Understanding Dreams in Developmental Trauma

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research-article2015
APAXXX10.1177/0003065115624231Joshua LevyInterpreting Dreams While Working Through Developmental Trauma
ja Pa
Joshua Levy / Paul Finnegan 64/1
A Clinical Case Presentation:

Understanding and
Interpreting Dreams While
Working Through
Developmental Trauma
The purpose of this paper is to demonstrate the unique place of under-

standing and interpreting dreams in the psychoanalytic process while
working through developmental trauma. This psychoanalytic process
extended over six years and is presented in four phases: establishing the
therapeutic alliance, a crisis, working through, and termination. Dreams
from each of these four phases of the analysis are presented, and the
collaborative work of understanding and interpreting these dreams is
highlighted. Evidence is presented that from this analytic work there
ensued an amelioration of the impact of developmental trauma and a
furtherance of the development of internal psychic structure.
Keywords: understanding and interpreting dreams, developmental

trauma, therapeutic alliance, crisis, working through, termination,
dissociation, transference, countertransference
T he complex relationship between traumas and dreams permeated

Freud’s conceptual foundation of psychoanalysis, both its theory
and its practice, throughout his life. Freud’s first theory (1900) was that
dreams are wish-fulfillments. Then, in Beyond the Pleasure Principle
Joshua Levy, Training and Supervising Analyst, Toronto Institute of

Psychoanalysis; faculty, Toronto Institute of Contemporary Psychoanalysis; Associate
Professor (Emeritus), Department of Psychiatry, Faculty of Medicine, University of
Toronto. Paul Finnegan, psychoanalyst in private practice, Toronto.
This paper was presented by Joshua Levy to the Toronto Psychoanalytic Society
in December 2011 and to the Toronto Institute of Contemporary Psychoanalysis in
April 2015. Submitted for publication May 15, 2015.
DOI: 10.1177/0003065115624231 13
Joshua Levy / Paul Finnegan
(1920), he accorded a central role to traumatic dreams “endeavouring to

master the stimulus retrospectively” (p. 32). Ferenczi (1931) expanded
on Freud’s two dream theories, stating that “every dream, even an
unpleasurable one, is an attempt at a better mastery and settling of trau-
matic experiences . . .” (p. 238). Many others (e.g., Erikson 1954;
Winnicott 1971; Segal 1991; Bion 1962; Bromberg 2011) have discussed
the intimate relations between patients’ dreams and underlying trauma,
but none of them have addressed the analysis of dreams in successive
phases of the working through of developmental trauma.
We will present a detailed account of the working through of trau-
matic dreams occurring in successive phases of a six-year psychoanaly-
sis. In the initial phase, careful attention had to be paid to the patient’s
fragile psychic structure, and to the limitations of her capacity to contain
the affective tensions expressed in her dreams, so that the dreams could
eventually be reflected upon, interpreted, and understood. Detailed atten-
tion will be paid to the patient’s interactive engagement during the work-
ing through of her internalized traumatic experiences. Further, we will
highlight the patient’s subjective responses to the analyst’s conscious and
unconscious intentions and interventions. This focus will allow us to
examine the complex issues surrounding the influence of the analyst’s
unnoticed misattunements and mistakes as he attempts to be emotionally
engaged and tries to offer helpful and valid interventions. In subsequent
phases of the analysis we highlight the reemergence of early traumatic
experiences in the patient’s dreams and present evidence of her develop-
ing capacity to symbolize, to contain her affects, and to benefit from the
analysis of her dreams.1
A NNE : A B r i e f H i s t o r y
Anne, thirty years old and single, came to analysis having suffered depres-
sive episodes of varying degrees of severity over the previous ten years.
Just before seeking analysis she was plagued by severe depression: she
could not make decisions, did not eat, withdrew to her bed, and feared
losing control and committing suicide. She had had brief periods of psy-
chiatric treatment over the years but had now decided “to get at the root”
1Joshua Levy, the treating analyst, will describe the case using the first-person singular.
Paul Finnegan collaborated in preparations for the workshops and in the writing of the paper.
14
Interpreting Dreams While Working Through Developmental Trauma
of her problem. As for the precipitating events for her bouts of depression,
she blurted out, tearfully, “All my relationships have gone nowhere.” She
recited a litany of failed attempts to form close relationships, with both
men and women. As long ago as she could remember, her teachers had
commented that she was blocked from realizing her potential. Now, as a
librarian, she performed her duties in a mechanical way under the super-
vision of a less qualified professional.
Anne was a middle child, having one brother four years older and
another three years younger. Her older brother had had severe behavioral
problems from early childhood. She observed violent clashes between
this rebellious brother and her father, who would come home exhausted
and demand absolute obedience. Anne became a compliant girl, quiet,
pleasing, and silent. Her stay-at-home mother had put aside her profes-
sion to raise the children and cater to her husband. Anne’s mother was
burdened by the destructive behavior of the older brother. As for Anne,
she grew up fearing the brother and being maternal toward her adorable
younger brother. Anne recalled that when she needed emotional support
from her mother after feeling disappointed and rejected by friends, her
mother would tell her: “Go buy a dress.” She had many short-term boy-
friends and became sexually active during her adolescence, though in all
her sexual relations with men she felt used.
P h a s e 1 : E s tab l i s h i n g t h e T h e r ap e u t i c A l l i a n c e
In the first week of the analysis Anne hesitantly brought up a dream that
had awakened her in a great fright:
I was climbing up a steep mountain . . . saw a lighthouse at the top . . . there was
a man there . . . I reached the top . . . I don’t remember what he said to me. . . .
Then I was going down . . . it was dark . . . I can’t remember the rest of the
dream.
We remained silent for about twenty seconds, and then I said: “You
saw a light at the top of the mountain.” The patient did not respond for
what seemed to me a long time, but I remained silent. Then she blurted
out, explosively, “I came down by myself!” She cried inconsolably for the
rest of the session, and there was no further attempt to look at the dream.
(Recall here that a traditional analysis of the dream would have
involved the analyst’s asking for associations in order to get beyond the
15
dream’s manifest content and uncover its latent content and unconscious
meanings.)
While this dream occurred at the beginning of the analysis, there had
been three indicators of an underlying traumatic experience. First, Anne
had awakened from the dream in great fright. Second, after she told me
the dream she was at first silent and then blurted out, “I came down by
myself!” and cried inconsolably. Third, there was a switch in her mental
state from an initial sense of hopefulness about the analysis to a state of
abject despair.
As this was the first dream presented in the analysis, did it suggest
something of Anne’s anxieties about the nature of the analytic process? In
the end would she be left alone, depressed, and forgotten, as she had been
so often after her brief sexual relations with men? I heard Anne’s underly-
ing plea that I be with her, talk to her, enlighten her, and not desert her,
and at the same time I also heard her dread that the promise of closeness
would not be fulfilled.
Neither of us returned to the dream. I wondered whether I had been
frightened of her abrupt and uncontrolled emotional outbursts and had
therefore avoided returning to it. (My countertransference reactions, of
course, could be subject to further analysis.)
There followed a few months during which Anne struggled in adjust-
ing to the analytic framework. Though she regularly attended the four
weekly sessions, promptly paid her bills, and seemed to enjoy the regular-
ity and continuity of the sessions, she at the same time greeted me with a
frozen smile and strained facial muscles and spoke in a quiet, deliberate
voice while relating the details of her daily life—about her work, her fam-
ily relations, and her friends, both men and women. Anne was extremely
polite and seemed to make strenuous efforts to comply with the “rules of
analysis.” She would say “Thank you” as she got off the couch to leave.
To a friend who asked her about her analyst, she said, “He is a very nice
man.” When I encouraged her to say more about this, she laughed off my
suggestion, saying, “But you are.” It became clear from her associations to
her initial experience of the analysis that she was viewing me as the oppo-
site of her father, who would come home exhausted and angry after a long
day at the office. The family had to be quiet and obedient and serve him.
Anne would be quiet, feel rejected by him, and avoid his sarcasm. In Anne’s
recounting of her daily activities I could sense underlying bubbles of anger,
but these were touched upon, if at all, only superficially.
16
Quite frequently, when Anne attempted to say what was on her mind,
she became silent, and would say: “I am up against a blank wall.” If I tried
to explore her silences further, she would experience me as putting pres-
sure on her and would then hint at her wish to leave the analysis. And she
would wonder how talking could help her with the personal problems that
had brought her to analysis. At such times, I felt she was resorting to sar-
casm, devaluing the analysis, and identifying with her father’s attitude
toward her, which she had so dreaded as she was growing up.
Her repeated failed relations with men had occupied a great deal of
her associations. Brief sexual relations with a number of men had ended
with depression. As we ended a session before a long weekend, she said
she was looking forward to a quiet break and being by herself. When the
analysis resumed, Anne said she had had sexual relations four times dur-
ing the weekend; she said this in a defiant manner and then quickly shifted
to a depressive mood. She rejected my attempts to start looking at her
experiences during the break and the shifting moods I observed in the
session. At one point she blurted out, “I have been rejected so many times.
That is a sufficient explanation for my depression.” She demanded that I
back off, maintain a certain distance, and take her at face value. I was
curious and asked about the “four times,” to which she responded angrily,
“Ya, ya, that’s what I told you.” I was wondering to myself to what extent
the analytic situation excited her sexually and whether this tension was
discharged through her sexual acting out. On many occasions I was left
feeling that Anne needed and demanded that I hold and contain her under-
lying disappointments and fury. It was important that I stay on the surface
and remain quiet at times I might wish to continue an analytic exploration
that was just starting to get off the ground.
Anne’s dreams during this period repeated the disturbing dreams she
had experienced since childhood. These were nightmare fragments. These
were dream fragments of being sadistically attacked, of being abandoned,
and of being left alone to starve. I regarded these dream fragments as affec-
tive experiences to which I was to respond with empathic resonance with-
out going beyond the manifest content. My attempts to work analytically
with them were often either disregarded or received as cognitive informa-
tion lacking the intended emotional impact. Alternatively, they were expe-
rienced as retraumatization—me bullying her in a repetition of the
oppressive emotional environment of her family life—with Anne respond-
ing by retreating into silent depressive states of traumatic aloneness and
17
struggling to avoid any awareness of inner deadness, fragmentation, or

