguably the worse possible trauma: participants were all former prisoners of Auschwitz. Polish researcher Wojciech Owczarski analyzed more than 500 dreams of 127 former inmates and concluded that most of their dreams were adaptive on their own or had “therapeutic potential.”

Only 10 percent of the dreams were recurrent, repetitive dreams that replayed actual trauma memories; most had begun to weave in present experiences with the past or were metaphors for the experience. Both of these kinds of dreams can be viewed as signs of potential recovery from the trauma. For example, one former inmate’s dreams of the concentration camp began to include his young wife, and he wrote, “There’s more confidence that both myself and my wife will survive.”

This research refutes an earlier study (Lavie and Kaminer, 1991) which suggested that in cases of severe traumatic experiences like the Holocaust, those who repressed their memories and did not examine their nightmares fared better. Owczarski found that while not all of the dreams of the Auschwitz survivors had therapeutic effects by themselves, “all of them seem useful and healing in psychotherapy, so suggesting patients repress their dreams would turn out to be a serious mistake.”

How to work with nightmares
So if even the most horrific dreams warrant attention in therapy, the next question is how to do this in a way that does not re-traumatize the client. In this, it can be helpful to take the lead from the dreams themselves as they indicate how far along the path to healing the dreamer has come. The man who dreams that his young wife is at Auschwitz with him has clearly come a long way towards recovery from his traumatic experience and would be able to discuss these dreams with relative ease.

In other dreams, you would have to be more tactful and resourceful to use the nightmare’s therapeutic potential. Recurrent dreams that replicate the trauma exactly demonstrate the least amount of progress toward healing – although they can be seen as a form of inner exposure therapy, a repeated calling for the dreamer to attend to the trauma. In these cases, forms of imagery therapy that invite the dreamer to continue the dream, and allow it to play forward have been shown to help.

I believe that the key to working with highly charged material is to help the dreamer to manage their physiological responses, to learn to keep calm in the face of recalled trauma. This process involves establishing and safe and supportive connection with the client, teaching skills that help the client learn to cultivate calm and keep a safe distance from the material. For example, clients can be encouraged to titrate: to work with the dream images one little piece at a time. They can also learn how to build an ‘observer self’ that is able to watch the trauma dream play out without the sense that they are reliving the experience.

There is more to this way of working than I can offer in detail here. The main point is that even with the worst nightmares, there is therapeutic potential, and to avoid the discussion may well be a mistake. Chances are you won’t make it worse because your client is “already enduring it.” In fact, having someone accompany them into their darkest places demonstrates the danger has past, and the trauma can be talked about constructively and healed.

Master an engaging, experiential way to talk about dreams with your clients by taking Leslie Ellis’ course How to Work with Dreams in Your Clinical Practice here on JungPlatform. You will also learn how the current science of dreaming supports its use and how to make the most of the healing potential inherent in your clients’ dreams.