**3.4. Providing a measure of therapeutic change**

In the course of CBT, the patient generally has two opportunities to gain new self-knowledge. Firstly, within collaborative empiricism, which involves a systematic process of the patient and the therapist working together [32], the patient's dysfunctional thoughts, beliefs, schemas, and coping strategies are identified [28]. Secondly, during psychoeducation, the therapist provides important information about the mechanisms of disorders, relapse prevention,

The patient extends his/her self-understanding when discussing his/her waking mental content with the therapist. However, dreams can also be a source of self-knowledge [26]. With reference to CBT, dreams may contain information about cognitive patterns [9], schemas [24], and cognitive distortions [2]. Dreams can also bring forth information about a patient's feel-

Individual's dreams can contribute to therapy by increasing the self-knowledge of the patient. The information obtained from discussing dreams can potentially lead the patient to greater self-understanding. Moreover, they can enhance the patient's motivation for therapy and provide the knowledge needed to change dysfunctional cognitive and behavioral patterns [26].

The therapist needs information about the patient to plan the therapeutic process and interventions adequately. The first phase of CBT includes individual case formulation and clinical diagnosis. In CBT, several ways of obtaining information about the patient are possible, for instance, clinical interview, and self-observational methods [28]. An additional way of gain-

The approach of finding relationships between dreaming and waking experiences, which is typical of the therapeutic setting, starts with a dream and goes into its connections with the waking-life issues of the patient. Studies on dreams in psychodynamic therapy have shown that they provide information about, among others, patient's patterns of interpersonal functioning, his/her personality structure, and images of self and others. Dreams can also reveal information the patient is not aware of, for instance, his/her attitude toward the therapist [26, 33]. Important information for the therapist in CBT that may be provided by dreams concerns the patient's cognitive patterns [9], core beliefs [2], schemas [24], cognitive distortions [2], pat-

Often dreams quickly and efficiently reveal information that is unique to the patient, especially information that the patient is not aware of or just does not want to share with the therapist. When the specialist recognizes this information, he/she can help the patient perceive it and subsequently change maladaptive cognitive and behavioral patterns. Dreams can also

Dreams can reveal much important information about the patient to the therapist. Working with dreams in therapy may facilitate the speed at which some personal material is introduced to collaborative therapeutic discussion, helps the patient recognize and express emotions and thoughts, and may even shorten therapy [26]. However, there is no research on this

ing information about the patient is to ask him/her about his/her dream content [26].

terns of behaviors [15], patterns of affective responses [23], and resources [2].

use of dreams related to providing clinical information to the therapist in CBT.

contain crucial information about a patient's emotions [26].

and so on for the patient [28].

104 Cognitive Behavioral Therapy and Clinical Applications

ings toward various situations and experiences.

**3.3. Providing clinical information for the therapist**

The last conceptual use of dreams in therapy refers to using dreams as a measure of therapeutic change. Dreams can provide information about the patient's functioning outside of therapy and indicate therapeutic change or improvement of the patient due to therapy [26].

Changes in dream content can occur not only when the therapeutic goal assumes working on dreams, but also when other goals, even those not related to dreams, have been accomplished. A shift in a dream can indicate that clinical improvement in relation to personality development and behavioral change has been achieved [26]. Interestingly, the anxiety content of dreams increases in patients who are successful in therapy. This possibly reflects an increase in tolerance and ability to cope with anxiety when awake [34]. These findings need to be examined in terms of CBT. However, even now it is recommended for therapists to bear in mind that an increasing level of anxiety in dreams may, paradoxically, not be a sign of worsening, but of improvement. Notwithstanding, the decision concerning whether an increasing level of anxiety in dreams is positive or not should be always be based on the broader context of the patient's functioning in the waking state.

Overall, dreams have the potential to indicate therapeutic change. In CBT, this way of evaluation of improvement may be additional to other methods, such as scales. Research on the mechanisms and directions related to therapeutic change and dreams needs to be conducted within the framework of CBT.