destructive internal forces. These frightening affective dream experiences
were being given over to me for holding and containment without further
exploration.
In reflecting on Anne’s dreams, and on the analytic interactions, I
could see evidence of a mental organization grounded in concreteness, a
foreclosure on inquiry, and a destruction of meaning. My goal was to
facilitate the creation of a psychic space within which we could work
through the multiple layers of her communications. In time, Anne was
gradually beginning to tolerate what she had initially experienced as
insurmountable obstacles. She was able to relax her vigilance and become
more trusting of me.
Five months into the analysis Ann had a dream that surprised both of
us. In the middle of a Monday session, after recounting numerous experi-
ences of the sort that frequently occurred during weekend breaks, she
related the following dream:
I had a dream . . . I was lying in bed and had a hose in my hand . . . and I was
spraying shit all over the walls . . . it did not bother me at all. I was pleased to
be doing it.
Hearing this dream from Anne, a woman who had so meticulously chosen
“clean” words in relating her experiences, took me completely by sur-
prise. Anne rushed to say, “This dream didn’t bother me at all . . . it didn’t
mean anything.” After a brief silence, she asked me, “Were you sur-
prised?” I said yes, and she replied, “I was, too.” And she added with
nervous laughter, “Don’t worry. I wouldn’t do it here.” A long silence
followed which I broke by saying: “It seems to me that you are speaking
about your dream from the position of an observer.” Anne responded:
“I would never say ‘shit’ at home in front of my parents.” My attempts to
get her to associate to the various aspects of the dream, and to her related
feelings, failed. For the rest of the session she went back to telling me that
during the weekend she had observed a discussion between her older
brother and her mother that she said was quite routine and meaningless.
Silently, I was wondering whether it had been one of the day residues for
the dream.
During the next three weeks Anne never mentioned the dream again,
nor did I bring it up, though there were occasions when I was tempted to.
The dream and its possible implications occurred to me during the
18
sessions and beyond. At first I was excited when I thought that it might be
a turning point in the analysis. I had to curb my enthusiasm. The dream
suggested to me that I needed to consider her unconscious perspective on
me as perhaps being “too polite,” “nice” “clean,” and “distant.” Was she
psychologically ready now to be challenged and to explore deeper psy-
chic layers of the dream? I recalled feeling that while presenting the
dream she was communicating a self-assertion in defying her family. In
talking to me about the dream, was she letting me know that she was
beginning to feel safer in the analytic situation, even though this was not
yet a dream she could associate to, reflect upon, and explore for its mul-
tiple layers of meaning? In my afterthoughts I sensed that she was afraid
I would abruptly end the analysis should she mess it up by expressing her
underlying explosive aggression.
This dream occurred after a weekend during which Anne had
observed “routine” interactions between her mother and her older brother.
I was wondering about her unconscious experience of having quietly wit-
nessed their interactions, and wondered what memories and related
affects this might have evoked within her. Was there an unconscious
intense aggression that her conscious mind considered “messy” and
“shitty”? Did the whole conflict, then, have to be dissociated and evacu-
ated? Was she also attacking me through the ordinary analytic recounting
of her daily experiences of failures and the intense shame that accompa-
nied them? Did she indeed wish to spray me with shit?
Assessing my experience of her perceptions of my interventions related
to her dream and her responses to them, suggested to me something of what
was unfolding in the transference. I was thinking about possible linkages
between the transference and her dreams. I was wondering if she was reliv-
ing an earlier developmental struggle associated with the “anal period,”
during which she was forced to comply with her mother’s schedule. I
thought that her experience of the dream as “not me” was a defense against
unassimilated and unbearably threatening psychic material that was being
represented and relived in the transference. When I tried to explore the
dream through free association, it appeared to put great pressure on her. So
I backed off. I was concerned that a probing analytic approach made prema-
turely might intensify her sense of inner badness and a damaged self.
We continued to process her repeatedly feeling miserable following
her sexual acting out and her thoughts about her meaningless job—both
of which I thought were related to her emerging traumatic background.
19
Though I endured prolonged defiant silences in the analysis, I had to

