The initial dream reported in psychotherapy provides clinically useful information. Analyzing 63 patients' first treatment dreams, independent evaluators found that these dreams almost always contain negative emotions. The psychodynamic themes in these dreams reliably predict core issues that emerge later in therapy. Transference—feelings toward the therapist—is evident in many initial dreams and is often negative. The most common dream themes fall into relational or injury categories. These themes, along with positive or negative transference, relate to how well patients progress in therapy. The findings confirm that the first dream reported in treatment offers significant predictive and clinical information.
Affect is central to understanding dreams, but it is unclear whether affective or narrative aspects drive dream development. In 24 patients who completed psychoanalytic treatment, affect appeared in 58.3% of manifest dream reports. The valence of affect became more positive over treatment, rising from 19.2% in the first dream report to 53.3% in the last. When affect was absent from a dream report, associations to the dream contained affect 94.1% of the time. Overall, affect was present in either the dream report or its associations 97.9% of the time. The positive shift in affect likely results from psychotherapy, though psychotropic medication (used by 46% of patients at the last dream report) and the passage of time may also contribute.