Emerging Theme - Resp[onding to dreams

(Web page version of Emerging Themes paper)

Responding to dreams in person-centred planning:

Stories and helpful tips

By Peter Bates, NDT

Introduction
A strong theme in person-centred planning is to pay attention to people’s dreams – their preferences, aspirations and ambitions. Dreams can be grand moments of achievement or tiny amendments that make our ordinary days more comfortable. Whether we are thinking about our own dreams, those of staff we supervise, friends or people who use services, the following four tasks are critical to this process:

We need to hear the dream – listen to the words, the feelings behind the words and the person’s behaviour in order to discover what they are striving for, what would make life better

We need to reflect on our attitude towards the person and their dream so that our attitude, values and responses don’t get in the way

We need to interpret the dream – especially when the person is unable to tell us exactly what they want in their life, we need to wisely draw out what the dream is telling us about the person and their hopes for the future

We need to harness the dreampower – rather than crushing the dream, we need to find ways to connect into the massive energy source that is represented by this dream.

Whilst some people have clear and consistent dreams, other people’s dreams are much more difficult to hear, interpret and harness. This is where the metaphor of the dream comes into its own, as our aspirations share many characteristics with night-time dreams.

The following paragraphs offer some illustrations and suggestions about how to work with dreams that are muddled, forgotten or forbidden. People attending NDT training with me during 2004 and 2005 contributed many of the ideas, although the structure of the material and responsibility for its presentation lies with me.

1. Dreams that are clear and consistent

Richard attends the day centre and has been asking if he can retire for some time, but his relatives do not want this to happen. Staff negotiated a reduction of attendance hours.

Helpful tips
	Hearing the dream. Ask, ‘if a miracle had happened, what would your life look like?’
	Reflecting on our own attitudes. Be clear whether we taking Richard’s aspirations seriously. These staff did not seem to do that.
	Interpreting the dream. Just go for it!
	Harnessing the dream. Use SMART goalsetting (Specific, Measurable, Attainable, Realistic, Time-defined) to help Richard work towards his dream.

2. Dreams that are beyond reach

Martin lives in staffed housing but wants to live with his brother who does not want to offer him a home.

Helpful tips
	Hearing the dream. Help Martin find out more about the goal – he may revise it or break it down into smaller steps. Invite Martin to visualise the fulfilment of the dream in great detail, as these details may reveal important aspects of the dream and its power. Is the dream as concrete as we are taking it to be? If it is broken down into small, achievable steps, has something been lost about the dream as a big, whole aspiration?
	Reflecting on our own attitudes. Check that I (or other people, or the rules and policies of an organisation) am not restricting Martin’s ambition simply because we wouldn’t want it in our own lives or because we have insufficient imagination, creativity, perseverance or courage.
	Interpreting the dream. Draw out the positive feelings that the dream bestows. Is Martin setting a series of challenges for the worker, as if the dream belonged to staff? Does he like to have an unattainable dream that can remain as a fantasy, rather than a job list? Is the dream somehow a denial of the past, rather than a way of planning a journey from the past to the future?
	Harnessing the dream. Help Martin harness dream power in other areas of life. Explore what life would be like if the dream was fulfilled. How can Martin take some steps towards his aspiration? Identify alternatives that are achievable.

3. Dreams that are muddled.

Susie is 38 and lives in a staffed home that is due to close. Her ideas for the future change from moment to moment, and she can say that she wants to live on her own and with others in the same sentence. Her words suggest she wants more independence, while her behaviour shows no sign of seeking more freedom.

Helpful tips
	Hearing the dream. Ask Susie to write, draw or act her dreams – this may help her to sort, prioritise or discard some elements. Allow lots of room for reflection. What would Susie ask for if she were to make a wish?
	Reflecting on our own attitudes. Does Susie feel obliged to say what she thinks others want to hear? Does she say whatever she thinks will please you at the time? Has she learnt that sharing your dreams means being given tasks and held to account, rather than just musing on possibilities? Do I really allow people to change their minds?
	Interpreting the dream.Seek common themes, recurring words or emotions within the disconnected elements. Is there one dream here or several? Look for links to what is happening at this point in time. It always feels like a muddle when we are contemplating valuable changes in our lives, when we are tired, unhappy, lonely, afraid or mentally unwell. Choose whether to go with the re-evaluation or set it aside until life is less of a muddle. How does Susie usually manage this kind of muddle in her life? Is the muddle serving some purpose?
	Harnessing the dream. Identify barriers to achievement. Identify what would make a difference. Identify times when Susie set herself goals and then reached them. Acknowledge that most of us only have rare flashes of lucidity. Motivational Interviewing offers a framework that acknowledges ambivalence and mixed feelings.

