**2. A historical perspective on working with dreams in CBT**

The main aim of this part is to introduce a historical perspective on dream analysis within the framework of CBT. A division into objective and constructive approaches toward dream work in this approach is distinguished. The first comes from the objectivist tradition in CBT and is represented by, among others, Beck and Freeman. The second is more focused on metaphorical, subjective, and affective ways of understanding dreams. To this approach belongs, for instance, Hill [4]. Differentiation of dream analysis orientations in CBT is worth mentioning, although we concentrate on various propositions of working with dreams without reference to this division.

The historical perspective on dream analysis in CBT concerns the works of Beck [9], Hill [4], Freeman [8], and Montangero [2]. The use of dreams in third wave schema therapy is also considered. However, the aforementioned authors are not the only ones who have developed the topic of dream analysis in CBT. Others include Gonçales and Barbosa [10], and Barrett [11]. Due to lack of space and the assumption that the historical perspective is only one part of the chapter, a presentation of all of these concepts is beyond the scope of this review.

#### **2.1. Aaron T. Beck: from psychoanalysis to a cognitive approach**

Aaron Beck is one of the founding fathers of CBT. Before he made a pioneering contribution to this therapeutic approach, he was trained in psychoanalysis. In 1959, he joined the research group led by Saul [12]. The main goal of their project was to examine the psychoanalytical theory of "inverted hostility" in depressed patients [13]. This concept assumes that a selfpunitive need to suffer occurs in depression [14]. It was suggested that "masochistic" dreams are related to depression and that subjects with masochistic tendencies might be more prone to this disorder, so the study confirmed the psychoanalytical concept of "inverted hostility" [13]. In fact, this is the only article by Beck in which he referred to psychoanalytical interpretation of dreams.

content [2]. Dreaming is also related to assimilation of personal experiences into one's existing memory system. During this process, waking life events are contextualized through the formation of connections between previous cognitive and emotional experiences and present circumstances [3]. Dreams are one way of assimilating waking experiences into the schemata because they help to classify emotional experiences from the waking state, compare them with memories, and plan future actions [4]. These processes are possible in the case of dreams that do not reflect powerful emotional traumatic events. Such dreams (usually nightmares) are very likely to be recurrent, as they are an attempt to complete the assimilation of negative

Treatment of recurrent frightening dreams within the framework of CBT is well elaborated [5]. This topic has been addressed in other reviews and meta-analyses [5–7]. Working with nightmares in CBT is developed and often applied, but working with dreams, in general, in CBT is barely elaborated and rarely used. A vicious circle occurs due to a lack of research on the use of dreams in CBT, and there is a very little knowledge about dream analysis in this therapeutic approach; therefore, therapists do not want to elaborate on this topic during

The main aim of the chapter is to present perspectives on working with dreams within the framework of CBT. The first perspective concerns the historical view on the usage of dreams in CBT. The second functional perspective includes an analysis of the conceptual functions of working with dreams in CBT. Finally, yet importantly, the processual perspective is focused

The main aim of this part is to introduce a historical perspective on dream analysis within the framework of CBT. A division into objective and constructive approaches toward dream work in this approach is distinguished. The first comes from the objectivist tradition in CBT and is represented by, among others, Beck and Freeman. The second is more focused on metaphorical, subjective, and affective ways of understanding dreams. To this approach belongs, for instance, Hill [4]. Differentiation of dream analysis orientations in CBT is worth mentioning, although we concentrate on various propositions of working with dreams without reference to this division.

The historical perspective on dream analysis in CBT concerns the works of Beck [9], Hill [4], Freeman [8], and Montangero [2]. The use of dreams in third wave schema therapy is also considered. However, the aforementioned authors are not the only ones who have developed the topic of dream analysis in CBT. Others include Gonçales and Barbosa [10], and Barrett [11]. Due to lack of space and the assumption that the historical perspective is only one part of

Aaron Beck is one of the founding fathers of CBT. Before he made a pioneering contribution to this therapeutic approach, he was trained in psychoanalysis. In 1959, he joined the research

the chapter, a presentation of all of these concepts is beyond the scope of this review.

**2.1. Aaron T. Beck: from psychoanalysis to a cognitive approach**

on practical issues related to working with dreams in CBT.

**2. A historical perspective on working with dreams in CBT**

waking experiences [3, 4].

98 Cognitive Behavioral Therapy and Clinical Applications

therapy sessions [2, 8].

In his next project, Beck, in collaboration with Ward, extended the research and confirmed his previous findings [15]. In discussion, he assumed that: (a) it is not necessary to analyze dreams, or assume any unconscious meaning, to assess their thematic significance; (b) the manifest dream content correlates well with important themes in a person's waking life; (c) the themes of a person's pathology and of his or her will correlate, suggesting the existence of a certain mechanism that regulates how we construct meaning; and (d) systematic and experimental study of dreams would be useful in isolating other thematic correlates of specific psychopathologies and pinpointing their mechanisms [14].

