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The Impact of Dreams of the Deceased on Bereavement: A Survey of Hospice Caregivers

Scott T. Wright, Christopher W. Kerr, Nicole M. Doroszczuk, Sarah M. Kuszczak, Pei C. Hang and Debra L. Luczkiewicz
AM J HOSP PALLIAT CARE published online 28 February 2013
DOI: 10.1177/1049909113479201

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Counseling/Pastoral Care
American Journal of Hospice
& Palliative Medicine®
The Impact of Dreams of the 00(0) 1-7
ª The Author(s) 2013
Reprints and permission:
Deceased on Bereavement: A sagepub.com/journalsPermissions.nav
DOI: 10.1177/1049909113479201
Survey of Hospice Caregivers ajhpm.sagepub.com

Scott T. Wright, BA1, Christopher W. Kerr, MD, PhD1,

Nicole M. Doroszczuk, LMSW1, Sarah M. Kuszczak, BS1,
Pei C. Hang, PhD1, and Debra L. Luczkiewicz, MD1

Abstract
Many recently bereaved persons experience vivid and deeply meaningful dreams featuring the presence of the deceased that may
reflect and impact the process of mourning. The present study surveyed 278 bereaved persons regarding their own perspective of
the relationship between dreams and the mourning process. Fifty eight percent of respondents reported dreams of their deceased
loved ones, with varying levels of frequency. Most participants reported that their dreams were either pleasant or both pleasant
and disturbing, and few reported purely disturbing dreams. Prevalent dream themes included pleasant past memories or
experiences, the deceased free of illness, memories of the deceased’s illness or time of death, the deceased in the afterlife
appearing comfortable and at peace, and the deceased communicating a message. These themes overlap significantly with previous
models of bereavement dream content. Sixty percent of participants felt that their dreams impacted their bereavement process.
Specific effects of the dreams on bereavement processes included increased acceptance of the loved one’s death, comfort,
spirituality, sadness, and quality of life, among others. These results support the theory that dreams of the deceased are highly
prevalent among and often deeply meaningful for the bereaved. While many counselors are uncomfortable working with dreams in
psychotherapy, the present study demonstrates their therapeutic relevance to the bereaved population and emphasizes the
importance for grief counselors to increase their awareness, knowledge, and skills with regards to working with dreams.

Keywords
bereavement, dreams, tasks of mourning, hospice, grief, counseling, dreams of the deceased

Introduction deceased, and dreams in which the deceased communicates a

message to the dreamer. The variation between these models
The death of a loved one is among the most painful events a
may reflect the nature of dreams themselves, which are inher-
person can endure and one that almost all experience during ently as unique and diverse as those who dream them. These
their lifetime. The grief that follows is marked by challenges
models are also typically based on small samples using quali-
in adjustment extending across emotional, cognitive, physiolo-
tative methodologies, and there are limited quantitative studies
gical, social, and spiritual domains.1 The myriad of changes
pertaining to bereavement dreams. The literature suggests that
experienced during bereavement may also include vivid, mean-
bereavement dreams typically feature the presence of the
ingful dreams that often feature the deceased and reflect the
deceased, are highly vivid and emotionally laden, and represent
grieving process.1-4
a source of meaning for the bereaved.
Several surveys have provided evidence that dreams of
Given the prevalence and emotional poignancy of dreams of
deceased loved ones are highly prevalent among the the deceased, these dreams are likely related to the process of
bereaved.5-7 Although bereavement dreams usually include the
mourning. Worden identified four Tasks of Mourning, which
presence of the deceased, there is substantial variability in their
emotional tone and context. Several theorists have made efforts
to identify the archetypal categories of bereavement dreams,
with varying levels of overlap.2,3,8-10 These models diverge
1
Center for Hospice & Palliative Care, Cheektowaga, NY, USA
substantially with regard to dream content, yet all feature
Corresponding Author:
themes of reunion and separation. Among the most frequently Christopher W. Kerr, MD, PhD, Center for Hospice & Palliative Care, 225
cited content themes are the deceased still living and interact- Como Park Boulevard, Cheektowaga, NY 14227, USA.
ing with the dreamer, the dreamer reliving the death of the Email: ckerr@palliativecare.org

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2 American Journal of Hospice & Palliative Medicine® 00(0)