4. Dreams that are different every time

Each week Bob changes his plans for the future, from living alone to sharing with others, from living locally to moving far away, from having a job to remaining unemployed.

Helpful tips
	Hearing the dream. Why is he not doing any work on any of these dreams? You or Bob might be able to spot how the ‘different’ dreams are variations on a consistent theme. Support Bob share his real dreams in his own time. If talking is not working, encourage Bob to write or draw. Does the dream fluctuate with changes in Bob’s mood? Pay attention to what Bob is saying through his behaviour, body language or tone of voice rather than through his words - this might reveal a more consistent set of preferences and aspirations.
	Reflecting on our own attitudes. Is the question being raised too frequently? Are we asking different questions each time? This welter of dreams might be blurted out if Bob feels threatened or under pressure to invent some aspirations. Or we might feel overwhelmed and inadequate by all these things and respond by taking control.
	Interpreting the dream.Does Bob recognise that his dreams keep changing – is it meeting a need, such as keeping the worker interested or avoiding doing any work? If we work on too many things, will this lead to nothing being finished and a repeated cycle of disappointment?
	Harnessing the dream. Invite Bob to keep a log of his dreams, build a list of all the elements of all the dreams and then prioritise any that are mutually exclusive. Celebrate their richness and see if they can all be met – try them out. Different dreams can be realised in different parts of Bob’s life – work, hobbies, holidays.

5. Dreams that are unsettling

Talking about the future makes Fay shout at people all day.

Helpful tips
	Hearing the dream. Imagining an alternative future may intensify problems or make today’s struggles too big to face. Ask why exploring ambitions feels unsettling. ‘Third person’ it - ‘if this was Sue, what would it be like for her?’ Be prepared to face issues of loss, change and disappointment.
	Reflecting on our own attitudes. Maybe Fay feels unsettled because I haven’t listened properly, I am misrepresenting her dream or I am trying to deny that it is challenging. Be supportive. It doesn’t have to be deep therapy – it’s just an opportunity to unfold and accept.
	Interpreting the dream.Has the dream triggered fears – what is the worst thing that could happen? The dream might have been simple, but sharing it and breaking it down into steps makes it too complicated to face.
	Harnessing the dream. Identify the steps towards the dream that have been achieved already. Give Fay permission to be unsettled – it might be the first step towards getting settled. Offer relaxation techniques to help Fay hold on while feeling unsettled. Support Fay to let go of things that she feels are impossible. Positive change might mean letting go. Refocus on short-term goals and ask what it would look like if each bit was resolved.

6. Dreams that are private

Harry is 40 years old, lives with his sister and works 2 days a week. He has an active social life with friends from work and the day centre. He has had lots of girlfriends over the years and likes to give them gifts, but doesn’t appear to take the friendships any further. If approached, he says that he is content with his lot and never shares anything personal, although his facial expressions indicate that he is unhappy sometimes. Over the years he has built up very strong relationships with long term care staff, but he continues to address them formally rather than use first names and building closer relationships has not led to any disclosures.

Helpful tips
	Hearing the dream. We all gradually reveal ourselves – and only as much as we want, so it might be acceptable to share the dream later, or just part of the dream now. Harry’s dream will change over time, rather than being fixed until the next review of care, so we need to keep on listening. Respect privacy – allow Harry to choose whether to disclose at all, where and when. Is there a non-verbal way he can share it – drawing, acting, showing? Ask someone Harry trusts more than you – and this might be a relative or friend rather than another worker. Start with small dreams. Share your own as this may help Harry to respond with his own story. Approach it obliquely, rather than asking directly about Harry’s ambitions.
	Reflecting on our own attitudes. Build a relationship of trust and unconditional positive regard so Harry gradually feels safe enough to confide. Ensure that staff have sufficient support and space to cope with their own discomfort. Do we feel a need to know and will we feel hurt, angry or incompetent if Harry chooses not to confide in us? We may need to actively give him permission to keep it private. Is this a new and unexpected topic or do you often discuss and give priority to people’s ambitions?
	Interpreting the dream. Power, inequality and previous bad experiences of disclosing might have made Harry unwilling to share, or the belief that a wish that has been revealed won’t come true. Paranoia, anxiety and depression will reduce trust.
	Harnessing the dream. We don’t tell work colleagues about our job applications if we want to claim all the credit for doing the thing or if we like the power of keeping things private or if we want to avoid changing people’s perceptions of us. So we need to understand why Harry likes to keep his dream private. Identify strengths (this will boost Harry’s self-esteem and confidence) and show him you value him – you may be rewarded with confidences. Talk about process rather than content – can you help Harry to work with his dream even though you don’t know what it is? Explore Harry’s ideas about what the consequences would be of disclosing the dream.