The aforementioned conclusions were fundamental for a cognitive shift of Beck's thinking about the mechanisms of mental disorders. Along with Beck's personal disappointment with the results of his own psychoanalytical therapy and his dissatisfaction with how psychoanalytical therapists treated their patients, his conclusions on dreams led him to abandon psychoanalysis and motivated him to work on his own therapeutic method [12]. In 1971, Beck published his last paper on dreams; this was the only one that concerned dreams and a cognitive approach [9]. In this article, he defined dreams as "(…) a visual phenomenon occurring during sleep" [9]. According to Beck [9], dreams reflect the patient's concept of the self, the world, and the future. Consequently, dreams are seen as reflecting a patient's cognitive patterns, which are specific to the individual and "exert a maximum influence on the content of dreams" [9]. Therefore, some dreams can be a useful tool in cognitive restructuring as they help reveal cognitive distortions, schemas, and maladaptive thought patterns.

Moreover, according to Beck [9], a single dream may provide a clarification of the patient's problem. After formulating a series of alternative hypotheses, a dream can support one of them, modify them, or offer completely different possibilities. Dreams might also be considered as a kind of biopsy of the patient's psychological processes. Pathognomonic dreams show, in turn, the way the individual sees himself, the world, and the future. Dream content may reflect changes in waking cognition due to progress in therapy [16].

Beck, at the beginning of his academic and therapeutic carrier, was deeply interested in dreams. After he established the basis of cognitive therapy, he wanted to spread his ideas. He was frustrated with the psychoanalytic politics of personal loyalty and in turn, psychoanalytic therapists were not interested in contributing to the "broad psychotherapy" postulated by Beck. Therefore, he turned toward behavioral therapists, who offered him a supportive community and opportunities for bringing cognitive therapy to a wider audience [17]. This alliance with behavioral therapists forced him to abandon his research on dreams. Subsequently, due to ideological, financial, and pragmatic reasons, Beck, decided not to continue his interest in dreams. CBT still bears the consequences of this decision: until now, working with dreams has been neither well implemented nor well researched. Freeman and White [8] pointed out other factors that may influence the fact that cognitive-behavioral therapists do not consider dreams as important: lack of training in the use of dreams in CBT, lack of a manual dedicated to dream work in this approach, and regarding dreams as unconscious or having no direct behavior component. Despite these reasons for the lack of interest in dreams in CBT, a few methods and guidelines for using dreams in this therapeutic approach have been developed.

**2.3. Jacques Montangero: the description, memory sources, and reformulation method**

of dreams is not univocal, but personal [21].

and (c) reformulating the dream description.

empirical research on this model.

**2.4. Arthur Freeman: guidelines for using dreams**

Montangero claims that "dreaming is a primarily cognitive phenomenon since it consists of creating representations, that is, evoking things that are absent by means of substitutes like mental images, words, etc." [21]. Dream representations are not meaningless; they are related to a person's aspirations and concerns and they are often complementary to topics from the preceding day that one does not want to or has no time to think about. Therefore, the meaning

Dreams in Cognitive-Behavioral Therapy http://dx.doi.org/10.5772/intechopen.70893 101

The goal of the systematic procedure of dream interpretation developed by Montangero [2] is to reveal this personal meaning of dream elements. The description, memory sources, and reformulation method (DMR) was elaborated in the 1980s and improved until the early 2000s [21]. The method has three steps: (a) complete description, (b) search for mnemonic sources,

In the first step, the patient has to immerse in the memory of his/her dream. He/she shares the dream content with the therapist, who writes down this description. The second step is focused on connecting the dream elements to autobiographical memories in order to clarify the meaning of the dream. The aim of the third step is to describe the dream content as a sequence of more general terms. The patient and therapist collaboratively categorize and find a definition or function for each element of the dream. These general ideas could later be applied to the patient's aspirations or concerns. Reformulation of the dream leads to its interpretation, which is based on relationships between dream elements and waking experiences of the patient [2, 21].

Montangero established the DRM method as a part of CBT as it has several general methodological principles in common with this approach; for instance, both the DRM and CBT use a systematic analysis of the mental content of the patient [21]. We were unable to find any

According to Freeman, a dream is a representation of an idiosyncratic dramatization of the dreamer's view of the self and the world. It reflects the waking cognitions and affective responses of the individual, not the "mysterious reflections of so-called deeper issues" [8]. Appealing to dream symbols should also be avoided; hence, in therapy, a dream should be understood in terms of the patient's life and his/her experiences from waking states [8].

Arthur Freeman has been working on dream analysis in CBT since the 1980s [8, 22, 23]. He had to rely on Beck's early papers because in other sources he failed to find any references to dreams, dreaming, or the use of dreams in CBT [14]. He listed points concerning "cognitive dream interpretation." The most recent version contains rules as, for instance: understand the dream in thematic rather than symbolic terms; the thematic content is idiosyncratic to the dreamer and must be understand within the context of his/her waking life; the affective responses to the dream image can be seen as similar to the emotional responses of the patient in waking life; dream content and images come under the same cognitive restructuring methods as automatic thoughts; the dream may reflect the patient's schema. The complete version is described elsewhere [8].