Table 1. Demographic Information of Survey Participants. Methods

Characteristic N ¼ 278 M % SD Participants
Age Participants were selected from a database of primary care-
Participants 63.37 13.77 givers of patients who died between March 2011 and July
Deceased Patients 79.00 12.66 2012 while under the care of a comprehensive hospice pro-
Gender
gram. Sixteen hundred caregivers who had indicated a willing-
Male 75 – 27 –
Female 203 – 73 – ness to be contacted after the death of their loved ones were
Ethnicity randomly selected from this database and mailed a survey
Caucasian 261 – 94.0 – package. The survey response rate was 17.4%; 279 caregivers
African American 9 – 3.2 – returned a response, and 1 response from a minor was removed,
Native American 2 – 0.7 – for a total of 278 participants.
Middle Eastern 2 – 0.7 – The mean age of the respondents was 63.37 years with a
Asian 1 – 0.4 –
range of 23 to 93 years. The mean age of the deceased at the
Multiracial 1 – 0.4 –
Relationship of Deceased to Participant time of death was 79.00 years, with a range of 35 to 101 years.
Spouse 117 – 42.1 – Almost all participants were Caucasian, and most were female.
Mother 99 – 35.6 – The majority of participants had recently lost a spouse or a
Father 26 – 9.4 – mother. Respondents had known their loved ones for an
Grandmother 7 – 2.5 – average of 51.85 years, with a range of 2 to 90 years. Table 1
Sibling 7 – 2.5 – displays more detailed demographic information.
Other 7 – 2.5 –
Friend 6 – 2.2 –
Aunt/Uncle 5 – 1.8 – Materials
Cousin 1 – 0.5 –
A 20-item survey was designed including questions regarding
Abbreviation: SD, standard deviation. basic demographics, the quality of the respondent’s relation-
ship to the deceased (eg, ‘‘How would you describe your rela-
formulate the process of bereavement in terms of tasks to be tionship with your loved one?’’), dream content and frequency
actively achieved, rather than stages to be passively experi- (eg, ‘‘Following the loss of your loved one, have you experi-
enced. The four tasks are (1) to accept the reality of the loss; enced dreams of him or her?’’), and the impact of dreams on
(2) to process the pain of grief; (3) to adjust to a world in which the bereavement process (eg, ‘‘Do you perceive dreaming of
the deceased is missing; and (4) to emotionally relocate the your loved one to have impacted your emotions in your
deceased and move on with life. He further suggested that the bereavement?’’). All survey questions were closed-ended but
dreams of the bereaved reflect their process of mourning and included spaces for open-ended descriptions of dreams and
that dream content can be correlated with the task of mourning their impact on bereavement.
they are working on at a given time.1 Various researchers have
applied this model to conceptualize bereavement dreams and to Procedures
reinforce the theory that dreams of the bereaved reflect the
mourning process.3,8,11 For example, a person struggling to After potential participants were identified, they were mailed a
process the reality of their loss (task 1) might dream that the letter describing the study and inviting them to participate
deceased is still alive, while a person working to move on with along with the survey and a preaddressed stamped return envel-
their life (task 4) might dream that their loved one appears and ope. The letter accompanying the survey explained that the par-
gives them permission to move on. Worden’s theory1 is consis- ticipants should only return the survey if they consented to
tent with dream content research, which suggests that dreams participate and to allow the use of their de-identified informa-
usually reflect the content and conflict of our waking lives.12 tion in publishable research. Respondents were also invited to
Despite this consonance between grief theory and dream request additional support through our hospice bereavement
research, there is a paucity of quantitative data on the relationship team, if they so wished.
between dreams of the deceased and the process of bereavement.
The present study was designed with the aim of learning from the Results
bereaved themselves, with the following four specific goals: (1)
assess the relative prevalence of dreams of the deceased among Prevalence of Dreams of the Deceased
bereaved family members whose loved ones died while under Dreams of the deceased were common; of 278 respondents,
hospice care; (2) explore the differences between those who 57.9% (n ¼ 161) reported dreaming of their deceased loved
reported dreaming of the deceased and those who did not; (3) ones. Those who dreamed about a loved one did so with vary-
quantify the content of dreams of the recently bereaved; and (4) ing frequency: daily (7.5%, n ¼ 12), weekly (23.6%, n ¼ 38),
assess the perceived impact of the dreams of the bereaved on their monthly (15.5%, n ¼ 25), less than monthly (26.7%, n ¼ 43),
emotional adjustment and cognitions related to their loss. and other (25.5%, n ¼ 41).

