(2007).

Psychoanalytic Quarterly, 76:835-861

On Dreaming one's Patient: Reflections on an

Aspect of Countertransference Dreams
Lawrence J. Brown

This paper explores the phenomenon of the countertransference dream. Until

very recently, such dreams have tended to be seen as reflecting either
unanalyzed difficulties in the analyst or unexamined conflicts in the analytic
relationship. While the analyst's dream of his/her patient may represent such
problems, the author argues that such dreams may also indicate the ways in
which the analyst comes to know the patient on a deep, unconscious level by
processing the patient's communicative projective identifications. Two
extended clinical examples of the author's countertransference dreams are
offered. The author also discusses the use of countertransference dreams in
psychoanalytic supervision.

A Dream from the Early Part of an Analysis:

The Case of Mr. A
Mr. A, a man several years older than I, began analysis in order to deal
with a chronic sense of stumbling into his life, especially with regard to
relationships with women. Although successful in business,
—————————————

A shorter version of this paper was presented at the Boston Psychoanalytic Institute in
January 2006.
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he found it very difficult to be firm with others when necessary, preferring

instead to be patient and understanding, a quality that we came to diagnose as
“chronically nice.” In our initial discussions about what he hoped to gain from
psychoanalytic work, Mr. A quipped that he wished for some “magical
injection,” which led me to inquire as to the nature of the substance that would
be injected. “Essence of balls,” he joked, and, though we both appreciated that
this was no laughing matter, his joke seemed to disguise what were surely more
painful feelings while simultaneously inviting me to make light of his deep
distress.
Mr. A began the tenth analytic session, the last of the week, by saying he
would like to take a nap. His thoughts turned to the new apartment he was
moving into; his daughter getting stomachaches as a child on Sunday nights
before school the next day; the fact that his brother had been in treatment for
ten years; and his nostalgia for the woman from whom he had recently
separated after a long relationship. I commented about the end of our analytic
week together and linked it to the themes of loss and separation.
He began to speak with considerable feeling about how looks can be
deceiving, especially with tall men who dress well, like Mr. A himself, and said
that “I'd walk into a room and people would think I was an ambassador or
something.” I remarked that on the previous day, he had been dressed in a
formal-looking suit, and indeed looked rather ambassadorial, yet today he
seemed to want me to know that looks can be deceiving and that he felt lonely
with the weekend approaching. He went on to elaborate more deeply on his
melancholy feelings.
That night I had the following dream:
I bumped into Mr. A somewhere, a casual place, like a beach or at the
movies. We started talking in a friendly way; I think he was with
someone else, perhaps his brother, F [who had been in treatment ten
years]. I was friendly and animated, and then realized that a good
part of the afternoon had gone by. One of us asked the other about
what to do next, and he may have invited me to go to the beach.
- 836 -

For some reason, I had to go somewhere and was driving my car on a

beautiful New England road in autumn with the leaves fiery red,
yellow, and orange. The road was going downhill to a lake, and as I
was driving down the road, I thought Mr. A would like to see this, as
though he were an out-of-town guest I was hosting. I turned around
and went back to where I had left him; perhaps I was with my wife.
When I got to that place, he and whoever he was with were preparing
to go to the beach. He was in shorts, and I noticed he had well-
muscled, thickly hairy legs, which made me feel somewhat inferior,
thinking that although he was older than I, he probably looked better
on the beach.
My first association to the dream was to my consciously friendly feelings
for Mr. A, which led me to wonder whether the dream was alerting me to some
kind of collusion aimed at avoiding painful emotions by allowing “a good part
of the [analytic] afternoon” to go by. I also associated to the obviously
competitive themes, and this brought to mind an older cousin of mine (with the
same name as Mr. A's brother), whose strength I admired and whose presence I
sometimes resented, who had lived with my family for some time during my
adolescence. Thus, I wondered whether the affable analytic mood, in addition
to resisting painful emotions, might belie underlying adversarial feelings.
I was also aware of feeling protective of Mr. A, an emotion that was
connected to the beautiful autumn road, which seemed to represent a wish to
show him that there are special pleasures to be had in approaching the autumn
of one's life, pleasures that differ from the fun of being a beach boy. But was
that wish also an evasion of his invitation to go to the beach and the possibility
of kicking analytic sand into the other's face, so that I instead sought out the
bucolic New England scenery? There was something about his looking like an
ambassador that seemed to stick in my mind, though I could not connect that to
the dream imagery. Was I competitively turning the ambassador (the
ambivalently valued older cousin) into a beach boy to undo my feeling of
inferiority?
- 837 -