wonder whether my analytic approach was sidestepping what she needed
most: namely, a search for the traumatic sources of her conflicts and
defenses, an area my approach had not yet addressed.
Three weeks after telling the dream, Anne excitedly related an expe-
rience she had had that day at work. A coworker less experienced than she
had been designated her supervisor and was telling her what to do. Anne
disagreed with her and said so. The dispute continued, with heated
exchanges. Anne did not back off and felt she could hold her own. She
went on in the session to examples from the past when she had disagreed
with this colleague but had nevertheless taken her direction. After a long
pause, she said the incident today reminded her of the dream of spraying
shit and she told it to me again. “Do you remember it?” she asked. “In
both situations,” I said, “you asserted yourself. You were pleased with
yourself, seeing it is an achievement.” Anne remained quiet for a long
while, holding back tears, and finally burst out crying. We remained silent
for the rest of the session.
Anne’s agony and depression following her brief sexual relations
with men had been the topic of many analytic sessions. However, she
had been extremely guarded when relating some of her personal sexual
experiences and left it up to me to imagine and speculate. Shame and
guilt inhibited her. Now, however, I noticed her efforts to bring forward
more specific details of her relations with men and her wish to explore
them. As a result of our analytic work, Anne was interested in exploring
what kind of men she had chosen to have sexual relations with. She
recently had met a man, and on the second date it was clear to her that
he wanted to sleep with her. She had told herself, “I don’t feel like it . . .
it is not going to work for me.” Nonetheless, she consented. She said
that during their sexual intercourse she “was just watching him . . . he
was very excited . . . [she] waited for him to finish.” She was now deter-
mined, despite the great pain that this engendered, to understand her
motives rather than to act out her tensions and anxieties over feeling
undesired and discarded by men unless she complied with their desires.
It became clear that these men had themselves had numerous brief sex-
ual affairs and were not intending to pursue the sort of long-term rela-
tionship that Anne consciously desired.
I raised the question who it was that the men she was drawn to reminded
her of. The question interested her, and we explored it at some length.
20
The dream of “spraying shit” came to her mind readily and spontane-
ously. As Anne was feeling more comfortable, safer, and less ashamed,
the dream element “shit” became a nodal point that facilitated our inquiry
into its multiple sources and our relating it to her inner intimate physical
and emotional experiences with men. “Shit” became an inner experience
reminding her how she had felt treated like “a piece of shit” by both her
father and her older brother. She was merely used to serve their needs.
Further, and this was painful for her to realize, she had not only been
unconsciously attracted to this kind of man, but had also treated them like
“shit” by abruptly and aggressively discarding them.
This analytic process brought to my mind a number of questions and
hypotheses that guided me in responding to Anne. I was aware of her
drivenness and self-destructive acting out. Would she eliminate me, as
she had repeatedly done with men, and would she abruptly leave the treat-
ment after a brief analytic fling? Would I raise these issues with Anne
and, if I did, when and how would I do it? And to what extent were these
questions influenced by my countertransference anxieties? Would my
attempts to explore this question mean to her that I was coercing her into
addressing these issues in order to satisfy myself? When on many occa-
sions I brought up the transference implications of her struggles with men
generally, and with her father and brother, she denied any emotional
resemblance. I found myself mainly asking questions to further explore
and clarify the underlying struggles I heard in her associations, in the
hope of opening up avenues related to her concerns and interests. I was
always wondering whether I was striking a balance between my quiet
tolerance of her “elimination” of me, on the one hand, and, on the other,
my facilitation of her development of a capacity for self-assertion. In this
initial phase of the analytic process, I asked, were we approaching the
inherent paradox commonly faced in analysis.
In the analysis I noticed an upward shift in Anne’s mood; she was
beginning to enjoy the fruit of her free association. Anne’s clinical
improvement at this stage suggested that she was benefiting from our col-
laborative understanding of her dreams and that access to her traumatic
experiences and affects was in the offing.
Anne’s gradual insights into her motivations for the self-destructive sex-
ual relations that resulted in withdrawals and depressions were accompanied
by inquiry into, and the working through of, matters related to her highly
unsatisfactory work situation. Though qualified to work independently, she
21
was under the supervision of a colleague who, as mentioned, was less well
qualified than she. Experiences of humiliation, bitterness, and controlled rage
within the context of this relationship were frequently topics of the analysis.
Anne decided to move to a job in which she would be able to function more
independently. This necessitated her undertaking a number of academic
courses, which she did with great enthusiasm and hope. But just when her
achievements and talents were recognized by the instructor, and the prospects
of better, more independent work became a real possibility, she began to dis-
play behaviors and attitudes that could have resulted in her failing these
courses. In many similar situations in the past, she had experienced paralyz-
ing indecision, had failed to complete required assignments, had become
depressed for “no reason” and had finally been left behind while her friends
moved on. She was amazed at her “irrational behavior,” and in letting herself
associate freely to this complex repetitive pattern what came to her mind
were situations in which she was doing something wrong and was caught by
her mother. She was able to make a meaningful connection between succeed-
ing in life and her pervasive, intense, long-standing feelings of “doing some-
thing wrong.” During this period, teetering on the verge of failing her courses,
she directed cruel attacks at herself, as well as outbursts of rage at me for not
helping her, and for just pushing her to complete the courses for my own
glory. What she needed from me was overt encouragement and support.
Despite her strong ambivalence, she finished the courses successfully.
Following this agonizing experience, she said, “If I were not in analysis, I
wouldn’t have completed the courses.”
Phase 2: A Crisis
For the next year and a half we went over variations of these conflicts
many times, as Anne’s free association brought out latent feelings, memo-
ries, and fantasies. My aim was to consolidate the gains and to continue
developing the unconscious communications in the analytic situation. We
recognized that her mood was quite optimistic, that her depressions were
significantly reduced, that her work situation was satisfactory, and that
she was functioning quite independently and happily. Further, Anne
stopped her impulsive and destructive acting out and was developing a
relationship with a man. But what surprised me was that, gradually, Anne
was showing a lack of interest in our analyzing her experiences and was
expressing a wish to discontinue the analysis. In trying to look at
22
my contribution to her disinterest in pursuing what I thought had been a

