2. Tread softly, for you tread on my dreams:
Therapists’ experiences of dreaming of their clients.
Brian Rich & Sue Wheeler

3. Literature Review
Only four empirical research papers published. None were conducted within the UK. Existing literature is based on clients’ manifest appearances in dreams. Though most therapists experience client-related dreams, they are rare: 69%-78% of therapists reported countertransference dreams (Lester et al, 1989; Hill et al, 2014). 0-2% of therapists’ dreams are “about clients” (Hill et al., 2014). Dreams often contain negative interpersonal content and affect (Kron and Avny, 2003; Spangler et al, 2009; Hill et al, 2014). Dreams are preceded by emotionally challenging clinical experiences (Lester et al, 1989; Spangler et al, 2009; Hill et al, 2014). Supervision is not widely used by qualified therapists (Spangler, 2009) and less than half of trainee therapists substantially discussed dreams with supervisors (Hill et al, 2014).

4. Aims What themes appear in the manifest content of dreams?
What is the context in which these dreams occur?
What meaning do therapists make of their dreams of clients?
How do therapists process dreams of clients?

5. Method
Design Qualitative Study Semi-structured interviews Ethical approval granted by University of Leicester and conducted in line with BACP Ethical Guidelines for Research Sample 10 psychotherapists/counsellors 8 women, 2 men 13 dreams Qualified or trainee status Range of modalities: Psychodynamic/Psychoanalytic, Person-Centred, Gestalt, Integrative Analysis Thematic Analysis (Braun and Clarke, 2006)

6. Dreams
Dreams were typically associative. Variantly, the client appeared in the manifest content. There were no variations in the significance, meaning or usefulness between these categories which challenges explicit and implicit assumptions in the literature.
Clinical literature focuses on manifest dreams
Associative dreams overlooked / Manifest dreams overvalued
Assumptions influence empirical research

7. Dreams
Typically, reported dreams were therapists’ first experiences of dreaming of clients: “…it was like oh my god this is fucking mad…stuff like this going on, it’s quite exciting as well you know this stuff really happens…” “it did feel odd and I suppose because unless I’ve forgotten it hasn’t happened before…” Typically, dreams occurred whilst the therapist was in training. Typically dreams occurred during the middle phase of therapy and less often during the early phase. They rarely occurred at the end of therapy or post-therapy.

8. Themes in Dreams
Typically, dreams contained conflict between dream characters:
“…the administrator came in and said there was a call from the client that he doesn’t want therapy anymore and doesn’t want to see you anymore...”
Disturbing feelings were variantly reported:
“…extremely paranoid and anxious and almost petrified with fear and lost in this dark place and alone…”
Variantly, therapists’ described troubling feelings:
“…guilt where even though I’ve not done something wrong in this situation somehow it’s going to end up with me being in the shit…”
Mixed feelings were variantly reported by therapists.

9. The Waking Context
Client and therapist were typically in conflict prior to dream. “…the sex was always there and you know he would ask me how do you relax at the end of the day and you almost felt like he was going to stand up and rub my shoulders in a minute…” Therapeutic process was variantly slow or stuck: “…I was floundering a bit…” A closeness / sudden connection with client was variantly reported prior to dream: “…I think I had a very strong empathy for her…I felt very close to her…”

10. The Waking Context
Internal conflict was generally reported by participants prior to dreams. Professional self-doubt typically followed from challenging clinical experiences: “…I could see why other therapists had failed and I could see me not succeeding at which point where does the client go…” “…I felt a bit out of my depth in terms of I couldn’t cope with this client…” Participants variantly described the waking influence of personal difficulties: “…I think it reflects part of my external world at the time I got quite a lot on my plate…”

11. Meaning-Making
Dreams were typically described in ways that indicated communication, either internally... “…I do see it as that sort of wake-up call…it was shouting at me in a way and was also very useful…” “…it was a missing piece” …or as a communication from the client: “…if the dream was where her needs and her projective identification was coming to me there couldn’t be a better place for it because that is where I was responding to her deeply…”

12. Meaning-Making
Dreams typically improved understanding of the client: “the feelings were strong and it gave me a real sense of the depth of feeling from the client [that] she wasn’t displaying…” … the therapeutic relationship: “…the client has all these introjects that I find objectionable but I’m not going to shift them and the client doesn’t want to shift them and therefore I need to work within that context…” … the therapist: “...I realised I needed to have my own personal therapy…”

13. Handling Dreams
Therapists generally processed their dreams. Supervision was typically used to explore dreams. Personal therapy was variantly used. Therapists variantly talked to a partner or close friend: “…it gave me what I needed just to let it out in front of someone…I didn’t get any feedback that I could have utilised but I think that’s all I was willing to do with it…” Processing dreams typically brought relief, whatever method was used: “…as long as we were going somewhere it was good enough and there wasn’t really the anxiety about having to reach this point by this time and that was good…”

14. Supervision
Reticence to take to supervision was variantly identified: “…[It was] quite an extreme psychopathic kind of dream…” “I’m thinking more and more as we speak I’m thinking maybe there’s an element of if that I’m embarrassed of and that’s why I didn’t make any time in supervision…” Variantly, therapists identified their motivation for taking dreams to supervision: “…I was just imagining what it would be if it was a sexual dream about a client but I would just feel obligated to bring any dream about my client to supervision…” “…it felt quite exposing but my curiosity was stronger than that really…”

15. Supervision
A supportive environment was typically identified as important: “…it was good to sort of explore it and see that the other people in the group could see that I wasn’t doing a bad job…” “…she was very open to talking about dreams and she was very interested in my own way of working with them as well…” “…working with the dream it felt good it felt collaborative and she was able to offer me some ideas about it and related it to the work…” Therapists variantly gained skills and insight: “…we focused more on my anxiety and how not to act in my countertransference…”

16. Limitations
Sample Small sample size. Predominantly psychodynamic and trainees. Methodology Raised risk of researcher bias. Inexperienced researcher of dreams. Findings No test for rater reliability. Limited feedback from participants.

17. Recommendations & Future Directions
Therapists
Therapists paying more attention to all dreams as additional source of data.
Encouraged to use supervision as a resource to explore dreaming of clients.
Supervisors
Can help therapists overcome ambivalence by showing an interest in dreams.
Providing a supportive, sensitive and responsive environment.
Future research
More research into non-psychodynamic samples.
Revisiting anonymous surveys.

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