7. Dreams that are unknown or forgotten.

Helena likes it here, likes everyone, and wants everything to stay just like it is.

Helpful tips
	Hearing the dream. Is she grieving over the loss of the ability to dream? Ask Helena what she used to dream about in the past or what she might dream about in the distant future. Ask what she would like to do tomorrow or next week. Ask Helena what the best and worst thing is in her life just now and use this to explore preferences and aspirations. Accept where she is now, but ask her to say why she doesn’t dream. Is her dream too small for you to see? Is Helena sufficiently confident and unafraid to dream? Build the dream out of lots of tiny preferences. Revisit the issue, as the dream that was unknown yesterday might have surfaced by today. Listen to the silences and the things that she doesn’t talk about.
	Reflecting on our own attitudes. Maybe Helena does really, but doesn’t trust you sufficiently to confide, or is so used to staff not listening, or asking about problems that these become the assumed focus of all conversations. Both Helena and you may need to raise your expectations. She might say the present is fine to show she is grateful to you. You may think that Helena’s circumstances are unacceptable and assume that she feels this way too.
	Interpreting the dream.Helena may be under such pressure to survive day-to-day life that setting targets is too big a strain at present. Old failures may leave Helena unwilling to risk more ambitions
	Harnessing the dream. Value the things that Helena likes about where she is now. Is she a contentment guru? Taste new experiences – find out about day-to-preferences, rather than big ambitions.

8. Dreams that are all about basic drives.

Joyce wants to move in with her boyfriend. A variety of agencies are involved, and day service staff talk to her about her plans, but have not actively pursued this issue. It is not clear if anyone is taking overall responsibility for helping with this dream, or whether managers would support efforts to achieve the dream, particularly as relatives are worried about her safety.

Helpful tips
	Hearing the dream. Identify the subject of the dream and acknowledge the power of these drives. Find out about the strength of the dream – is it something the person thinks about often? Does dreaming like this bring happy feelings or other kinds of responses?
	Reflecting on our own attitudes. Review your skills and knowledge – how do you respond to issues around basic drives – sex, death, power, love? Do you recognise a common humanity with Joyce and offer acceptance? Acknowledge the dilemmas at the heart of this work – allow staff to be uncertain rather than creating an impression that everything can be fixed with a policy.
	Interpreting the dream.Joyce’s basic needs may not be being met at the moment, so dreams of safety may indicate she is being abused in some part of her life. Review Joyce’s life experience, her level of socialisation and institutionalisation and any limitations placed upon her opportunities (e.g. legal detention) – can anything change?
	Harnessing the dream. Acknowledge the boundaries that constrain Joyce. Tackle it one bit at a time. Emphasise practical actions that can help. Seek ways to widen her opportunities.

9. Dreams that are ‘forbidden fruit’ – things that are illegal or things that I both want and feel ashamed about.

Gary has seriously hurt people in the past and now wants to kill a worker he feels has wrecked his life. Staff identified that he has a strong sense of justice and helped him to positively harness this by using the formal complaints mechanism to challenge the worker’s practice. Exploring his dream also led them to consider whether this sense of justice could be harnessed in other positive ways.

Helpful tips
	Hearing the dream. Continue talking and exploring until you get to something that you can work with. Where has the dream come from? Has he had similar dreams in the past? What happened in those circumstances?
	Reflecting on our own attitudes. Be respectful and non-judgemental, but take care not to collude. You will need supervision and support. Are you of the appropriate grade, role, discipline and level of responsibility? Who says it is forbidden?
	Interpreting the dream. Are there any parts of the dream that are acceptable and can be supported? Ask Gary to imagine how he would actually feel if he followed through the dream – there might be a more mixed set of emotions just under the surface. Similarly, ask Gary what he thinks would happen if the dream was followed through and explore what he thinks of these consequences.
	Harnessing the dream. Are there aspects of it that are forbidden (you can do that, but not in a public place)? Recognise moral discernment and self-restraint as strengths. Also that in sharing this dream, Gary has trusted you and shown an ability to disclose personal and perhaps uncomfortable aspects of himself – this might be a real demonstration of his wish to build an honest relationship with himself and you. Be clear and honest about boundaries and consequences. Remember that you have a duty to try and keep everyone safe, so the safeguarding role is a key aspect of the job, but should not overwhelm the task of positively harnessing Gary’s dream. Tell Gary that you may need to seek legal advice or enforce other boundaries. Are there other, less harmful ways in which he could achieve some of the feelings and outcomes associated with this dream?

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Last updated 18th March 2006
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