These thoughts, centering largely around rivalry and status, swirled about
in my mind, and I was left with the sense that the meaning of this dream
escaped me; thus, the dream was placed on the proverbial back burner to await
further elaboration as the analysis unfolded.
Countertransference Dreaming
A dream of one's patient can be an unsettling event, filling the
psychoanalyst with doubts and uncertainties as to its meaning. Quite often, one
has the sense of having trespassed beyond an illdefined boundary by bringing
the analysand into that most private of places, the uniquely personal realm of
dream life. At other times, the analyst may feel the patient's appearance in the
dream as an unwelcome intrusion that may mirror the analyst's waking
experience of the analysand. In such situations, the analyst is inevitably left
with the feeling of having shared an intimate exchange with the patient, despite
the analysand's absence of awareness of it. And, upon seeing the patient the
morning after having dreamt of him or her, the analyst may feel awkward, as
though a secret knowledge of the patient has been gained and cannot be
revealed. Thus, the analyst may feel alone with a sense of the patient that may
seem like an ill-gotten gain—something the analyst is loath to share with
colleagues, a hesitation that has at least a hint of shame and a measure of guilt
that might require some act of analytic contrition, such as the analyst's return to
his or her own analysis.
Indeed, encouraging the analyst who has dreamed of a patient to return to
analysis was regularly suggested in the years prior to our more current view of
countertransference in its various manifestations. In our contemporary
literature, a clinical report that does not include both the yin of the patient's
transference and the corresponding yang of the analyst's experience is
considered incomplete. It is interesting to note that, while the shift toward a
two-person psychology has had the effect of providing the analyst with the
freedom to openly explore his or her subjective reactions to the analysand, the
phenomenon of the countertransference
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dream has remained in a kind of time warp until very recently, one in which
dreams about the patient have tended to be viewed as problematic.
The main goal of this study is to examine our psychoanalytic
understanding of countertransference dreams and to offer an additional point of
view on the subject. My primary hypothesis is that, while dreams of one's
patient may reflect problems in the analyst or in the analysis, they also
represent a means by which the analyst is coming to unconsciously know the
analysand. This unconsciously registered knowledge must be unwrapped, so to
speak, through the analyst's self-analytic work; consequently, we may find that
what we have unwrapped is important information about the analysand's
emotional world—or, perhaps, it is a misrecognition that discloses more about
the analyst. Further, the analyst's unconscious misrecognition of the patient
may be an obstacle to the full development of the patient's transference.
Getting to Know the Patient
But what does it mean to say that we know a patient? To expand on a
question borrowed from Elizabeth Barrett Browning's poem that begins with
“How do I love thee? Let me count the ways,” there are many different ways in
which we know our analysand. There are the facts of his or her life, including
information about family members, births, deaths, place among siblings, etc.
To these data, we add the emotional meaning that the events of the patient's life
have upon him or her. Our analysands relate their sadness, dread, joy, anxiety,
terror, and passions to us, and we share, sometimes very deeply, in their
emotions through processes that we call—depending on our theories—
empathic immersion, projective identification, reverie, trial identification, and
so on. This emotional knowing brings color to the black and white of our
factual knowing, both of which occur largely on a conscious or preconscious
level.
Bion (1965) has designated this kind of accumulation of knowing the
patient as a transformation in K where K (knowledge) represents a link
between the analytic couple in which the analyst is in
- 839 -

the process of getting to know about the analysand. However, Bion states that
this gaining of information “does not produce growth, only permits accretions
of knowledge about growth” (p. 156).
Another layer of knowing a patient occurs on an unconscious basis—a
knowing that only very slowly begins to dawn on the analyst, a knowing that
derives from the patient's having found or been given a place in the analyst's
mind. This deep, unconscious knowing is an underground current of meaning,
the detection of which may be glimpsed by the analyst's slips of tongue, other
parapraxes, or barely noticed fleeting reveries in relation to the patient. Then,
often with a sense of surprise, the analyst, quite literally caught unaware, has
the realization that he or she knows the patient in a particular way, which may
or may not be accurate. This is a manner of knowing that Bion (1965, 1970)
terms transformation in O, where O represents the slow evolution by which the
“ultimate reality of [emotional] truth” (1965, p. 140), itself essentially ineffable
and only approached asymptotically, is gradually apprehended.
O, according to Grotstein (2004), is the emotional truth about the hour
that is present in both patient and analyst. Mitrani (2001) describes how the
analyst establishes contact with the patient's O through
… the introjection by the analyst of certain aspects of the patient's
inner world and experience, and a resonance with those elements of
the analyst's own inner world and experience, such that the latter is
able to feel herself [the analyst] to actually be that unwanted part of
the patient's self or that unbearable object that has previously been
introjectively identified with. [p. 1094]
It is this last kind of knowing, the deeply unconscious transformation in O,
that I believe is a central feature of the countertransference dream. The analyst
is constantly taking in information about the patient through the channels of
knowing about experience (transformation in K) and knowing through
experience (transformation in O). Although Bion is clear that transformations
in K do not produce emotional growth, this accumulation of knowledge
- 840 -

is central in guiding the analyst to areas that yield deeper emotional

understanding. Thus, there ought to be an evolving interplay between these two
modes of experience.
Returning to Mr. A, my dream about him may be approached from
multiple perspectives, one of which is that the dream reveals the analyst's
diminished sense of competence, a view that derives from discussions of
Freud's famous dream of Irma's injection (Erikson 1954; Freud 1900; Zweibel
1985). Freud's treatment of Irma left him feeling inadequate, and he dreamed
that her poor response was due to someone else's failure: his friend Otto's. He
concluded that “the dream … was that I was not responsible for the persistence
of Irma's pains, but that Otto was” (p. 118). While my dream of Mr. A
expressed similar themes of threatened competence, there was an additional
component in which I resonated with his anxiety about the fact that, although
he appeared ambassadorial, he actually felt insecure.
From this perspective, the dream also reflected my unconscious
identification with the depth of Mr. A's feeling of inadequacy, an unconscious
communication that was transformed by my dream work into the fabric of the
countertransference dream by the stitching together of elements from Mr. A's
story with associated aspects of my own life. This is what Freud (1912) meant
by the analyst's using his or her unconscious as aninstrument of the analysis:
through projective identification (Brown 2004; Zweibel 1985), the patient
conveys affects for the analyst to absorb, give unconscious meaning to, and
then decode through self-analytic work.
There is, however, another level of meaning, one informed by an ongoing
process of transformations of O, having to do with our coming to
unconsciously know our analysands more deeply, a knowledge stored in our
unconscious that we do not know we have. My initial associations to the
countertransference dream about Mr. A had to do largely with concerns around
competition and feelings of inferiority. These ideas led me to be on the lookout
for such themes; however, neither Mr. A's thoughts nor my private reactions
confirmed these speculations. Instead, he spoke about his sense of finding
himself in this or that situation, and he wondered
- 841 -

