The Clinical and Predictive Value of the Initial Dream of Treatment

The authors collected the initial dreams of treatment from 63 patients and independently evaluated the manifest dream report (MDR). Variables included: Affect and Valence of Affect; Associations; Psychodynamic Theme; Psychodynamic Theme as Predictor of Core Psychodynamic Issues; Transfer- ence; Gender; Psychodynamic Theme Categories; Clinical Progress in relation to Psychodynamic Theme Categories and Transference. The initial MDR invariably contains Affect that is frequently Negative. The Psychodynamic Themes of MDRs are dependable predictors of Core Psychody- namic Issues that emerge during treatment. Transference is evident in a signifi - cant number of MDRs and is often Negative. Gender of the majority of MDRs is predictable. The most frequent Psychodynamic Themes of initial MDRs fall into Relational and Injury Categories. Relational and Injury Themes, as well as Positive and Negative Transference, are associated with clinical progress. This study confi rms that the initial MDR of treatment provides a signifi cant amount of clinical and predictive information. Historically, the initial dream of psychoanalytic treatment is considered to be of special signifi cance. Stekel (1943) proposed that the fi rst reported dream reveals the patient's entire life history. Saul (1940) concluded that early dreams reveal the patient's core psychodynamics, and are more revelatory because they are not yet infl uenced by interpretations and resistance. Bressler (1961) observed that the initial dream is similar to a Catholic confessional; it contains the basic elements of the patient's