Dream processes and affect regulation in psychotherapy: a longitudinal clinical case study.

Abstract

Anxiety disorders frequently emerge in contexts of chronic interpersonal stress and are often accompanied by disturbances in affect regulation and heightened sensitivity to bodily signals. In patients with chronic somatic conditions, these processes are commonly conceptualised within psychosomatic frameworks emphasising interactions between emotional regulation and stress-related bodily systems. Although psychotherapy may facilitate psychological adaptation, less is known about how dream processes reflect ongoing changes in affect regulation during treatment. The present study explores longitudinal changes in dream narratives during psychotherapy in a patient with anxiety and depressive symptoms in the context of ulcerative colitis. A qualitative, process-oriented longitudinal case study was conducted within analytically oriented psychotherapy with a 28-year-old patient. Over one year, the patient recorded dreams, from which five clinically significant dreams were selected. Dream reports were analysed alongside psychotherapy process notes and in-session associations using thematic analysis, informed by Jungian amplification. Three thematic constellations were identified: vulnerability and loss of control; threat perception and emotional overwhelm; and emerging control and agency. Early dreams reflected helplessness and heightened threat sensitivity, whereas later dreams increasingly depicted the dream-ego as capable of recognising danger and responding more adaptively. Findings suggest that dream processes may serve as indicators of changes in affect regulation and relational functioning, offering a process-sensitive window into psychotherapeutic change in psychosomatic contexts.