how to “tap dance my way out of it.” My suggestion that this pattern might be a
retreat from more active, competitive strivings yielded few emotionally
significant associations.
I found that the word ambassador kept reappearing in my mind, though I
could attach no particular significance to it other than matters of status. Then
one day, I suddenly remembered that my father had once bought a new AMC
Ambassador, an automobile I had been very proud to drive. I was surprised at
not having made the connection previously, and this revelation led once more
to further associations to my older cousin, who had spent time with my father
tinkering with cars (an activity that excluded me). This association led to my
awareness of affects tied to missing my father, and permitted a shift in attention
to Mr. A's yearning for his father's counsel (the “magical injection” of “essence
of balls”), without which he felt adrift, and its appearance in the transference.
The surprising connection to the Ambassador automobile signaled a
knowledge of Mr. A that I had acquired, yet did not know I possessed—a
knowledge masked by my focusing instead on issues of competition and
inferiority. Was this inattention to the latent paternal transference an expression
of my resistance, based on my identification with the patient (Favero and Ross
2002; Rudge 1998)? Probably so. But what I wish to emphasize here is the
process by which I was coming to know Mr. A on a deep, unconscious level. It
can be said that we come to know another person by attributing to him or her
(through projective identification) aspects of our own inner object worlds, and
that we unconsciously scan their reactions to see how they conform or not to
these unconscious perceptions. In this process, we learn something about them
and something about ourselves (Caper 1996)—a process through which, in
analysis, we are always coming to know the patient and ourselves by successive
accretions in the transformation of O (Bion 1965; Grotstein 2004; Ogden
2003).
In the case of Mr. A, my initial interpretation of the countertransference
dream, based upon themes of rivalry and inadequacy, was a misrecognition of
him at that point in time that was corrected by my later realization. This
realization—that I had introjected
- 842 -

and identified with Mr. A's longings for an unavailable father's guidance (Mr.
A's unacceptable O)—afforded me a new level of knowing him; therefore, my
countertransference dream was expressive of my unconscious working
attempts to transform the evolving O of Mr. A.
Furthermore, I believe that my inability to recognize the paternal
transference was linked to my anxieties in recognizing my own disavowed
paternal longings because of their homoerotic associations (expressed in the
dream in the form of Mr. A's “wellmuscled, thickly hairy legs”). Thus, this
resistance was a joint endeavor that was constructed at the point where Mr. A's
anxieties meshed with analogous conflicts in me (Smith 1997).
Ogden (2005) notes that the supervisory process involves a kind of
dreaming the patient into existence through the collaborative imaginative work
done by analyst and supervisor. Similarly, I view the countertransference
dream as revealing the deep, unconscious way in which the analyst is dreaming
the patient into existence, that is, introjecting the patient's projections and
finding common ground with them through analogous experiences of the
analyst's own, in order to get some sense of who the patient is and who the
patient is not. When the analyst has a dream in which a patient appears, the
analyst is both dreaming about, and dreaming into existence, that analysand.
To dream about a patient implies that he or she figures as a character in the
dream—perhaps embodying an aspect of the analyst, representing his or her
self overall, or standing in for someone else in the analyst's life. In this respect,
dreaming about the patient is an aspect of a transformation in K. By contrast,
dreaming the patient into existence is an unconscious mental activity by which
the analysand gradually comes emotionally alive in the analyst's mind. Thus,
dreaming the patient into existence is a component of a transformation in O.
The distinction being drawn here between dreaming about the patient and
dreaming the patient into existence relates to Bion's (1962, 1992) views of why
we dream. He believed there is a function in the mind (the alpha function) that
transforms raw emotional experience into thoughts and images that may be
combined to
- 843 -

form the elements of a dream—elements that, upon analysis, yield their latent
content. Bion asserted that this process occurs not only when we are actually
sleeping, but also in the unconscious waking state, meaning that the psyche is
constantly engaged in a course of emotional alchemy by which unrefined
affects are processed. When a patient is unable to dream, he or she is incapable
of absorbing new affective experience, and therefore cannot grow
psychologically; the capacity to dream, as Bion understood it, permits a
broadening of emotional life that fosters learning from one's experiences. Thus,
dreaming one's patient into existence (while awake or asleep) is the means by
which the analysand gradually and unconsciously comes into being as an alive
and sentient individual in the analyst's mind (Grotstein 2000, 2004; Ogden
2003, 2004). That is, such a dream represents a step in the process by which the
analyst transforms the O of the patient—a step that inevitably involves some
emotional reworking of the analyst's conflicts.
My dream of Mr. A, which occurred after the tenth analytic session, thus
represented my unconscious attempt to get to know him at the outset of
analysis by introjecting his unacceptable O (his longing for a father), which had
been transmitted to my receptive unconscious.1 Having taken in this
unconscious transmission, I “dreamed” Mr. A's O by linking it with analogous
emotional trends in myself (the “ambassador factor,” which, when analyzed,
yielded the underlying yearning for a father and anxieties about such wishes).
Ogden (1996) has stated that we should consider an analysand's dream as “no
longer simply the ‘patient's dream'” (p. 892), but rather as a product of the
interaction between the analyst's and analysand's subjectivities. It seems likely
that this assertion would also apply to a dream authored by the analyst.
—————————————

