Dream Analysis in the Treatment of Psychosis

​Working with psychosis in psychoanalysis is taxing. The delusion that stitches together the ego of the psychotic subject is difficult to encounter day in and day out, and a false step on the part of the analyst may lead to an acting out that ruptures the treatment at best or, at worst, leads to more terrifying consequences. Jacques Lacan offered a theory of psychosis that has allowed the Freudian School of Quebec to develop a holistic treatment model, founded in psychoanalysis, that has proven effective in allowing psychotic patients respite from their delusions, and given them the ability to live, work and love. Their work with psychotic patients often centers on dreams. The dream, as a function of psychic life not subject to the same censorship as thought in waking life, offers a challenge to the delusion. If the analyst can sustain this challenge in the dream analysis, the psychotic may be led to question their delusion and begin the arduous process of rebuilding a healthier psychic life. Bret Fimiani is a psychoanalyst working in Oakland with people experiencing psychosis. He has worked and studied with The Freudian School of Quebec for years and is on the Board of Directors of the Hearing Voices Network. His 2022 book, "Psychosis and Extreme States" is a manual for the treatment of psychosis. Dr. Fimiani returns to Sacramento this year for a talk focussed on working with dreams in the treatment of patients suffering from psychotic disorders.