productive period of analysis, I realized that we had hardly touched on her
relationship with her mother. I wondered whether there were intense anxi-
eties that had led us to avoid exploring this sector of her personality. Was
it this that had prompted her disinterest in the analysis? If so, had I missed
or avoided opportunities to help her inquire into possible conflictual
aspects of her relationship with her mother? If that were so, it would have
been a serious countertransference obstacle to the analytic process. An
additional complication was that Anne had stopped bringing up dreams,
which would have helped me arrive at an hypothesis about her uncon-
scious anxieties and my contribution to them. I wondered whether her
improvement had stirred up unconscious lifelong conflicts, of the sort that
might be expressed in thoughts like “I don’t deserve a better life.” When
I raised this question, Anne replied, “This is ridiculous.” What did not
occur to me at the time, but in retrospect seemed plausible, was the need
to connect her relationship with her mother and her feeling of not deserv-
ing a better life.
Shortly afterward, Anne surprised me again by determinedly assert-
ing, “I’ll be stopping analysis in four months.” This was followed by a
prolonged silence. Quite early in the analysis we had become familiar
with the motivations that underlay her history of relying on silence as
self-protection. Anne’s stubborn refusal to explore this decision led me to
wonder whether her stance was related to having to relive in the analysis
aspects of her oppressive infantile environment. Again, Anne rejected
looking into this possible connection. All of my attempts to analyze her
silences and her abrupt decision to end the analysis failed. But I did not
stop trying. Based on her scanty associations, I wondered aloud what in
the analytic situation had brought about the change in her mood and atti-
tude and had led to her decision. Anne consistently refused to cooperate.
I made it clear that I objected to her manner of ending the analysis. I
added that we could arrive at a sound decision whether to end the analysis
in the light of understanding the motivations that had prompted her deci-
sion. Her response was that she had already made definite plans to move
out of town and that she had withheld these plans from me.
I came back to a line of intervention that connected her decision with
the underlying fear of continuing to benefit from the analysis, but again
she angrily rejected the idea. As I repeatedly encouraged her to look for
the sources of her decision, Anne burst out angrily: “I had no guts to leave
23
my father . . . I will not repeat this with you.” My attempts to draw her
attention to her affects, memories, fantasies, and defenses, a process with
which we had become familiar, were a complete failure. She would not
talk to me unless she chose to and was no longer interested in exploring
her affects and inner conflicts. Thus, an analytic approach based on coop-
erative, interpretive uncovering of deeper layers of the motivations and
meanings expressed within the transference was completely rebuffed by
Anne. There were definitely changes in the “father transference,” with a
movement from the benevolent father to a negative, tyrannical one. Was
she unconsciously trying to stir up a negative attitude in me that would
result in my withdrawing from her or assaulting her? Of course, provok-
ing the analyst by zeroing in on his perceived vulnerabilities is a common
occurrence in analyses. Reflections on my countertransference brought
me no clue about how to proceed. Despite my best efforts, what I experi-
enced was Anne’s destructive attack on me, and on herself, that paralyzed
the analytic process and would most likely lead to ending the analysis.
When I continued to search for the underlying motivations for the
stalemate, her original symptoms returned in full force: staying in bed and
missing work, not eating, feeling paralyzed by indecision, and suffering
from crying spells and depression. Anne would talk to me only about her
depression and her deterioration. The gap between us was widening. I felt
intense guilt and fear that her decline would reach a psychotic state. This
progressive deterioration lasted a month.
I then decided to reconsider, and finally to change, my analytic
approach. I sensed that Anne needed interventions that communicated my
acceptance and empathic clarifications, and that conveyed to her my feeling
of her pain while she silently relived an early traumatic environment. I
needed to overcome feelings of resignation, failure, hopelessness, rage, and
incompleteness and to stop resorting occasionally to inappropriate, cruel
responses in retaliation for feeling narcissistically injured.
I abandoned an interpretive stance and paid greater attention to
Anne’s silence, to its rhythm and beat, and I said little except making an
effort to clarify her feelings inside and outside the analysis. Her response
to the change in my approach was positive. The debilitating symptoms
began to lessen, and slowly Anne began to manifest the mental state char-
acteristic of the period before she declared her intention to leave. She
spoke very little and frequently mentioned the date for ending the analy-
sis. Again, my attempts to get her to cooperate in analyzing her decision
24
got nowhere—but this time I did not insist. Finally I agreed to her sug-
gested date, which was about four weeks away.
After I accepted her decision to end the analysis, Anne continued to
maintain the gains in her social and professional life. The prolonged
silences continued until a week before the agreed date to end the analysis;
then she surprised me again, by telling me the following dream:
I gave birth to a baby with a heart defect . . . a doctor performed a heart trans-
plant and the baby was all right.
After telling me the dream Anne initially remained silent, after which
she sobbed for about five minutes. I found myself feeling very pleasantly
surprised and in associating to her dream asked myself questions like
Who is the father? Who is the doctor? What about the heart defect . . . the
baby . . . the transplant? This seemed to me to be a dream with multiple
layers of meaning.
Anne calmed down, interrupted my reverie, and began associating to
the dream: “The dream is about me . . . I have an emotional defect . . . I
break close emotional contact.” I said: “Your decision to stop the analysis
was an example of breaking off a close emotional contact.” Anne
responded, “If I stop the analysis now I’ll be doomed to a life of suffering
from intense loneliness . . . I would like to continue.” I did not go back to
the dream but shared her hope that through the analysis we would better
understand the sources of her feelings of having an emotional defect and
how it had come about. I agreed to continue the analysis.
Anne’s dream, occurring as it did during the crisis phase of this analy-
sis, stimulated in me a number of questions based on an understanding of
dreams from various points of view. I felt that Anne needed to connect
with me as she was trying to make connections between her inner reality
and her relations in the external world. What kind of doctor had I been to
her? Was I the right kind? Was the heart defect a displacement from below?
The classical interpretation of feeling castrated as a female came to mind.
But would this interpretation shift our understanding of the source of her
emotional conflicts to a biological basis, and might that not stir up feelings
of hopelessness leading to a defensive strengthening of her schizoid ten-
dencies? I knew I had to reflect privately on all of these questions.
On the following day, Anne started the session with a long silence.
When finally she began talking, she told me for the first time that before
25
her decision to end the analysis, she was having frightening feelings of
hatred toward members of her family, particularly her mother. “I feel like
killing her,” she said. This shocked her because these feelings “came from
nowhere.” We remained silent for a while, and then Anne said that the
night before she had had the following dream:
It was summertime and I was sitting on a riverbank with a man. My feet were
dangling in the water. I was very happy. I was wearing a pajama top. Suddenly,
I felt I had to run away . . . I ran to a dark town and saw five people wearing
black clothes. They were chained to each other. [After a moment’s pause:] There
was an old woman taking to her house a beautiful, bright girl, four years old.
When she and the girl arrived at the house, the woman could not find the key.
After relating the dream, Anne was very sad and while sobbing said,
“What’s wrong with me . . . why can’t I enjoy close relations with a
man?” The first part of the dream took place in a setting she consciously
enjoyed, as she was an avid swimmer. The man reminded her of the man
she was currently dating, whom she described as “single, intelligent,
exciting, and loving.” She asked, “Why do I still keep running away from
men?” She directed this question to me and expressed her deep dissatis-
faction with the progress of the analysis.
“You also ran away from the analysis,” I said; “can you recall . . .”
Anne interrupted me and said: “In the dream, I left the man and found
myself with a group of people, five, five members of my family.”
“You were protecting yourself from what?” I asked.
“I was running home . . . to protect myself. I was afraid to have close
and sexual relations with the man . . . at home I felt enclosed, boxed, and
smothered . . . the five people were chained to each other . . . they were
wearing black clothes in dark surroundings, my home where I felt
depressed.”
And then she went silent.
“It’s very difficult to break away from this home,” I said.
Anne asked: “How do I free myself?”
We remained silent for a long while. Finally I said: “Continue to say
what comes to mind, and you’ll find an answer.” In this context I asked
myself, “Why did she run away from me? Are you up to the task?”
In the next part of the analysis Anne repeatedly came back to these
dreams and made many direct and indirect references to them. She said
26
that the themes and conflicts they brought to light captured what she called
“the story of my life.” The elements of the second dream (“running away
from the man and to her home”) reminded her that during the past several
years she had tried to establish a sense of autonomy for herself. She was
forming satisfactory social contacts, was engaged to be married, and had
received deserved praise for her professional work. In this context, she
suddenly would be overwhelmed by intense feelings that she’s “done
something wrong.” These feelings would be accompanied by terrifying
nightmares and fantasies of being sadistically attacked and mutilated by
men, abandoned by women, and left to starve on a desert island. She would
try as hard as she could to maintain her independence, but would fail, and
in desperation she would run home to live with her parents.
Her attitude toward these two dreams fluctuated. What made her
curious was the manifest sequence in the second dream: her running from
the man to the five people who were chained to each other, and then an
old woman and a beautiful girl were together, but the key to the house was
lost. These scenes sometimes became nodal points of our joint inquiry,
but then Anne’s curiosity would wane and she would lose her enthusiasm
for understanding the dream. Anne would oscillate between collaborative
exploration of her dreams and wishing I would share the pain attending
her everyday frustrations. In this latter state, transference interpretations
were received as critical attacks and humiliations.
The old woman and the beautiful girl reminded Anne of glimpses of
closeness and loving relations with her mother that were abruptly inter-
rupted. I asked, “Was this before your younger brother was born?” Anne
had been told that when she was three years old her mother, during a dif-
ficult pregnancy with her younger brother, had become sick and had with-
drawn to bed for a prolonged period. I reminded Anne of the “lost key” in
the dream, and she said, “Like the feeling of loss and failure in my rela-
tions with men.”
It seemed to me that in her sexual acting out with men Anne was
desperately searching for the very early idealized relationship with her
mother that had abruptly been ended during her mother’s illness and the
subsequent birth of the younger brother. When I conveyed this to Anne,
she went on to recall additional memories about her family. Her father
was preoccupied with his unstable business, was emotionally unavail-
able, and when physically present was extremely irritable and demanded
27
to be served. Anne had vivid childhood memories of observing her father

beating up her rebellious older brother and verbally abusing her mother.
Her mother’s typical response to this was to say, “I’m sorry . . . it was all
my fault.” These recollections moved Anne to tears. She was sobbing and
crying as she said, “Have I copied my mother?” She had become a model
child, quiet, pleasing, and subservient, as she imagined her parents wished
her to be, the extreme opposite of her older brother. However, Anne
recalled that from time to time she would be upset and burst out crying.
Her mother’s response to Anne’s distress was to remind her of how pleas-
ant and quiet she had been as a young child, referring, Anne thought, to
the time before her younger brother was born. These memories, though
mentioned before, were now both detailed and vivid, and more intensely
experienced.
In her first attempt to associate to the “five people . . . chained to each
other,” she met a “blank wall,” a common experience she had had at the
beginning of the analysis. Now Anne sensed that she needed to come
back and try again. It meant a great deal to her to be able to meaningfully
relate the five chained people in her dream to the five members of her
family. “They were not moving,” I pointed out, to which Anne responded:
“They were five frozen people, tied together.” She saw herself in the
middle of the chain, holding the family in balance and having an
especially significant position in the family. To separate from them would
be tantamount to attacking and destroying the family unit. She was caught
in this powerful fantasy, which blocked her from developing a separate
life independent of her family.
Anne associated to aspects of her relationship with her “frozen”
mother. In her teens Anne imitated her close girlfriends, envied their
superior qualities, and tried desperately to be like them—but often she
would be suddenly dropped by them. Anne recalled in great detail that
when she spoke of her sadness and disappointments to her mother, she
would be told, as mentioned earlier, to go shopping and buy a dress.
During her adolescence, while in the midst of mild necking, Anne
would be gripped by a paralyzing fantasy—“I am going to be caught
out”—and would run home. What was extremely upsetting to her was the
recollection that during her latency years her older brother had forcefully
lain on top of her. When Anne told her mother about this, the latter’s
response was: “He is upset. Ignore him.”
28
Gradually, our working together on the many levels of the two dreams
excited Anne. Through an understanding of the dreams, and of the trans-
ference, we reconstructed some specifics of her psychic reality that orga-
nized her internal object relations. It was a major analytic task to work
through her entanglements with all the members of her family, not just her
relations with her mother. The relations with each family member were
associated to the analytic situation and were relived in the transference,
which meant both trying times and slow progress. These impediments to
the analytic work connected with the traumatic family relations, her per-
sistent search for an early idealized relationship, and the rage she felt
when she met with repeated disappointments would tempt me to resort to
“deep interpretations.” But I learned from Anne’s responses that these
were ineffectual. Her responses signified her wish either to comply, sub-
mit, and surrender, or to rebel, defy, and cut me off. In trying to work
through my countertransference, I needed to be more sensitive to how her
responses to my interventions were being processed through her trauma-
affected psychic structure. At times I was identified with and lived out
different aspects of that structure. I was searching for a balance between
staying sufficiently close to, and sufficiently distant from, Anne’s intra-
psychic life. She was developing an active interest in understanding her
dreams as expressions of her intrapsychic life, and yet the process contin-
ued to frighten her. The result was that she would dissociate herself from
elements of her dreams related to traumatic familial experiences.
After the analysis of the “family” dream, Anne returned to the first
dream—the baby with the heart defect and the doctor who performed a
successful heart transplant. In her associations to the “doctor” I was seen
to have been good at making the diagnosis, but I had failed to cure the
illness. On many occasions this evoked a furious rage at me: she experi-
enced me as having taken her apart and having left the pieces fragmented
and dispersed. Her aggression toward me, whom she also felt to be caring
for her, frightened her, as it threatened to result in my abandoning her.
In this process Anne was gradually establishing links between what-
ever was happening in the immediacy of the analysis and its genetic ante-
cedents in her infancy and later life. However, interpretations aimed at
severing her internal connections to her family members were experi-
enced as forcing her to surrender these object ties and threatened her with
the agony of abandonment and powerlessness. She had internalized an
intense need to protect her family from disintegration.
29
In the fourth year of the analysis, paralyzing depressive hopelessness