1 One would assume that there also exists an “acceptable O,” perhaps something akin
to Freud and Breuer's (1905) reference to the “common unhappiness” (p. 305) of
everyday life, which the patient is fully capable of transforming without the analyst's
help. However, patients seek us out to help them bear and transform emotional
experiences that are too powerful for them to manage (“unacceptable O”), and for
which they require our services to “dream undreamt dreams” (Ogden 2004, p. 859).
- 844 -

However, one might argue that, since my dream of Mr. A occurred so

early in the analysis, it had more to do with the analyst —me—than with the
patient, and that linking it to the analysand's life would therefore be rather
spurious. This seems a valid objection and should serve as a reminder to the
analyst not to jump too quickly to conclusions about the workings of the
patient's mind. Smith (1997) has similarly cautioned the analyst, emphasizing
the need for a commitment to a multilayered self-analysis in order to sort out
the patient's dynamics from those of the analyst and from the interaction
between the two. In the case of Mr. A, I thought I knew something about the
patient when my initial dream associations led in the direction of competitive
conflicts, but his associations did not proceed in the same direction. More
importantly, I was dreaming him into existence, trying to unconsciously sense
who he was and who he was not. In this connection, and more to the point for
this discussion, my dream was a beginning step in a continuous unconscious
process (transformation in O) of my coming to know Mr. A.
A Dream from the End of an Analysis: The
Case of Ms. B
Ms. B was in a long analysis that was very helpful to her, although it
required her to struggle with wrenching feelings of being excluded from an
archaically organized oedipal couple (Brown 2002). In particular, her
transference, to which she clung for several years, was characterized by
fantasies of my wife draining me of energy by the endless sexual demands that
Ms. B imagined her having. Ms. B hated any other female patient whom she
experienced as similarly stealing away my attention and affection, and thus
starving Ms. B herself.
Ms. B's marriage was plagued by the same conflicts in that the connection
to her husband was based on the model of a “feeding couple.” Consequently,
their partnership was simply that: a sexless collaboration centered around
providing for the children, but with no joy between them, conjugal or
otherwise. Through her
- 845 -

analysis, Ms. B was able to work through her traumatic past in the transference,
enabling her to have a considerably more satisfying marriage. Termination was
very painful for her, stirring once again her old feelings of being tossed away to
starve by a couple who loved and cared only for themselves.
After terminating her analytic treatment, Ms. B continued in weekly
psychotherapy because she felt my ongoing help would be useful, especially to
aid her in coping with her son, who was experiencing substantial anxiety at the
time. While pleased to offer assistance in psychotherapy, I was also aware of
my own wish not to say goodbye to Ms. B completely. Internally, I also
questioned whether I might have agreed too quickly to terminate, even though
we had dealt with her leaving for well over a year.
Then one night, several weeks after ending her analysis and taking her into
psychotherapy, I had the following dream:
I am lying in bed on my back, but perhaps not under the covers, and
Ms. B is there to my left, next to the bed. We have been talking about
something, perhaps her concerns about her son, and then she comes
over to me. She stands near my head and leans over and kisses me
gently; I think first on the forehead and then lightly on the mouth. I
say that that feels very good. She agrees, and says it would feel even
better to make love. I find myself getting analytic and starting to say
something along the lines of “What do you think that would be like?”
But instead I say, “Yes, that would be nice.”
At this point, my wife walks in and Ms. B quickly goes to a corner of
the room. My wife, seeing her, asks insistently, “What is she doing
here?” and emphatically says that Ms. B has to leave. Ms. B then
 leaves the bedroom, and I sigh with relief that my wife has intervened
in such a direct manner.
This was a compelling emotional dream with many layers of meaning in
my life, and I will address only those features that are relevant to Ms. B's
analysis.
One point of view is that the dream reflects my uncertainty over having
agreed to end the analysis too readily; it thus expresses
- 846 -

