Regular Features:
Edition 3: Feb 09



Deb's Digest
Deb Gould

> Deb Gould is a STARTTS Clinical Psychologist and clinical supervisor.

 

Nightmares

You are 12. You wake up at 5am, having seen in terrible detail your home being burned. Your father has pulled you from the flames and you stand outside together, watching your sister burn to death. In a rage of pain, your father shakes you. You cannot go back to sleep, fearing that you will be taken back to the burning house. You wake feeling unprotected, grieving, scared and perhaps guilty. In the morning, you see your father in the kitchen and feel intensely anxious. At school you are tired and constantly think of the flames, checking to see where the fire hydrants are.

Nightmares are re-traumatising: the intrusion of visual images of the trauma mobilises primitive survival reflexes which involve physiological hyperarousal and subsequent avoidance (in this case, of sleep). It is not surprising that nightmares are a symptom of PTSD. They are bad dreams that go a step further, carrying a sense of impending and inevitable pain or death and feeling very real. This is more acute for children who are less able to separate internal from external: in her post-nightmare confusion the child does not know that the father who shook her in the dream is not the very father before her at the table. I hold in my mind that this is how her internal world is populated and that someone not only failed to protect from danger but has caused pain.

I once read that nightmares are the psyche’s attempt to resolve core anxieties (for example about abandonment, destruction and goodness) by revisiting them. The more I think about it, the less useful I find this explanation in relation to traumatic nightmares. The post-traumatic nightmare is different from others; its content is very close to what was once reality; the details and plot are usually represented directly. Even psychoanalysts tend to take the unusual approach of not working symbolically with post-traumatic nightmares as symbols are not used by the mind to disguise the threat or the anxiety.

Some people’s nightmares don’t fulfil a restorative function. They often recur for many years after the trauma. There is no development of new narratives, particularly when the degree of anxiety awakens the dreamer and the story remains incomplete. In these instances, it would be important to provide support against the anxiety so that a healing narrative can be developed. This could be achieved in many ways but I’d like to mention an approach I have found useful. Once the story of the dream is told it takes on slightly externalised feel and we might discuss, draw or role play various possibilities:

  • for outcomes if they had stayed asleep;
  • for protection eg a shield, a soldier;
  • active ways of being in the dream eg asking questions of the attacker, demanding safety.

And sometimes, the telling is simply an opportunity to desensitise where the images become memories and eventually decreasingly anxiety laden. There is much we don’t know about nightmares. We do know that these intrusions of trauma into sleeping life have impacts on a child’s capacity to be present in their lives. Working through them can offer an opportunity to discover resources believed to be lost or destroyed.  

> Deb Gould
Deb is a Clinical Psychologist and clinical supervisor at STARTTS. She was trained in South Africa and has over 20 years experience as a clinician and supervisor in the psychotherapy field.

 

 

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