was no longer part of the clinical picture. And in her personal life Anne
concentrated on developing satisfactory relationships with both men and
women, applied herself energetically to doing her job well, and continued
to struggle to change her relationship with her mother and her older brother.
In my afterthoughts I recalled that in the manifest content of her sec-
ond dream Anne had mentioned the “key” but did not associate to it. It
had remained a concrete image or element in the dream. In my reverie,
the image of the key symbolized that there was a “door” to be opened—
that Anne was ready for, and moving toward, a further exploration of her
intrapsychic life, with a lessening of her dread of exploration. The task
ahead of us was to find the key.
Phase 3: Working Through
Anne had fallen in love with Gary, was able to see both his assets and his
weaknesses, was able to experience mutual caring, and was quite optimis-
tic about their future together. In contrast to her earlier feeling of being
frozen and miserable during and after sexual relations, her sexual experi-
ences with Gary were enjoyable. She and Gary made plans to get married
and move out of town, and it was in this context that she briefly refer-
enced the topic of termination.
At the same time, Anne experienced tormenting doubts about her
decision to marry, and this evoked intense negative feelings about me.
She feared that I, like her parents, might interfere with her plans and
destroy her love relations with a man. As the sources of her anxieties were
understood, a definite change was seen in her attitude toward the analysis,
and she became more relaxed and spontaneous in her associations. Anne’s
work situation was now more gratifying, and she became more assertive
in her social relations. In this context she had the following dream and
presented it in a self-assertive way:
You were driving a big tractor, and harvesting bananas. I was sitting beside you.
The bananas were ripe. . . . Suddenly, I was in a rowboat by myself, and there
was a hole in the boat. I was sinking. But before I sank I was able to float and
enjoy the swimming.
We remained silent for a while. Then Anne said she had been tempted to
have a one-night-stand with a fellow worker. “It would be a completely
30
new experience,” she said. “He did not know my history . . . am I ready
for a long-term partner? I’m happy with Gary. How can I do this to him?
I see him every day.”
Then I said: “Him?”
And Anne replied: “You mean you? Are you ever tempted?”
We remained silent for ten minutes until the end of the session.
During the silence I wondered about a number of things. Why were there
two parts to the dream? And I thought of the “hole” and of the sexual
aspects in the dream. I wondered whether Anne unconsciously saw me as
using her for my own sexual gratification and then discarding her—this
being parallel to her sexual use of men whom she then discarded.
The next day Anne started the session saying that the dream had
aroused in her strong mixed feelings about me, feelings that frightened
her. First, she had depicted me in the dream as strong and supportive of
her growth and independence, just as she had experienced me in the anal-
ysis. Yet the “hole” in the dream reminded her of vulnerabilities the anal-
ysis had not repaired, and this evoked in her angry and bitter feelings
toward me for having failed her. Further, the “hole” reminded her also of
the “heart defect” dream she had dreamt after the period of crisis when
she wished to leave the analysis. She asked me whether I remembered
this dream. I said I did, and she continued to feel despair as to whether her
“defects” would ever be cured. I reminded her that her father had ridi-
culed her, and had expressed sarcasm and belittlement when she spoke
about her ideas, opinions, and wishes. And she remembered his having
rejected her as a person and her having passively submitted to him.
She then recalled that in the dream she was sitting close to me and
feeling sexually excited. There was a pause in her associations, and at this
point I said that the closeness had been interrupted. She agreed, adding
that “suddenly” she “was in a rowboat that had a ‘hole’ in it.” Anne then
asked me: “Do you feel sexually excited?” She then remained silent. I
wondered to myself if she was frightened, and after a period of quiet I
said, “If we act out our sexual feelings, we destroy the analysis.” A change
of mood followed, and Anne expressed concern whether she was ready to
terminate the analysis. She recalled her experience in the dream when she
had been “able to float and enjoy the swimming” while at the same time
struggling against sinking.
At the time we analyzed this dream Anne continued to struggle with
the temptation to have a one-night-stand—a repetition of the very
31
behavior that had brought her to analysis in the first place. We did not
analyze this dream any further, and I was left with a number of questions.
How were we to understand the dream image of the “hole” in the context
of the transference and in the context of her social relationships? What
did the “bananas” represent? Did being close to me arouse incestuous
feelings she was struggling against? Was she demanding of me that I
show appreciation of her and that I regard her as a worthwhile person who
could enjoy love on many levels—that I be unlike her father? And what
were my own “holes” and “defects”? My impression was that Anne was
showing an increase in trust that was not based on a passionate sexualized
transference. In my countertransference I recalled the musical My Fair
Lady and Henry Higgins’s line “I’ve grown accustomed to her face.”
At the beginning of the sixth year of the analysis, Anne expressed a
vitality I had not previously experienced. She spoke of herself as follows:
“I feel I have a sense of purpose. I’m firm, lively, and competent. I think
for myself. I’m different from those who live for others and never develop
themselves. I’m beginning to say no.” She was planning to get married
and move out of town. We tentatively agreed on a date of termination
eight months later.
For the next few weeks we continued to work through the various
feelings, wishes, and fantasies related to the termination in a relatively
calm manner—until Anne started a session with a dream that had been
very upsetting to her:
My mother was dying of cancer . . . cancer of the hands, and she could not hold
anything.
I sensed her intense sadness and agitation and wondered to myself whether
Anne would withdraw into silence. I wanted her to continue to associate
to the dream, and I asked her how she was feeling at the moment. “I can’t
deny any more how angry I feel toward my mother . . . at times I feel like
killing her.” Her associations led us to the circumstances that had trig-
gered the dream. A couple of nights before, her mother had been talking
to Anne about her older brother. “Poor Bill,” she said, “he’s drinking
again, and overeating again, and he’s absorbed in mysticism.” Her mother
conveyed to her, in a desperate voice, the closeness Anne had witnessed
between her mother and her older brother from her early childhood and
that had been so disturbing to her. This had evoked in Anne early
32
memories of feeling emotionally deprived and of being envious of the