doubts about my analytic competence. Furthermore, a powerful sense of

seductiveness was the central affect in this dream, and I wondered whether my
getting analytic at a key point in the dream might have represented a defense
against strong sexual feelings. Ms. B's treatment was highly erotized, with an
intense transference and countertransference, but this segment of our work had
more to do with mourning the end of the analysis and other losses in her life,
especially her children growing up and leaving home.
I remembered that Ms. B frequently transmitted her dependent longings in
sexual language, an association that led to doubts about whether I was
unresponsive to such longings following the end of analysis. It seemed that my
wife was brought into the dream to represent the other side of my ambivalence
about letting go of Ms. B: she would be to blame if my patient was pushed out
the door, just as Freud's friend Otto was at fault for Irma's lack of treatment
progress in Freud's dream.
These associations felt relevant to my dream, yet there was a lingering
sense that something important remained unappreciated. The associations
regarding my ambivalence about termination, the seductive sexual atmosphere
that conveyed Ms. B's yearning for closeness, and the assignment to my wife of
the task of sending my patient away all seemed obvious. A comment of Freud's
(1900; see also Scalzone and Zontini 2001) seemed especially applicable as I
considered these issues further: “There is often a passage in the most
thoroughly interpreted dream which has to be left obscure …. This is the
dream's navel, the spot where it reached down into the unknown” (p. 25).
Some days later, I realized that, in the dream, Ms. B had been placed in the
position of the psychoanalyst: I was lying down, and she was behind me and
slightly to my left, just as I was in relation to her during analysis. She offered
to comfort me, and I struggled with my wish for that versus continuing to
function as her analyst. Thus, my dreaming her as a former oedipal partner—a
necessary aspect of the termination that I relegated to my wife—appeared to
cover a deeper level of the dream that was symbolized by my dreaming her as
my analyst.
- 847 -
 As I mulled over these thoughts in my mind, Ms. B continued to express
her concerns about her son's intense anxiety, which led to my asking if she
were worried about how I might be affected by the ending of our analytic work.
She immediately said that my income had just dropped considerably, and joked
about how I would manage the financial loss. I commented that her humor
seemed to be a way of clouding her fear that, like her son, I needed her comfort
in order to manage being on my own.
Internally, I also began to question whether there might be some accuracy
to Ms. B's concerns about my emotional well-being, and this brought my
training analysis to mind. My analyst had had to interrupt the analysis for a
time, with the result that we had spent considerable time questioning whether I
was “ready” to end treatment. This memory and realization permitted me to see
how I had likely identified with Ms. B's anxious son, whose mother/ analyst
was leaving. This piece of self-analysis allowed me to feel more at ease with
the decision to terminate, and, in a parallel manner, Ms. B's anxiety about her
son substantially diminished.
This countertransference dream reflected my conscious anxiety about
making a competent decision in regard to Ms. B's termination. Furthermore, the
fact that the dream venue was my bedroom came as no surprise, serving to
highlight the strong oedipal atmosphere at the end of analysis. The act of
casting my wife as a spokesperson for one side of my ambivalence also
appeared selfevident. These “insights” from the dream added nothing new and
did little to illuminate the nature of the patient's immediate concerns about her
son, which constituted her ostensible reason for continuing in weekly
psychotherapy. Indeed, I thought her telling me about her son's anxiety was
more a communication about how panicked she was feeling.
But, to the contrary, if we consider my dream as an unconscious attempt to
transform an emotional experience evoked in me by Ms. B (her objectionable
O as conveyed through projective identification for me to “dream”), then we
might wonder what had been unconsciously communicated to me that I could
not yet find the symbols for in order to know that I knew it. When I later
realized
- 848 -

she was dreamed as my analyst, Ms. B's concerns about her son took on new
meaning: she was accurately experiencing me as having been made anxious by
her termination (evidenced by my identification with her anxious son as well as
with Ms. B herself, whose analyst might have been letting go of her before she
was ready), and therefore that I required her soothing. This realization led to
my bringing up Ms. B's fears about the effects of termination on me, which in
turn significantly enlivened the hours because my anxiety was significantly
lessened, thereby freeing her to experience her own deep terror of leaving and
her near conviction that someone would die as a result.
 Thus, while it was true that I was consciously anxious about the wisdom of
termination, continued analysis of the dream clarified the more frightening and
unconscious determinants of my anxiety, which reached down toward the navel
of the dream and were receptively connected to the O of Ms. B's transmitting
unconscious that had found common cause and resonance with similar
unprocessed feelings in me.
Discussion
My dreams about Mr. A and Ms. B, like other countertransference dreams,
are complex products that may be understood on multiple levels. Zweibel
(1985), for example, states that such dreams are “the sign of a disturbance in
the analytic relationship in which both partners take part” (p. 87), involving a
perceived threat to the analyst's competence. Myers (1987) similarly
emphasizes that dreams of one's patient occur within the context of a
“countertransference bind” that may be deciphered through the analyst's self-
analysis. These points of view surely apply to aspects of my dreams of Mr. A
and Ms. B. Themes of analytic competence were evident in both instances and
formed one vertex of each dream's meaning.
However, especially with Mr. A, my dream did not seem to be primarily a
response to a countertransference bind. Rather, it was dreamed in the context of
getting to know my patient, and neither Mr. A nor I was experiencing any
difficulties in getting the analytic
- 849 -

work underway. The dream of Ms. B was more intensely charged with emotion
and surfaced in the context of my conscious anxiety around whether
termination had perhaps been premature. It did not seem to express a particular
quandary in which we were stuck as much as it suggested the way in which my
unconscious represented her fears—that is, it seemed to capture her anxieties
about how I had been affected by the termination and how her accurate,
unconscious perception that I was anxious tied to my own experiences in my
training analysis.
There is another axis, that of unconscious communication, from which the
countertransference dream may be appreciated. Zweibel (1985) states that the
analyst's dream of a patient occurs when there is intense projective
identification that evokes powerful feelings in the analyst, which tax cognitive
capacities and which the analyst may ultimately be unable to manage. Zweibel
uses projective identification in the evacuative sense to signify a means of the
patient's unburdening himor herself of unbearable emotions, ignoring the
communicative aspects of projective identification (Bion 1959). Rudge (1998)
more accurately states that “the countertransference dream warns the analyst
that some symbolic elaboration is necessary” (p. 110).
Favero and Ross (2002) also adopt this view, emphasizing that the
countertransference dream is the analyst's attempt to mentally digest what the
patient has unconsciously communicated through projective identification.
Unlike Zweibel and Myers, they do not see the analyst's dream as embedded in
conflict or signifying a treatment difficulty. Indeed, they stress that the
countertransference dream, once understood through self-analysis, may assist
the analyst in becoming aware of his or her resistance to accepting the patient's
transference. This was certainly the case with my initial assessment of the
dream about Mr. A, in which my focus on themes of competition and rivalry
served as a resistance to accepting the paternal transference.
Yet another dimension of the countertransference dream derives from
Bion's (1992) statement that “the origin [of a dream] is
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an emotional experience … that is worked on to produce the dream” (p. 135).

