Danielle Bergeron has written cogently and beautifully about the use of dreams in psychosis psychotherapy-helping the person with schizophrenia move from delusion to greater differentiation between internal and external reality. I have found that the use of the therapist's dreams of an analysand especially helpful at times of impasses and stasis in the therapy. Recently, a person I am seeing (whose delusions and suicidality has led to multiple hospitalizations and forensic involvement), has moved into an adamant and rather contemptuous refusal to make any emotional use of me. He refused to see what was going on in his internal world, transference, past experiences, etc. Having endured this for a very long time, I had a dream based on a memory (similar to the delusional process he himself engaged in-a memory leading to a delusion-I had a terrifying memory leading to a terrifying dream). It was imbued with sadism and horror. The memory I had was of a scene from a 1950's horror movie in which someone used binoculars in which rods drilled into his eyes causing him to become blind-his face was a bloody mess (I also wondered about my own parents allowing me to see such a film and the issue of parental protectiveness-which plays a strong role in my analysand's early life). The dream involved an assassin doing this to him and then pursuing me to do the same. It occurred within the confines of a hospital which became a university (my own and my analysand's defensive use of intellectual and academic involvement to stay out of madness). I awoke before being blinded. I told my analysand the dream. This resulted in a much deeper emotional relatedness between us. I was afraid at first of his interpreting my murderousness towards him. We got to the not seeing eyes-blinding oneself to avoid a deathlike state (which from my way of thinking is a form of madness which is designed to ward off madness). A wave of intense sorrow and sadness permeated his feeling state. He remembered one of his first suicide attempts as a youngster and wondered what could have happened to him to drive him into that state of utter despair and mental pain. He discovered within himself compassion for this youngster inside who has been hell bent on killing himself (and almost succeeding) for many years of his life.His arrogant, contemptuous and haughty narcissistic state seemed to thaw out, at least for the time being.

Brian Koehler