union between her mother and her brother.
Anne also recalled comforting, loving, holding experiences with her
mother, but these were short-lived because of her mother’s preoccupation
with Anne’s destructive older brother. Anne made frequent self-deprecating
comments about herself as being “just feminine” in relation to her older
brother, whom she idealized, envied, and regarded as “intellectual.” Anne’s
feeling in response to having been “dropped” by her mother was one of
intense rage, and this led to her aggressive wishes to break the bond
between her mother and her brother. Further, through her associations,
Anne realized that her aggression was directed also against her own hands,
for masturbating and providing her guilt-ridden sexual pleasure. Anne also
associated to the ending of the analysis as her being “dropped” by me. This
evoked in her a rage at me and a wish that I would be inflicted with cancer
and die—just as she was afraid she would die at the end of the analysis.
It seemed that working with the dream had facilitated Anne’s assimi-
lation of her aggression as an experience she owned. Recognition of her
murderous rage toward her mother advanced her differentiation from the
suffocating hands of her mother and furthered the working through of the
defensive dissociation of the “sweet self” from the “aggressive self.” It
seemed to me that our collaborative analysis of the dream—explicitly of
the transference and implicitly of the countertransference—enabled
Anne’s assimilation of her aggression as an essential aspect of her intra-
psychic functioning, and helped her face the murderous rage she had felt
originally toward her mother, had then turned upon herself, and now, in
the immediacy of the transference, had turned upon me. This was taking
place in the context of her experiencing the ending of the analysis as
being “dropped to perish.” Her developing capacity to associate to, and
elaborate upon, her manifest dream content, as well as her capacity to
weave together her understanding of her present and past relationships,
including the transference relationship, facilitated her efforts to lessen her
bonds to the sadistic internal objects that had played such a crucial role in
her character formation and in all her later relationships.
During this phase of the analysis there was no need for active reassur-
ance on my part and, as we observed together, there were improvements
in her social, professional, and sexual relationships.
In conjunction with the emotional pain of working through the end of
the analysis, Anne struggled with her decision whether to end her
33
relationship with Gary, the man she had agreed to marry. She was
extremely disturbed by his preoccupation with the wife he had separated
from, with his keeping tabs on his wife’s whereabouts, and with his jeal-
ousy of her boyfriends. In a state of intense upheaval about these matters,
Anne recognized that her present experiences with Gary reminded her of
what she had intensely hated in her relationships with both her father and
her older brother. In our exploration of these struggles, Anne came to
recognize her pattern of feeling she was being treated as a “second wife,”
of feeling abused by these three men and their authoritarian attitudes
toward her and yet submitting to them and coming back for more. This
crucial decision about her relationship with Gary was very difficult for
Anne, as she was getting on in years and viewed this relationship as her
last opportunity to get married. If she did not marry Gary, she felt, she
would remain single, childless, and lonely the rest of her life.
During the Christmas vacation, while being away from me and deter-
mined not to see Gary at all, Anne spent most of the time reflecting on her
situation. One of her significant realizations was that she could be alone
without either of us and not fall apart. When we resumed the analysis she
told me, in a sad tone, that she had decided to break off her relationship
with Gary in order not to repeat her past relations with her father and her
older brother.
In the past Anne had been impaired in relationships with people
toward whom she harbored both positive and negative feelings. In such
circumstances she had experienced confusion and despair and been para-
lyzed by indecision—and she had left such relationships with her ambiva-
lence unresolved.
I noticed that Anne was trying to interrelate the various contradictory
feelings she felt toward Gary. In this process she was demonstrating a
capacity to address ambivalent feelings—a capacity she had been devel-
oping in the process of analyzing her dreams. She kept in mind her loving
relationship with Gary but also recognized the self-destructive potential
of choosing this man as her husband, as it would be lead to a repetition of
the miseries she had experienced in her relationships with her father, her
older brother, and other men. Anne mourned the loss of this opportunity
to be married, and she emphasized that she deserved a better life. I noticed
that during this period of decision making Anne did not present any
dreams. I wondered to what extent the unresolved transference was a
prominent factor in her decision making.
34
Following the breakup with Gary there was a gradual return of her
old depressive, withdrawn state in which there was little overt emotional
communication between us. However, I knew Anne well by this time and
could sense her unspoken anguish; this facilitated my efforts to make
emotional contact with her. I was trying to put into words for myself what
she could not say to me about herself. We observed a weakening of the
determination and resolution that had sustained her during the decision
making with respect to Gary, as she now faced additional stresses. Anne
missed Gary as a person and as a satisfying sexual partner. Her sexual
tension was mounting, and a brief sexual affair only increased her misery.
Jealousy of married couples tortured her. In addition, she was experienc-
ing stresses connected with her work, as her boss was leaving town. While
initially having experienced him as authoritarian, humiliating, distant,
and formal (her “bad father”), she found that as she got to know him bet-
ter he responded positively to her, encouraged her development, and
asked for her opinions and criticisms. Anne experienced the separation
from him as a significant loss and expressed genuine sorrow. She decided
to leave her job, where she had earned a very good reputation, and apply
for a job that offered her better opportunities to use her talents. That she
was going to face stiff competition aroused an intense dread of failure.
She recognized the gap between the ideal she had set for herself and her
present reality. “Men run away from me,” she cried. In this she was
expressing her old feeling of being psychologically deformed, a feeling
that something about her was so wrong it could never be cured.
The stress of these unresolved issues resulted in Anne’s regressing to
old symptoms. “I am back to square one,” she said, depreciating the anal-
ysis and showing clear signs of hopeless resignation. She became quite
depressed and retreated to her bed. There was an escalating transference
resistance as she rejected, especially, any interpretation relating her
depression to the impending termination. Her feelings of disappointment
in me and her envy of married couples were very intense. She refused to
free associate and returned to prolonged silences. She experienced my
encouragement to free associate as an authoritarian demand made to meet
my needs and she refused to submit. Further, she struggled against enact-
ing wishes to harm me physically. It looked as though we had lost the
analytic alliance.
While these developments were discouraging for me and aroused dis-
turbing doubts as to the appropriateness of the date we had set for
35
termination, I recalled similar regressions in her analysis that had ended