Freud (1912) taught us that the unconscious of the patient transmits to the
analyst's unconscious, and that we should use our unconscious as an instrument
of the analysis; however, he did not instruct us as to how this is done (Brown
2004). If we put Freud's notion of the transmitting unconscious together with
Bion's concepts, then we may conclude that the patient transmits an
unprocessed emotional experience through projective identification to the
analyst's receiving unconscious. It is then up to the analyst to “dream the
analysis,” meaning that the analyst discovers within himor herself symbols that
represent the formerly untransformed emotional experience of the analysand.
Thus, Bion (1992) concludes somewhat wryly that the analyst “must be able to
dream the analysis as it is taking place, but of course he must not go to sleep”
(p. 216).
Needless to say, the analyst does literally go to sleep at night and
constructs dreams around a day residue, just as a pearl is formed around a grain
of sand. At the heart of a day residue is an emotional experience that initiates a
transformation of unrefined emotion into the dream symbols from which the
dream is fashioned. In the case of a countertransference dream, the day residue
is an emotional experience that emanates from the analyst's encounter with the
patient. This may have been a troubling engagement that threatened the
analyst's sense of competence, or perhaps it was an emotional experience that
was forcefully evoked in the analyst by the patient's powerful projective
identification. Alternatively, the day residue around which the analyst's dream
of the analysand forms may be the result of an ordinary process of unconscious
communication that expresses the patient's wish to be known by the analyst
interested in knowing him or her.
In this connection, the analyst is constantly engaged in finding a place for
the analysand in his or her mind by coming to know the patient both
consciously and unconsciously, a knowledge that is shared with the patient
(through interpretation), who deeply desires to be known. While much of the
analyst's activity may be categorized
 - 851 -

as transformations in K, the countertransference dream is a component of

“transformations in O [that] are related to becoming or being O” (Bion 1965, p.
163). This “becoming or being O” is accomplished by the analyst's receptivity
to the analysand's projected, unmentalized emotional truths (Grotstein 2004)
and the analyst's identification with them. This is a trial identification (Fliess
1942) that is perhaps the most difficult aspect of what has been called “taking
the transference” (Mitrani 2001), realized through the analyst's “dreaming the
analysis” while he or she is awake in the consulting room. I have termed the
more deeply unconscious aspect of this process dreaming the patient into
existence, an idea first coined by Ogden (2005).
The countertransference dream is thus a special instance of the analyst's
coming to know the patient while the analyst is sleeping; a significant amount
of self-analysis is required for the analyst to discern which elements relate to
the patient and which to the analyst's self. Thus, we must proceed with
significant respect for what we do not know, remaining mindful of Bion's
(1992) caveat that we should “use our knowledge and experience to gain more
knowledge and experience” (p. 183).
While it is surely true that the countertransference dream is a product of
what Ogden (1994) calls the intersubjective analytic third, my experience
leads me to conclude that there is a qualitative difference between the analyst's
reveries while awake during an analytic hour and the analyst's dream of the
patient while asleep at night. Both these kinds of dreaming may provide access
to the evolving O of the analytic relationship; however, the analyst's waking
reveries, when he or she becomes aware of being in such a state, can be
contextualized in the ongoing give and take between analyst and patient in the
analytic hour. Thus, the connection between the reverie and the analysand's
associations is more readily established.
The situation of the analyst's nighttime dream of the patient is more
complicated. On the one hand, a countertransference dream may indicate a
delayed transformation of an emotional experience from the session that was
too powerful for the analyst's reverie to
- 852 -

manage,2 a point that Ferro (2005) appears to support from a slightly different
perspective by stating that night dreams consolidate what has not been fully
processed during the day. On the other hand, in all likelihood, there have been
many intervening events in the interim between the analytic session and the
countertransference dream, and so the connection between the day's session
and the analyst's dream may be more difficult to discern. HeenenWolf (2005)
appears to reach a similar conclusion:
 Now the night dream represents a mode of psychic functioning that is
much more under the sway of the primary process of the subject (the
analyst) than the analyst's “reverie” during the session, which
remains more colored by secondary processes. Furthermore, the night
dream is temporally deferred in relation to the session. The content of
a session or other elements arising from the analytic situation are
thus in danger of being taken up and “used” for the analyst's own
psychic purposes. [p. 1545]
In this regard, the dangers of the analyst's gaining “knowledge” of the
analysand that is in reality a misrecognition appear to be greater with the
countertransference dream.
Consequently, it is difficult for the analyst to know what to do with
“evidence” about the analysand gleaned from dreams in which the patient
appears. Bion (1965) viewed the countertransference dream as an important
event, but was cautious about the use to which it could be put: “The analyst
should be cognizant of dreams in which patients appear, though his
interpretation of the significance of their appearance will relate more to their
characteristics as column 2 phenomena than to the significance of his own
psychopathology” (p. 50).3
—————————————

