Successful analysis of a dream leading to relief from the symptoms of obsessive compulsive disorder

This dream is of a 17 year old teenager; a talented musician who was plagued with crippling anxiety. Around the age of 10 or so he had crippling obsessions. He had the following dream, the successful analysis of which resulted in significant improvement: I am in my house, in my room, where I feel the safest. I hear commotion on the ground floor, as if somebody is throwing pots and pans and causing other disturbance. I come down and see my parents sitting on the dinner table. My sister is sitting on the bar stool. She is flipping a religious book. It is more like illustrated book of religious symbols, something like a comic book, for children. It is open at a page where there is cross. It is violet in color. And there is writing next to it that declares that I will be crucified for my sins. I view it sarcastically. I see two severed heads in the oven. It is grotesque but there is no blood to it. There is a sticky pad note on the oven that I will meet the same fate. Then we all sit down to dinner. Everybody knows that I will be killed, but my family is indifferent to it. Somebody comes and grabs me from behind and is about to strangle me when I wake up with fright in cold sweat. It took me long time to realize that the dream is not true. The boy came to treatment because of harrowing anxiety, constant irritability towards parents including feelings that they should die, feelings of unreality, severe fears of others, feeling that his friends and others kids don't like him, feeling like he is a fake and not a real person, fear that others can sense his thoughts and know that he is evil, guilt about having sex with his girlfriend, and thoughts of ending it all with suicide. The only relief from the turmoil in his mind and difficulty in interacting with people was in giving himself to writing music and playing it with his band. Fragments of some of his dreams had been analyzed before, and the therapy had proceeded far enough for him to have the insight that his obsessions were displaced expression of his repressed hostility. It was this awareness, along with the fact that he did not fear censure expressing such thoughts in therapy, that allowed his mind to dream the above frightening dream. I am in my house, in my room, where I feel the safest. This was the actual state of affair in his life as well. He was running away from the world out of fear of the consequences of his hostile impulses. The house and his room symbolized withdrawal into the womb - primal womb fantasy - where the dangers of the external world could not follow him. I hear commotion on the ground floor, as if somebody is throwing pots and pans and causing other disturbance. This was the stirrings of his hostile impulses in the dream. In the dream he had taken refuge in the sanctuary of your room, but his destructive impulses were following to and he had to pay attention to them as they emerged in form of pots and pans being thrown around in the kitchen. And they were emerging in regression. When he was much younger, he was given to throwing things in the kitchen when things did not go his way. I come down and see my parents sitting on the dinner table. My sister is sitting on the bar stool Now these three are the primary objects of his hostility. This had been established in earlier sessions through analysis of some of his obsessions. One such obsession was the compulsion to do everything four times. For example he had to open and close the refrigerator four times to make sure that the food inside had not gone bad [which would result in food poisoning of his sister, parents and himself; he had suffered from a few episodes of food poisoning himself]. There were four members in the family and opening and closing four times was "undoing the death wish" four times. If his attention was not fully upon this undoing process then he would have to repeat the ritual in multiple of four. He would have to do opening and closing of the fridge 16 or 64 times. His parents were on the table and the sister on the bar stool symbolized the different level of respect he accorded to his parents versus his sister. He had much greater hostility to his sister and less guilt over its emergence. That he had less probelm over visualizing his sister's death had been confirmed through analyzing a tormenting obsession of his from the past. The obsession involved checking and rechecking the toilet to make sure the cat [sister] had not drowned and died in it. She is flipping a religious book. It is more like illustrated book of religious symbols, something like a comic book, for children. It is open at a page where there is cross. Here the dream work had changed the logical sequence of the thoughts behind the facade of the dream. The punishment for the transgressions was being shown before the actual crime. The cross was showing that he will be nailed to the cross as a punishment for his death wishes. The fear that he will be nailed to the cross or subjected to other severe punishments was reinforced by his attending the Bible classes and listening to the sermons in the church when he was 10 to 11 years old. At that age his obsessions were at their zenith; sometimes he would lay awake all night dreading his impending death. Now at age 10, he believed in what was being taught to him in the church, about sin and punishment. But at 17, and under the influence of therapy, he was having doubts that if it was really possible for him to be nailed to the cross for having thoughts of his parents death. So the whole religious an-eye-for-an-eye doctrine was being mocked by declaring that it is as good as a comic book. It is violet in color. And there is writing next to it that declares that I will be crucified for my sins. I view it sarcastically. The association to the violet color was weakness and sissy stuff. This was once again making a mockery that one cannot take seriously what is taught in church about sin and punishment. I see two severed heads in the oven. The patient did not agree with my construction that they were the heads of his parents. Instead he said they were the heads of his grandfather and his girlfriend. Why them? Because his grandfather was given to licentiousness and in his mind she was no different. The interpretation was easy. It was she who had tempted him into sex, and it is she who is now causing this castration anxiety, and it is she who should be punished by beheading (a regular substitutive symbol for castration) not me. It is grotesque but there is no blood to it. It is lessening of the dread of castration to let him sleep. The essential nature of dream is to protect the person from waking. There is a sticky pad note on the oven that I will meet the same fate. His parents were in the habit of leaving sticky notes as a way of communicating in the family and generally for ordering the children to do things. This lack of direct communication, by the way, also contributed for the child to develop obsessions. So the fear of castration had its origin in fear of parents (father). Then we all sit down to dinner. Everybody knows that I will be killed, but my family is indifferent to it. It is unclear why they are having dinner. This part escaped analysis or rather I failed to inquire in to it. Perhaps it has to do with oral aggression and impulse to poison their food. Recall here his dread that he will poison them with rotten food of the refrigerator. Also at this point he also recalled a dream in which he was contaminated and had to go through a door to a chamber where he was decontaminated. This contamination dream alluding to his wish to contaminate the food of his family. The indifference of the family was alluding to the punishment being well deserved. Since he was wishing them dead, they were indifferent to his death. Somebody comes and grabs me from behind and is about to strangle me when I wake up with fright in cold sweat. This was his own violent impulses that were being redirected from others on to himself. The dreams showed it as causing the beheading of his girlfriend and grandfather and poisoning of his family but the facade could not be maintained too long and the aggression found its final outlet against his own self. Here too the dream kept on its purpose of maintaining the sleep by projecting out the violent impulse as coming from a stranger with which he can fight, but then the fear led to his not breathing [sleep apnea] and he woke up in cold sweat. It took me long time to realize that the dream is not true. This signified the intensity/strength of his desire to do harm and gave the vividness and sense of reality to the dream