Cliffe, Alison; (2025) Dreams and Psychic Change in Child and Adolescent Psychotherapy. Doctoral thesis (D.Psych), UCL (University College London).

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Abstract

This thesis examines the role of dreams in the psychoanalytic treatment of children and adolescents, with a particular focus on how dreams can contribute to tracking and facilitating psychic change. The research is presented in three parts: a literature review, an empirical study, and a reflective commentary. Part One provides a comprehensive review of existing literature on the function and significance of dreams. Beginning with Freud’s foundational work, The Interpretation of Dreams, and contrasting it with Jungian perspectives, it explores historical and contemporary theories, including neuropsychoanalysis, while highlighting key themes that arose such as transference and countertransference dreams, and the relationship between dreams and psychic change. Three theories of dreaming were discussed, the continuity hypothesis, the threat-simulation theory, and the affective re-establishment theory, each offering a significant development in our understanding of the function of dreaming. When considering the role of the dream in psychoanalytic treatment, three areas also emerged – the dream itself, the dream brought to the analyst, and what the patient/analyst dyad create with the dream in the liminal space of the therapeutic relationship. As the literature review took shape, another ‘three’ emerged in terms of the role of the dream in treatment, which suggested a three-fold function, 1) dreams bring about psychic change, 2) dreams can be used to track psychic change, and 3) dreams provide insight into current psychic dynamics. As the literature review highlighted, dreams represent our waking preoccupations, ego development, psychic structures, and states of mind. They are purposeful in and of themselves and can allow for the processing and integration of emotional experience. Sharing a dream in a therapeutic context enhances the analyst’s understanding of the patient’s psychic development, providing insight for both the patient and the analyst. Despite the findings that dreams play an important role in treatment, there was a gap in the literature in terms of technique for working with children’s dreams, including early childhood, latency, and adolescence. Children’s dreams are significant because they communicate the nature of the developing psyche, the internal world and its representations, and the transference manifestations in the here-and-now of the therapy relationship. Part Two builds on the findings from the literature review by empirically examining the use of dreams in the treatment of an adolescent male with depression. The study utilises a coding system (Innovative Moments Coding System, IMCS) designed to track psychic change during treatment6. By incorporating dream material from the patient, the study investigates how dreams may illuminate changes in his mental state and his engagement with the therapeutic process. This empirical investigation aimed to provide further evidence of the value of using dreams in treatment broadly, while also addressing the challenges of applying the IMCS in psychoanalytic practice. There were many elements to consider – the coding system itself (IMCS), the type of treatment (Short Term Psychoanalytic Psychotherapy, STPP), the patient (an adolescent male with depression), and the use of dreams during the treatment, including whether the dreams highlighted the psychic change discussed in the literature review. For the purpose of streamlining, the focus was on the coding system, psychoanalytic treatment of adolescents, and the use of dreams. Together, these parts aim to deepen the understanding of dreams as a tool for tracking and facilitating psychic change in children and adolescents. They seek to bridge the gap between theoretical concepts and practical application, ultimately contributing to more effective therapeutic techniques for working with dreams in this population. The unifying aim of the thesis is to explore how dreams can be used both to effect and track psychic change, providing new insights into the therapeutic process and advancing psychoanalytic treatment with children and adolescents. Part Three, the reflective commentary, describes the author's process of engaging in research whilst training to be a child and adolescent psychoanalytic psychotherapist, using fairy tales and Romanyshyn’s ideas on researching with soul to illuminate this process.

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