2 I am indebted to members of the Klein Study Group of the Massachusetts Institute

for Psychoanalysis for this observation.
3 Column 2 of Bion's (1977) grid refers to phenomena that are the stuff from which
lies and deceptions may be constructed. These occurrences exist solely in the mind of
the patient or analyst, without any corroboration from the other. Column 2
phenomena may pass for the truth, but may actually be falsehoods. Thus, the analyst
must be cautious about the use to which he or she puts the countertransference dream
because it is a potential lie (or misrecognition) about the patient, one that has a life
only in the analyst's mind.
- 853 -

Later, Bion (1967) cautioned the analyst to eschew “knowledge” that only
the analyst possesses because this may distract him or her from the more
important mission of attending to what is not known in the analytic hour. The
analyst may delude himor herself into believing the patient has been
understood by virtue of the analyst's having dreamed about the patient, but this
supposed “knowledge” may actually be a resistance to comprehending the
deeper, initially unmentalized resonance with the O of the analysand.
Indeed, Bion (1965) defines resistance as an anxiety-based reluctance to
transform K Æ O, meaning that the patient (or analyst) finds it less
discomfiting to know about some emotional truth than to experience that truth.
I believe this occurred in my dream about Mr. A when my focus on
competitive aspects served to distract my attention away from experiencing
myself as the transferential father, including the erotic aspects of this. The
same phenomenon transpired in my dream of Ms. B, when I found it more
familiar to know about oedipal issues in the termination than to experience her
profound anxiety and concern over my ability to survive without her, and how
that was linked with uncertainties in the termination of my own analysis.
The Countertransference Dream in Supervision
Just as the countertransference dream was initially viewed as problematic,
so there has also been a parallel tendency to consider countertransference
dreams discussed in supervision as reflective of treatment difficulties. Langs
(1982) did not discuss the countertransference dream per se, but offered the
view that any dreams reported by a supervisee during supervision represented a
“supervisory crisis.”4 It seems likely that he would also consider dreams of
—————————————

4 Interestingly, when this paper was presented, one of the discussants, a

psychoanalytic candidate, reported a first countertransference dream the night after
having read it. The candidate described having a sense of “permission” to dream
about a patient that reading this report by a senior analyst seemed to grant. I have
subsequently spoken with other candidates who expressed a reluctance to talk about
countertransference dreams in supervision because of some sense that they are
inappropriate.
- 854 -

one's patient as illuminating a problem in the supervising relationship or the

treatment. Such dreams convey the supervisee's unconscious perceptions of the
supervision: “Supervisees report dreams to their supervisors as a means of
conveying highly significant perceptions and fantasies that are either entirely
repressed within the supervisee, or too dangerous to communicate directly in
supervision” (Langs 1982, p. 594).
Although I believe Langs was too narrow in his exclusive emphasis on the
dream as expressing a crisis in the supervision, he nevertheless implicitly
supports the communicative importance of the dream shared in supervision. In
addition, his description of the dream as encoding something “too dangerous”
to discuss in supervision underscores the importance of the supervisee's feeling
safe to experience the emotional truth (Bion 1965; Grotstein 2004) of what is
happening in the treatment and/or in the supervision. Unfortunately, Langs's
perspective that dreams reported in supervision indicate a crisis inevitably
leads to an atmosphere that restricts the supervisee's freedom to speak freely
and candidly (not to mention the freedom to dream with a sense of abandon).
Instead, the supervisory experience ought to provide what Mollon (1989)
calls a “space for thinking” that puts out the welcome mat for a variety of
experiences, including that of reporting dreams of one's patient. This view of
supervision aims at assisting the supervisee in expanding the material
considered relevant to clinical work, emphasizing an examination of the
conscious and unconscious processes between analyst and patient, and between
analyst and supervisor, as well as the multitude of influences among these three
persons.5 This approach accesses different channels of learning and discovery
that enable both analyst and supervisor to simultaneously know about the
analysis (transformation in K) and experientially become the analysis
(transformation in O).
—————————————

5 I will not discuss here the broad literature available on this subject and instead keep
my focus on the countertransference dream. The interested reader is referred to the
many excellent articles that address this matter, including Berman (2000), Coburn
(1997), Doehrman (1976), Gediman and Wolkenfeld (1980), and Ricci (1995), to
name a few.
- 855 -

Ogden (2005) characterizes this latter approach as “dreaming up the analysand

in the supervisory setting” (p. 1267), and observes that:
Creating the patient as a fiction—“dreaming up the patient”—in the
supervisory setting represents the combined effort of the analyst and
supervisor to bring to life in the supervision what is true to the
analyst's experience of what is occurring at a conscious,
preconscious, and unconscious level in the analytic relationship. [p.
1268]
I would add that, in addition to “dreaming the patient into existence” (p.
1269) through mutual reveries of analyst and supervisor, the
countertransference dream, when shared in supervision, may constitute yet
another channel that is tuned into the unconscious resonances flowing among
the analysand, the analyst, and the supervisor.
Supervision, especially of long analyses, may become stale when it centers
primarily on extracting meaning from the verbal material, and a situation may
arise in which patient, analyst, and supervisor collude in a faux analysis and a
faux supervision. This is associated with the kind of resistance described by
Bion (1965) in which there is no transformation from K Æ O.
In this regard, I would like to revisit an earlier paper (Brown and Miller
2002)—one of the few that discusses the use of countertransference dreams in
supervision—and offer an additional perspective on what my coauthor and I
discussed at that time. We presented the case of an adolescent analysis during
the termination phase, a case in which Miller (the supervisor) and I (the
treating analyst) had implicitly acquiesced to the patient's avoidance of
emotion. There was a tacit assumption that this teenager was avoiding dealing
with separation, and my interpretations addressed his defenses against
separation feelings.
In the midst of this atmosphere of resignation, Miller told me of a dream
that he had had about me the previous night, a dream filled with much anxiety.
He offered some associations that had to do with my nearing completion of
analytic training, and also with his memories of his own son having reached
oedipal age. Interestingly,
- 856 -

