Therapeutic Analysis of Dreams – A Cognitive-Behavioral Approach

The two activities that we spend a third of our lives doing are sleep and dreaming. Everyone dreams, but only 1 in 3 of us recalls dreams consistently. Dreams account for about 20% of the time sleeping. Most persons enter and exit dreaming approximately four to give times per night with about 90 minutes between cycles. They last from 10 to 25 minutes with increasing duration as sleep unfolds. Decreased sleep latency, the time to actually fall asleep, is strongly associated with clinical depression. Psychoactive and psychotropic substances and medications are known to alter sleep and dream architecture.

With respect to the functions and meanings of dreams, Sigmund Freud wrote in 1900 that “they are the royal road to the unconscious.” Research also regards dreams as providing integration, repair, restoration, and consolidation of memories. In those who are deprived of sleep and dreaming, there is rapid deterioration and disintegration of various cognitive functions even to the extreme point of psychosis.

Some research indicates that dreams are mostly random experiences designed to keep mental process periodically active during sleeping. Clinicians, such as myself, regard them as the deeper and meaningful “stuff” of life relevant to underlying issues, conflicts, and even providing us with solutions.

With powerful neuroimaging tools, we see a dreaming brain that is even more active than in the waking state. While the prefrontal cortex and cortex is relatively quiet, the limbic brain and the occipital lobe (the primary visual cortex) are quite activated. I regard the limbic region to be the “reacting brain.” All of our emotions and motivations emanate from this region, and so does our memory storage. In addition, our attraction and bonding to others is likewise centered here.

Dreams, then, represent the whole of our life experiences, and reflect experiences that make us feel good — and bad. At times, we participate very actively, while in others, we are more passive. Dreams are experienced in all major sense modalities, and are particularly visual. There are known differences in the themes of men and women. We men tend to dream of strangers, sex and aggression. Women tend to dream of intimates, romance, and being the targets of aggression.

When I conduct dream analyses, I tend to use a cognitive-behavioral approach, which I will describe briefly here. I pay close attention to the actors, setting/context, action, and importantly, dreamer’s automatic thinking, attitudes, and feelings as the action unfolds. I have them account the dream in whole. I then slow the action down from frame-to-frame, inquiring about above. We rate the intensity of the feelings using the Subjective Units of Distress (SUD) scale from 1 to 10. One represents slight distress and 10 indicates maximum intensity. Then, inquire about the personal meaning in each of the dream sequences.

I also pay very close attention to the ending, and to any leftover residue impacting the dreamer upon waking and for a few minutes afterwards. We then analyze the person’s plan of action related to the fundamental themes aroused during the dream. I outline these steps:

CBT Analysis Framework:

  • Identify the situation (S)
  • Identify the feelings (A)
  • Identify the automatic thoughts (AT)
  • Idenitfy the attitudes (ATT)
  • Identify what this means to the dreamer (M)
  • Identify the core belief/s (CB)
  • Identify, the personal meaning of the dreamer (PM)
  • Identify the plan of action in the dream and out (PA)

Here I offer a dream that I recently interpreted for a 22 year old female college student. She has a recurring dream consistently on Christmas Eve, and many of her feelings are quite intense. She is in a church basement alone. Suddenly, a man she does not know starts chasing her. She runs into the church alter but he keeps chase. She goes to the next floor up, which is the nursery. He follows her. See spies a smaller door leading to another nursery, and at first he can’t get in. She looks out a window and sees her sister & a friend. They don’t notice her at all. She jumps out of a window to the street below. She turns around and notices him holding a gun. He then shoots her in the shoulder, and she wakes up.

Upon analyzing each sequence in this dream, she recognizes the man as her former brother-in-law, her sister’s ex-husband. She depicts him as aggressive and violent in real life. Eventually, her sister divorces him for this reason despite several attempts to reconcile their marriage. Initially, she is perplexed as to why the sister kept returning to him. They have a son together. Kayla worries about her nephew because of the father’s aggressive and violent patterns. He lives in the same small town as they all do. He has regular visitation; while the mother has physical custody.

She is terrified of him. She identifies very closely with her sister. She is quite protective of her sister and nephew. She realizes that while he could actually harm her, he cannot kill her!

The church represents her faith. The nursery represents her nephew. She finds that the jointly arrived interpretation to be 95% accurate. And, it gives her direction for the future in facing this very real threat.

For those who do not consistently remember their dreams, clinicians can still access the unconscious processes by the following techniques: free association, transference, and paying close attention to a form of countertransference that I call projective identification.

Now, can you tell me what you dream?


Lange T, Dimitrov S, & Born J (2010). Effects of sleep and circadian rhythm on the human immune system. Annals of the New York Academy of Sciences, 1193, 48-59 PMID: 20398008

Freud, S. (1964). Standard edition of the complete psychological works of Sigmund Freud (Vol. 22).

Freud, S (1900). The interpretation of Dreams. Standard edition of the complete psychological works of Sigmund Freud (Vol. 6). Reprinted in 1960.

Hirshkowitz, M. (1997). Understanding sleep: The evaluation and treatment of sleep disorders. Washington DC. American Psychological Association.

Hobson, J. A. (2002). Making Sense of Dreaming. New York. Oxford Community Press.

Van de Castle, R. L. (1994). Our Dreaming Mind. New York. Ballentine.

Image via Elena Schweitzer / Shutterstock.

Richard Kensinger, MSW

Richard Kensinger, MSW, has over forty years of clinical experience in behavioral healthcare as a psychotherapist, trainer, consultant, and faculty member in the Psychology Department, Mount Aloysius College. He has also taught at Penn State, University of Pittsburgh, and Temple University. He is also a lover of "football", known in the USA as soccer. He is currently associated for over 30 years with youth "football", 26 as a referee.
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