The dreaming therapist: use and meaning of countertransference dreams in psychotherapy. A scoping review

Introduction: Empirical and clinical evidence demonstrates that dreams psychotherapists experience about their patients, also known as countertransference dreams (CTD), contain valuable information about the nature of the therapeutic relationship and can provide psychotherapists with important clinical insights. The objective of this scoping review is to explore existing evidence on countertransference dreams in therapeutic, as well as their use and significance throughout history, trying to answer research questions such as which thematic categories can be identified within CTD and how are these dreams utilized within the therapeutic process. Methods: A systematic search was conducted in PEP Web and EBSCO/PsycINFO and an array of additional databases, including studies published from their inception until February 5, 2025. Eligible studies included literature that document dreams experienced by psychotherapists, irrespective of their theoretical orientation or background, in which the subject of the dream was their own patient or the therapeutic relationship. Studies that provided information on the nature and use of countertransference dreams were also included. The findings have been synthesized into a narrative summary. Results: The countertransference dreams included in the scoping review were categorized based on the presence of the following themes: a) danger, b) care, c) aggression, d) sexuality, e) helplessness, f) intrusiveness, g) closeness. The use of countertransference dreams by therapists was examined through a narrative approach, with a focus on the profiles and characteristics of the patients associated with these dreams. This review underscores a notable increase in the focus on countertransference dreams beginning in the 1990s, reflecting a broader recognition of this aspect of the therapeutic relationship during that historical period. Discussion: The aim of this scoping review is to enhance our comprehension of the unconscious realm experienced by therapists by offering a systematic arrangement of the predominant characteristics and applications of countertransference dreams. The present study undertakes a comprehensive analysis of CTD throughout history, with the aim of broadening our understanding of the intricacies of the therapeutic relationship. Additionally, it seeks to explore the potential clinical insights that may be revealed when therapists dream about their patients.