with beneficial effects once I was able to find a balance between empathic
clarifications and understandings and addressing her destructive tenden-
cies toward both of us. When I was tired and discouraged I attempted to
“resolve” the impasse through interpretations that highlighted her repeat-
ing with me past patterns of relating to her parents. This added another
source of disruption for Anne, and for me as well, as she experienced my
interpretations as being out of tune with her emotional state.
I noticed that I found myself feeling affectionate and compassionate
toward Anne in her state of distress. A sequence was emerging in the
progress of the sessions. While at the beginning of a session Anne would
report her complaints in a mood of despair, somewhere in the middle of
the session her mood would change, indicating restored confidence in her
capacity to cope with her stresses. I brought this rhythm to her attention.
Eventually Anne related a series of dreams and was willing to analyze
them. Understanding her dreams became an important avenue for restor-
ing her feeling of safety in the analysis. There were a number of dreams
that contributed to the working through of some of the unconscious deter-
minants behind the return of her symptoms. Here is one of her dreams:
My mother was holding me down . . . and did not permit me to move. She was
blocking my esophagus . . . preventing me from breathing. I was going to die
. . . she was laughing . . . I was trying to break loose.
Upset and crying, Anne asked, “Why did my mother torture me”?
The dream element of the “choking mother” was a sadistic image of her
mother that stood in sharp contrast to the then current image of her mother
as someone she regarded as “reassuring and loving,” who “likes to take
care of me.” Anne wondered why she had had this dream at this point in
her analysis, and we attempted, though unsuccessfully, to link its occur-
rence to the stresses mentioned above. This dream reminded Anne of her
choking sensations during asthmatic attacks—attacks that had stopped in
the middle phase of the analysis when we analyzed her suppressed rage at
her mother. She had memories from childhood of sitting rigidly beside
her mother in church and of suppressing the urge to scream and to run out.
Now this dream was beginning to make sense as it revived her internal
situation of choking back her anger as an aspect of her relationship with
her mother. Two representations of her mother were emerging—the pres-
ent one as attentive and caring, the past one as suppressing Anne’s anger.
36
Anne was able to contain and compare these two representations. Her
demonstrated capacity to experience her anger and her ambivalence was
an important step in her psychological development. She became aware
that “choking back” her anger had become an unconscious internal
dynamic that contributed to her struggles with ambivalence and was read-
ily activated in her personal relationships and in the transference. The
accumulated current stresses, particularly the impending termination, had
left her feeling alone and abandoned and had aroused feelings of having
to “choke back” her anger.
How was I to assess this dream of the sadistic mother? It was a dra-
matic metaphorical demonstration of a life-and-death struggle to break
free of an intense anxiety related both to the choking back of her intense
aggression toward her mother and to her wish to disrupt the envied bond
between her mother and her brother. Was this a sign of failure or of her
capacity to bring out components of the trauma that needed further
analysis?
At best we were able to address only some aspects of this multilay-
ered dream, but Anne’s symptoms were alleviated and she became more
involved in the analytic process.
P h a s e 4 : T e r m i n at i o n
While still applying for the new job, Anne said, “I’m a failure . . . defeated
. . . paralyzed.” She then spoke of her family life in her preadolescent
years. It was during this time in her development that she saw the origins
of her characteristic feelings of holding back, refusing to give, feeling
forced to give, and feeling empty and impoverished when giving. What
came to her mind was her pervasive feeling that throughout her life no
one had been aware of her needs. Now she was beginning to appreciate
that in consequence of this she had difficulty herself being aware of her
needs. She spoke of the emotional atmosphere in the family home around
the time she was ten and her father returned home from work. Her mother,
by word and gesture, would indicate to the three children that their father
needed peace and quiet and that he was not to be “burdened” with their
troubles. Anne would remain pleasant and quiet. Soon a crisis would
develop. Though the mother tried to shield her husband from the emo-
tional stress she experienced with the older brother, she somehow con-
veyed to the father something of their son’s destructive behavior. This
37
would result in an outburst of rage from the father and in his beating up
the boy, which would be followed by a blowup between the parents. The
mother would apologize, and Anne’s parents would leave the room.
“I never knew how they made up,” she said; “I was shut out . . . alone
again.” She then associated to being at school where she would “sit down
and do nothing.”
Throughout this reconstruction we had opportunities to understand
Anne’s parallel experiences in the analysis. This revived her rage toward
me for asking her to produce, to work for me, all without her experiencing
my love. She had a picture of herself after the end of the analysis as sitting
by herself, immobilized—again left unloved. Recognizing that she
wanted to get something concrete from me before leaving analysis, she
exclaimed, “What can you give me—a baby?” She chuckled.
While Anne was searching for a man to whom she could express her
love and with whom she could enjoy sexual relations, George, an old
boyfriend, came to town for two weeks. Although she knew he was not
available for more than this two-week period, she defiantly said, “I don’t
care.” She rejected her insights about her previous relationship with
George and pursued an intimate relationship with him, thinking of him as
her “ideal man.” During this period Anne had the following dream:
Gary was trying to make love to me . . . I was like a frozen object. I felt sorry
for him, but I could not respond. There was a chest of drawers and water was
coming out of it.
Anne related the dream with confidence and self-assertion. Her asso-
ciations were as follows: “I tend to divide men into two . . . George I love,
and Gary, I hate . . . like my father and older brother . . . I’m confused . . .
both are parts of me.”
Anne was blocked when she tried to associate to the other part of the
dream, the “chest of drawers.” This seemed completely disconnected
from the first part of the dream. It later reminded her of “a dark, brown
secretive, enclosed and safe place,” and she linked this to her genitalia.
This was followed by her remembering her bed-wetting until the age of
eight and in the past having had to restrain herself from urinating during
sexual intercourse. George surprisingly surfaced in her associations. She
recalled our lengthy analysis a couple of years before when she had been
strongly tempted to resume a self-destructive relationship with George
but had finally borne the tension and restrained herself. The dream image
38
of Gary reminded her of me. Angrily, she said she felt cold toward me:
“You are just sitting on the fence, doing nothing.”
At the same time, another transference dynamic was emerging in
which Anne struggled with concerns about expressing her artistic talents,
both in her dreams and in reality. Her taking initiatives at work that
brought praise aroused both guilt and inhibition within her.
Anne’s achievements prompted the return of old symptoms of minor
self-injury. This gave us another opportunity to analyze her tendency to
spoil and sabotage her successes, as well her underlying wish to extend
the analysis. “I’m worried,” she said, “that I won’t be able to put the
pieces together by myself . . . I’ll get stuck on my dead-end street . . . here
you put in something . . . I learned a lot here . . . first to take a chance . . .
it was my last resort and I didn’t anticipate that it would be as hard and as
painful . . . nothing comes without hard work and a few tears.”
Though Anne was struggling with the depressive and paralyzing
effects of the return of these symptoms, she still had enough energy and
motivation to consistently meet the demands of her new position and to
cultivate pleasant and close relationships with two girlfriends. On the one
hand, we had evidence of realistic achievements related to intrapsychic
changes indicating greater inner cohesion and a firmer identity, while on
the other were disappointments over unfulfilled life goals. I wondered if
the analysis had helped her develop sufficient capacity to bear disappoint-
ments and to mourn. And had she developed an internal capacity to resist
her self-destructive sexual impulses?
In the final six weeks of the analysis Anne became very involved in
her brother’s life and in asking her mother about him. Anne initiated fre-
quent meetings with him and was curious about his feelings and relation-
ships. She admired his intellectual achievement and felt vastly inferior to
him. He had been her “ideal man,” despite her awareness of the deep
psychological disturbances that had necessitated his repeated psychiatric
hospitalizations. Anne had gradually revealed fragments of her adoles-
cent experience of sexual molestation by her brother, and at times she
insisted that these traumatic experiences were sufficient explanation for
her destructive sexual relations with men. I suggested to Anne that she
consider whether her drawing closer to her brother had anything to do
with her disappointment that the analysis had not resulted in her securing
an emotionally satisfactory relationship with a man. She was quietly
indifferent to this line of inquiry.
39
These developments at the end of the analysis stirred in me varying

degrees of despair and confusion that required an intensive working
through in the countertransference of a number of questions and uncer-
tainties. Had the analysis failed to lessen Anne’s attraction to a person, her
older brother, from whom she had suffered emotional injuries? Was she
bound to compulsively repeat this relationship with other men, out of an
intense need to repeat an old, infantile pattern the analysis had barely
touched? Was her reviving the relationship with this brother a subtle
attack on the analysis and on me?
Gradually it became clearer that in her discussions and confronta-
tions with her brother Anne was trying to separate fantasy from reality—a
significant dimension of the process of working through. For instance,
she asked him, “Do you think about me when I’m away from you?” His
silence enraged her. I encouraged her to look at the transference implica-
tions of this question. We both remained silent for a long while. The next
day, after a long silence, Anne told me a dream she had had the night
before:
I was in a taxi with George. My mother was ahead . . . she passed us and waved
. . . then she got into a traffic jam, Mother left her car and got into ours and we
drove together . . . everything was fine . . . we paid and got out . . . then mother
disappeared and we continued, we were going to get married . . . we came to a
church and mother was there, but then after a while she wasn’t there . . . George
told me “don’t wait for her” and he pulled me away. . . . Then we were in a
hospital (the office reminded me of yours) . . . we were waiting for the doctor,
but I didn’t feel sick . . . so I left by myself and George stayed there.
After a long silence I asked Anne where she would like to begin.
What intrigued her most was “the traffic jam,” “being stuck . . . my mother
and me.” Anne asked me,” Do you remember George?” I answered yes.
From then on, Anne carried on by herself, not needing my encourage-
ment. She recalled her tumultuous relationship with George, of repeat-
edly feeling betrayed and abused by his infidelities. She had been “stuck”
to George until finally she became severely depressed—which was what
prompted her to seek psychoanalysis. “George reminds me of my older
brother,” she said. Both, she felt, treated her in a similar manner and she
was “stuck” to them. In the dream she was going to be married to George,
and in her infantile fantasy life she would be married to her brother.
40
Further, Anne felt that she had been stuck because she was looking for
men like him.
The next day Anne summarized the insights she had gained from our
analysis of the dream in the previous session. She wished to continue the
work so she could understand parts of the dream we had not gotten to. I
asked about her associations to my “office,” and she recalled that she and
George had ended up in my office, which in the dream was located in a
hospital, and that she had left George there. Her parting from him was
understood to represent her wish to separate from her older brother and to
differentiate herself from him. We remained silent for a while until Anne
related her own fear of breakdown and needing to be hospitalized. The
George figure in the dream was seen to represent both her older brother
and herself, but the transference implications of the dream were not
addressed.
The mother’s role in the dream stimulated a chain of memories about
Anne’s position in her family. These memories had been gone over before,
but now they were being analyzed further. Anne’s brother’s behavior and
disturbed mental state had preoccupied her parents. She recalled envi-
ously observing her father interrogating her brother, becoming angry with
him and beating him. She also enviously observed the physical and emo-
tional closeness between this brother and her mother. Now she was able
to put into words her wishes to change places with her brother in his
relationships with their parents. Recall that when Anne complained to her
mother about her brother lying on top of her and rubbing his penis against
her body, the mother’s response was “He is upset. Ignore him.” Sobbing,
Anne continued: “She sent him to me . . . to ease her pressure . . . she is a
partner in the abuse . . . when he was on top of me it was as if her body
was touching mine.” Anne also recognized her own wishes to seduce her
brother, both then and now.
During this period Anne linked me emotionally with George and with
her brother. She spoke of how I too had disappointed her: “You are leav-
ing me up in the air . . . you never expressed value judgments . . . you
never said ‘That’s good, Anne’ . . . therefore I still don’t know you as a
person.” She stopped and seemed to be concerned about how I would
experience her critical comments and how I would react. We remained
silent for a while and then I said: “You are not sure how I feel about
you . . . whether I reciprocate your feelings of love.” Anne continued: “I
have cried here more than I have ever cried before in my life. . . . What I
41
have learned here was not an intellectual learning . . . it is a learning

