The Ontology and Phenomenology of Dreaming in Psychosis: A Group-Analytic Approach With a Neuropsychological Perspective *

Group-analytic psychotherapy can help people with psychosis rebuild their ability to dream, which in turn eases their symptoms. In psychotic dreaming, a crude fantasy of the primal scene dominates, unlike the richer dream phenomenology seen in neurotic patients. By systematically analyzing dreams as they evolved through three developmental phases—primordial/archaic, intermediate bodily and mental images, and reality-oriented—the work shows how patients transform this archaic core into a more adequate dream experience. The findings also suggest directions for future neuropsychological research into the neuronal correlates of dreaming in psychosis and its reconstitution through group analysis.

Study at a glance

Abstract

The present study further explores the idea presented first in my book Dreams in Group Analysis (Koukis, 2004), i.e., that group-analytic psychotherapy can help patients suffering from psychosis to reconstruct their ability to dream, thereby easing their symptoms. It demonstrates the way in which patients with psychosis transform what Freud (1900) described as the archaic ontological nucleus of dreams—a crude representation of the fantasy of the primal scene that prevails in psychotic dreaming to the detriment of its phenomenology—into a good enough phenomenology, as usually expressed in the dreams of patients suffering from neuroses. To do this, the study uses a systematic analysis of dreams as they evolved during the patients’ group-analytic psychotherapy, following the three phases of the group from its primordial/archaic (or oral-sadistic) stage, to the intermediate level of bodily and mental images (or paranoid-schizoid position), and to the level of reality (or depressive position), according to Foulkes (1964), Klein (1946), and Bion (1992) respectively. The study likewise indicates the directions in which the deficit in the phenomenology of dreaming in psychosis, especially the attempt to reconstitute it through group analysis, could be investigated by exploring the neuronal correlates of dreaming on the structural and functional level through neuropsychological research.