MHM Magazine

40 | MENTAL HEALTH MATTERS | 2022 | Issue 5 MHM Here are three levels of using REM dreams in patient care: Minimal Facilitation A healthcare worker may simply ask a patient to think about what they dreamt about to aid the patient to become more conscious of their family, personal, collective, and cultural influence on a decision to take a certain medication or to undergo a necessary hospital procedure. This may challenge the patient to explore their personal unconscious in their recovery process. For example, a patient may have dreamt about being at their grandmother’s funeral who died of an adverse reaction to medication used during hospital treatment. The same patient may be faced with a decision to start a new trial of medication. The dream may then signify a fear based on a real past event causing panic or apprehension in the patient. The healthcare worker does not actively need to be a part of this process but may simply engage the patient in a discussion encouraging them to make the connections themselves. In addition, a healthcare worker may simply ask a patient if the mood they woke up in is due to a bad dream that they had, encouraging that patient to explore it further with a mental health practitioner with training in dream analysis. This is expected to assist in addressing unconscious influences on the patient’s recovery. Moderate Facilitation Asking a patient to focus on symbols or strange occurrences in the dream they had may reflect more in-depth meaning about what a patient may be processing. For example, a patient may dream about all their hair falling out although they have perfectly healthy hair (in reality). This may symbolise having to accept body changes related to losing their youth or vitality, especially if they’re a patient (for example) that has been diagnosed with a chronic illness. In making this connection the patient may be able to better channel their energy into actively feeling youthful and focusing on other aspects of youth they still possess unaffected by the chronic illness they have been diagnosed with. Here, dreams can be used to redirect a patient’s energy from irritability, lowmood, and lowmotivation to making the most of the inevitable circumstances. Through this, looking at a patient’s dream assists in processing an unhealthy complex a patient may have about themselves that impacts negatively on compliance and successful recovery. Maximum Facilitation Asking a patient to focus on all symbols in the dreams and how they interact with each other, and to explore this further with their treating psychologist or other healthcare workers with training in dream analysis. For example, a complex patient with an unknown diagnosis may dream of themselves as a doll, where their significant partner is a child playing with other dolls, only noticing the doll that represents the patient once it starts breaking or bleeding. This dreammay represent multiple underlying psychological conflicts in a neglectful marriage that has resulted in a patient presenting with conversion disorder. In this case referral to a relevant mental health practitioner may assist in using the dream as a diagnostic tool. In addition, for dreams that have come to life; for example, after a terminal diagnosis (or during the acute treatment of a serious illness) if a patient begins sleepwalking or talking in their sleep, as well as, having a disturbing recurring dream or of a loved one that has passed on this may be symbolic of a plethora of psychological challenges. In these cases, further recommendations to a sleep specialist (i.e., neurologist specialised in sleep, sleep clinic etc.), mental health practitioner, hypnotherapist, and or spiritual practitioner may assist the patient to explore their personal and collective unconscious that may be part of their medical ailment. The Dreamless Patient Dreaming is a natural state of mind. If a patient is unable to dream it may be an indication of severe depression, severe PTSD, substance abuse, imbalanced circadian rhythms, sleep breathing disorders (severe snoring, sleep apnoea etc.) or because of overmedicating. Conclusion Healthcare workers are encouraged to take time analysing their own dreams and to seek out reputable information about basic dream analysis or to register in a course (scope permitting) that may help them understand their patients better, using dreams. It’s also important that health workers never directly interpret their patient’s dreams for them in keeping with ethical care and professional boundaries. With this is mind using dreams in patient care can reap great rewards in improving patient care.