where I rely on my memories.”
A few sessions later, Anne brought up the following dream:
It was in this office. On the side of the desk there was an art display . . . I had
something to give you, two crowns . . . Then I was lying down and you made
love to me . . . I let you enter me . . . I expected it . . . I derived no pleasure or
pain . . . I had no guilt, no emotion. . . . Then you said good-bye and I went away
. . . I didn’t know where I was. . . . On the sidewalk, I saw three beautiful girls
. . . I could not figure out where I was. . . . Then I realized that I had no glasses.
I left them here. So I came back . . . I had to climb up many stairs to come to
your office . . . I saw people standing in line and I told your secretary that I came
back because I left my glasses. . . . She told me to go to the desk, where I saw a
sign: Lost and Found. I found my glasses. When I woke up, I felt very uncom-
fortable. . . . How could I tell you this dream . . . I enjoyed it.
We remained silent for a long while. I sensed her wish that I would
imagine her fury and despair related to her traumatic sexual experience
with her brother and how it had damaged her mind. But Anne interrupted
my musing, saying with great excitement and rage, “That’s what I get
from men . . . you use me and then throw me out . . . like my older
brother.” After a pause she expressed surprise at her outburst and felt that
what had emerged in the dream were her internal sexual wishes and her
dependency on me. She was proud of herself that she was capable of hav-
ing dreamt the dream and having presented an “actual sexual” scene for
us to reflect on. I said, “You were not afraid that I would intrude . . . that
we are not going to act on our mutual sexual feelings.”
I mentioned the Lost and Found sign, but Anne felt it would be more
meaningful for her to combine it with her leaving her glasses in my office.
This reminded her of her body image as a tall, skinny, flat-chested woman
wearing glasses. As long as she could remember, she had wished to get rid
of her glasses, as they represented for her a sense of herself as an “ugly
duckling.” She said she had retrieved the glasses because she had devel-
oped self-confidence as a woman and that wearing glasses no longer mat-
tered to her. As for the secretary in the dream, she stood for my wife,
whom Anne accepted as the woman she could not displace. Anne went on
to emphasize that she had learned that her dreams, and whatever she had
to say about them, would help her resolve her problems. In this regard,
she said, “You made me feel that it was worth listening to everything that
came to my mind.”
42
In subsequent sessions Anne returned to this dream, feeling anxious

that it represented to her how she would feel at the end of the analysis.
She fantasized being dismissed by me with a formal good-bye, feeling
abandoned, belonging nowhere, and being left out in the cold. I drew her
attention to what had happened in the dream before she was dismissed by
me. She recognized that she had initiated our lovemaking as the fulfill-
ment of her fantasy of “loving intercourse.” The emotions of pleasure,
guilt, and sorrow that were evoked in the transference led Anne back to
recounting the pain associated with her sexual excitement with her
brother. This ended with her sobbing, “I’ve lost him . . . a weight has been
removed.”
In her further associations we surprisingly came across a new moti-
vation for her confrontations with her brother. She was urging him to go
into analysis, emphasizing the benefits she had derived from it. She won-
dered if she was responsible for his mental illness, as she recalled his
saying to her, “Mommy gave you everything and nothing was left for
me.” Anne recognized that her feelings of guilt and responsibility with
respect to his mental illness had led to her efforts to heal his wounds
through her sexual submission to him. Further, she recognized that this
pattern of submission had been a repeated aspect of her sexual relation-
ships with men throughout her life. The transference implications of this
aspect of her dream were not analyzed. Nevertheless, there was clear evi-
dence that Anne was owning, in a more comprehensive way, the affects
and insights emerging from the analysis of her dreams. In analyzing them,
we could observe the development of new and imaginative forms of per-
ception, feeling, and thinking as these related to her traumatic
experiences.
Quiet reflection prevailed in the last few sessions. Three sessions
before the ending of the analysis, Anne told me the following dream:
I’m in a zoo . . . there were farm animals in cages. In each cage there were two
animals, one dead and one alive beside it . . . I remember that I saw rabbits and
chickens.
After telling the dream Anne cried out, “Does separation from you mean
death?” This emotional distress did not, as it would have in the past, lead
to a paralysis of Anne’s process of self-inquiry. The dream stimulated an
independent revisiting, in her associations, of many affectively intense
family experiences from different stages of her development that had
43
been relived and addressed during the course of the six years of the analy-
sis. The process of analysis had freed her, she felt, from the bonds to her
family—bonds that had been represented in the earlier dream imagery of
the “five people . . . chained to each other.”
Analysis had not helped Anne achieve her life goals of marriage and
having children, but it had helped her in overcoming her chronic pessi-
mism, in developing the capacity to bear depression, as well as not being
overwhelmed by the fear of psychic deterioration—a fear that was linked
to her identification with her older brother. Her self-esteem had grown as
she experienced realistic achievements at work and developed gratifying
relations with her girlfriends. Anne’s personal identity had been consoli-
dating, and it seemed to me she was able to accept both the limitations of
the analysis and her own personal limitations. It also seemed to me that
her ambivalence toward me, though reduced, had not been resolved.
At the end of the analysis there was a question whether Anne’s symp-
toms might return post-termination. Uncertainty was in the air.
References
Bion, W.R. (1962). Learning from Experience. London: Heinemann.

Bromberg, P.M. (2011). Awakening the Dreamer: Clinical Journeys. New
York: Routledge.
Erikson, E.H. (1954). The dream specimen of psychoanalysis. Journal of the
American Psychoanalytic Association 47:5–56.
Ferenczi, S. (1931). On the revision of The Interpretation of Dreams: Notes
and fragments. In Final Contributions to the Problems and Methods of
Psycho-Analysis, ed. M. Balint, transl. E. Mosbacher et al. London:
Hogarth Press, pp. 238–242.
Freud, S. (1900). The interpretation of dreams. Standard Edition 4/5.
Freud, S. (1920). Beyond the pleasure principle. Standard Edition 18:7–64.
Segal, H. (1991). The royal road. In Dream, Phantasy and Art. London:
Tavistock/Routledge, pp. 3–15.
Winnicott, D.W. (1971). Dreaming, fantasying, and living: A case history
describing a primary dissociation. In Playing and Reality. New York:
Basic Books, pp. 26–37.
44
Joshua Levy
35 Castlefrank Road
Toronto, Ontario
CANADA, M4W 2Z5
E-mail: josh.levy@utoronto.ca
Paul Finnegan
554 Spadina Avenue
Toronto, Ontario
CANADA, M5S 2J9
E-mail: pfinnegan@sympatico.ca
45

Understanding Dreams in Developmental Trauma

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Joshua Levy / Paul Finnegan 64/1

A Clinical Case Presentation:

The purpose of this paper is to demonstrate the unique place of under-

Keywords: understanding and interpreting dreams, developmental

T he complex relationship between traumas and dreams permeated

Joshua Levy, Training and Supervising Analyst, Toronto Institute of

(1920), he accorded a central role to traumatic dreams “endeavouring to

struggling to avoid any awareness of inner deadness, fragmentation, or

Though I endured prolonged defiant silences in the analysis, I had to

my contribution to her disinterest in pursuing what I thought had been a

to be served. Anne had vivid childhood memories of observing her father

In the fourth year of the analysis, paralyzing depressive hopelessness

Phase 3: Working Through

memories of feeling emotionally deprived and of being envious of the

termination, I recalled similar regressions in her analysis that had ended

These developments at the end of the analysis stirred in me varying

have learned here was not an intellectual learning . . . it is a learning

In subsequent sessions Anne returned to this dream, feeling anxious

Bion, W.R. (1962). Learning from Experience. London: Heinemann.

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