Not All Nightmares Are the Same: The Critical Difference Between Ordinary & PTSD Nightmares
According to Carl Jung, dreams are meaningful messages from our psyche, pointing us forward and offering useful insights for our conscious lives. This is often true even for ordinary nightmares, which can be analyzed to reveal hidden tensions and unresolved issues.
But what about the nightmares that haunt those with post-traumatic stress disorder (PTSD)? These are a different phenomenon entirely. They don't contain the same helpful insights and must be worked with in a unique, careful manner to avoid causing more harm.
Working with an Ordinary Nightmare
Ordinary nightmares, even when repetitive, are usually symbolic. A therapist can work with a client to explore the dream's content, looking for subtle differences in each recurrence that might reveal unconscious truths.
For example, dream experts Lewis and Krippner share a case of a man who repeatedly dreamed of being in a swimming pool with his ex-wife. By carefully recalling the dream, he noticed a tiny change—the water temperature was slightly different. This small detail was a powerful symbol, indicating a shift in the underlying tension in their relationship that he hadn't consciously recognized.
By exploring the dream, he gained valuable insight.
Why PTSD Nightmares Are Different
This same approach can be detrimental for someone with PTSD. PTSD nightmares are typically not symbolic metaphors; they are reruns of the traumatic experience.
Asking a person to hold onto these memories to look for subtle differences can be re-traumatizing. As Lewis and Krippner state, "It is as if the trauma were so severe that it cannot be put into metaphors and symbols." These nightmares are not pointing forward with helpful messages; they are pointing backward, trapping the dreamer in the past.
Because of this crucial difference, therapists use specialized techniques to help clients suffering from PTSD nightmares.
Two Therapeutic Approaches for PTSD Nightmares
Here are two effective methods for working with the unique challenge of trauma-related nightmares:
1. Imagery Rehearsal Therapy (IRT)
IRT empowers the dreamer to take control of the narrative. The process is simple but powerful:
The dreamer writes down the nightmare in detail.
Working with a therapist, they consciously change the dream, altering the theme, storyline, or ending to make it positive.
The new, rewritten dream is then rehearsed daily.
This method allows the client to replace the unwanted content, so that when the nightmare tries to reoccur, the new, positive version can take its place.
2. Focus Oriented Dreamwork (FOD)
FOD is a body-focused approach that emphasizes self-regulation and calming techniques. Instead of just rewriting the dream, the goal is to find the "help" or "life forward energy" that is believed to exist in every dream—elements that are "beautiful, awe-inspiring, young, vibrant, and alive."
If a client has trouble finding this positive energy within the nightmare itself, the therapist helps them "dream the dream onward," continuing the narrative beyond the traumatic event to create a new, safe ending. This process has been found to significantly decrease the frequency of PTSD nightmares.
References
Lewis, J.E., and Krippner, S. (2016). Working with dreams and PTSD nightmares: 14 Approaches for psychotherapists and counselors. Praeger.