several days later, I had a very frightening dream of someone with the same
name as the patient, and my associations were to scary themes of castration and
guilt related to maturing into manhood.
There were many overlapping elements in Miller's dream and my dream;
the two seemed to elaborate a previously unconscious anxiety shared by the
two of us. Thus, my dream appeared to be an elaboration of Miller's dream
about me. As this was discussed in supervision, the understanding of the
patient's “resistance” shifted from resistance against experiencing separation
feelings, to resistance against feeling terrifying “coming-of-age” anxieties. This
animated the supervisory hours, and I began to shift the interpretive focus to
the analysand's very intense anxiety about what “coming of age” unconsciously
meant for him. This change in my interventions prompted a dream of the
patient's that graphically depicted the terrors he connected to the coming-of-age
theme that permeated the total atmosphere of both supervision and treatment.
Miller and I concluded that “all three participants contributed to the affective
disavowal of termination and that reluctance occurred at the intersection of the
personalities of each party” (p. 819).
Miller and I referred to the interactive meshing of emotional vectors from
patient, analyst, and supervisor as the triadic intersubjective matrix. For the
purposes of this discussion, I want to underline the process we described in
which the analyst literally “dreams up” (while asleep, and not through the
unconscious waking thought of a reverie) the patient (Ogden 2005) and,
perhaps more importantly, dreams the “field” (Baranger, Baranger, and
Mom 1983; Ferro 2002, 2005), out of which the collective resistance may
emerge. Ferro (2005) notes that “the presence and constellation of anxieties
and defences in the analyst ‘costructure' the field together with the patient” (p.
10)—to which I would add, in the case of supervision, the defenses of the
supervisor also costructure the field. Thus, the triadically composed field of
resistance that Miller and I adumbrated, in which the treatment and supervision
were mired, may be characterized by the communal inability to transform the
field from K Æ O. It was only through a succession
- 857 -

of dreams, initiated by Miller's revelation, that the triadic intersubjective matrix

could evolve beyond the relative comfort of the familiar K (resistance to
separation anxieties) to confront the intensely anxiety-laden and shared
unknown O (terrors associated with coming of age) of the analytic threesome.
Seen from another angle, Miller, my patient, and I were engaged in a
process of mutual unconscious communication that gradually transformed
coming-of-age anxieties into a more manageable form for all of us. Miller, my
analysand, and I ran aground on the shoals of a shared resistance in which each
of us participated in our own unique way, a resistance that required analysis to
overcome. However, this was not a collective resistance that required the mere
sweeping away of defensive forces blocking its appearance, but rather one that
called for a mutual process of containment and transformation (Ungar and
Ahumada 2001)—a process enabling that which was resisted to be
represented/mentalized. Miller and I had unknowingly surrendered to a sense
that my patient was just being his typical passive self, an impression from
which we were suddenly awakened by Miller's surprise dream.
Smith (1995) links the appearance of such surprises in individual analysis
to a sudden shift in the resistance that is a compromise formation between
intersecting conflictual areas in patient and analyst:
Surprise may then reflect a momentary reorganization of those
compromises, a shift in forces as the analyst allows himself to
overcome an internal resistance and to see something “new” in the
patient because he has gained or regained access to something he has
been fending off in himself. [p. 71]
The same may be said of resistances in supervision that stem from the
failure to contain and transform unformulated anxieties resulting from a
compromise formation that draws from the unconscious anxieties of patient,
analyst, and supervisor—resistances that seem to await the arrival of a surprise
dream, whether one of waking or of sleeping, to free the analysis to take its
course.
- 858 -

Conclusion
Like any other dream, the countertransference dream has at its core an
emotional experience that is worked on to produce the dream. In the case of the
countertransference dream, the stimulus is an emotional reaction experienced
by the analyst in response to the patient. The dream may have little to do
directly with the patient, who may appear as a stand-in for someone else in the
analyst's life. However, the appearance of the patient in the analyst's dream
may also be stimulated by the transmitting unconscious of the patient, which is
making contact (through projective identification) with the analyst's receptive
unconscious, in order for the analyst to contain and transform (or “dream”)
some mental content that is as yet “undreamable” (Ogden 2004) by the patient.
I suggest that this aspect of the countertransference dream may enable the
analyst to become aware of how his or her psyche is experiencing the patient—
or, to put it another way, how the analyst is dreaming the patient into existence.
This opens the possibility of gaining knowledge about the patient, which Bion
(1965) refers to as a transformation in O—that is, the analyst “becomes”
(through introjection) the unacceptable part of the patient, finding symbols
within himor herself to represent what the analysand has been unable to
mentalize independently. I have tried to demonstrate this process both through
the detailed examination of two of my countertransference dreams, and through
a discussion of how these issues apply in psychoanalytic supervision.
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Article Citation [Who Cited This?]

Brown, L.J. (2007). On Dreaming one's Patient: Reflections on an Aspect of
Countertransference Dreams. Psychoanal Q., 76:835-861!