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Wright et al
Figure 1. Proportions of pleasant and disturbing dreams of the
deceased.
Comparison of Dreamers and Nondreamers
Respondents who dreamed of the deceased (mean [M] ¼ 61.21
years of age, standard deviation [SD] ¼ 14.12) were on average
younger than those that did not dream (M ¼ 66.00 years of age,
SD ¼ 12.76), t(271) ¼ 2.87, P < .01. The loved ones of those that
dreamed (M ¼ 77.19 years of age, SD ¼ 12.85) were also sig-
nificantly younger than those loved ones of those that did not
dream (M ¼ 81.63 years of age, SD ¼ 11.75), t(270) ¼ 2.90,
P < .01. Those that dreamed also knew their loved ones (M ¼
50.24 years known, SD ¼ 13.20) for a significantly shorter
period of time compared to those that did not dream (M ¼
53.92 years known, SD ¼ 15.29), t(262) ¼ 2.09, P < .05. Of
those respondents that did not dream, 52.2% (n ¼ 59) indicated
they would like to dream of their deceased loved ones.
Content of Dreams of the Deceased
Most respondents reported that their dreams were pleasant (n ¼
89), with many also describing both pleasant and disturbing
dreams (n ¼ 50). A minority experienced only disturbing
dreams (n ¼ 11) or dreams not falling into these categories
(n ¼ 10). Figure 1 illustrates the relative proportions of partici-
pants who rated their dreams pleasant or disturbing.
Most respondents who dreamed of the deceased reported
that their dreams featured pleasant past memories or experi-
ences (n ¼ 105). Other prominent categories included the
deceased free of illness (n ¼ 65), memories of the deceased’s
illness or time of death (n ¼ 56), the deceased in the afterlife
appearing comfortable and at peace (n ¼ 43), and the deceased
communicating a message (n ¼ 41). Content data are
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3
represented visually in Figure 2. Many respondents described
the content of their dreams in vivid detail, and Table 2 lists
examples for each category represented in the data.
Impact of Dreams on Bereavement
Most respondents who dreamed of the deceased felt that this
experience impacted the emotions related to their bereavement
process (60.2%, n ¼ 97). Respondents also assessed the impact
of their dreams on specific bereavement processes (increased,
decreased, no effect).The majority of respondents rated their
dreams as having no effect on 9 of the 12 processes. However,
many also reported an increase in certain emotions and atti-
tudes (eg, acceptance of death, comfort, spirituality, sadness,
quality of life). Figure 3 summarizes the reported impact of
dreams on grief responses of the bereaved.
Some reported that their dreams helped them accept the
death of a loved one. For example, one participant wrote ‘‘[the
dream] put my mind at peace about my brother’s death. I miss
him very much but I know he is in God’s hands and happy.’’
Others described how their dreams helped them to retain a
connection with the deceased: ‘‘I feel closer to mom than at the
time of her death. At the time I felt cut off. Now feel as if I was
reconnected in at least a small way.’’ Some explained how their
dreams intensified their feelings of sadness: ‘‘My sister and I
cared for our mother around the clock. The dreams just make
me sadder and I miss her when I wake up.’’
Discussion
The current study presents data from a retrospective survey
designed to assess bereavement dreams with respect to preva-
lence, content, and subjective meaning from the perspective of
the bereaved themselves. In the present study, nearly 58% of the
bereaved hospice caregivers reported dreaming of the deceased,
which is consistent with other reported prevalence rates that
range between 26% and 90%.5-7 With respect to dream content,
the results of the current study validated aspects of existing mod-
els of bereavement dreams.2,3,8-10 Commonly reported dream
content included dreams in which the deceased was alive, in
health, during illness, in the afterlife, and communicating a mes-
sage to the dreamer. Several previously described dream cate-
gories were not reported in the current study (eg, deadly
invitation or telephone-call dreams4), possibly due to limitations
of the survey questions. However, the content of dreams may
vary or depend on variables such as length of bereavement,
phase of the grief process, nature of the death (eg, violent, peace-
ful) as well as the relationship of the dreamer to the deceased.8 A
definitive categorization of bereavement dream content may
therefore prove to be difficult, if not impossible
The current results support the hypothesis that dreams of the
bereaved have an inherent therapeutic or healing quality and serve
to maintain a connection with the deceased during the bereave-
ment process. The emotional tone of bereavement dreams was
expressed as pleasant or both pleasant and disturbing, while few
reported purely distressing dreams. The type of bereavement
4 American Journal of Hospice & Palliative Medicine® 00(0)

Figure 2. Dreams of the deceased content categories by prevalence.

a
Table 2. Examples of Dream Content Categories.

Dream Content Category Example

Pleasant Memories ‘‘I find the dreams comforting – they are always of pleasant memories. I am sad to wake to reality, but the
memories override the sadness.’’
Deceased Free of Illness ‘‘I occasionally dream of my sister. She is younger with long hair - not the way she looked at her death.’’
Deceased during illness ‘‘In my dreams I see him lying there in the last few minutes of his life’’
Comfortable in the afterlife ‘‘She was in a group of three or four people and just smiled at me. She didn’t say anything, but she looked
healthy and at peace.’’
Communicating a message ‘‘My mother speaks to me while I dream. She tells me things about situations in my life and how to handle
them. I get to hold my mother in my dreams and get to feel her warmth and love.’’
Other ‘‘I dreamed of the deceased, but he didn’t know that he was deceased, and I had to tell him.’’
With other deceased loved ones ‘‘Our daughter Jane had a dream of her [deceased] mother walking on the beach shore holding the hand of a
small boy named Eric. We had previously lost a baby and named him Eric, who had died before Jane was
born. Eric was to be our last of three children, but when he died we had Jane.’’
Unresolved issues ‘‘The fact the times my mother was in my dreams and never spoke made me feel sadder. I just wanted her to
talk to me—maybe try to let me know I didn’t let her down.’’
Distressed in afterlife ‘‘I dreamed that he was very stressed and then became peaceful and went home with God.’’
a
No details were shared for the Memories of End-of-Life Services category.

dream most commonly associated with pleasant content involved
reliving pleasant past memories of the deceased.
Impact on Bereavement and Implications for Counselors
Previous studies have not asked the bereaved for their perspec-
tives on the relationship between dreams of the deceased and
the bereavement process. In this study, most respondents noted
that dreams of the deceased carried emotional significance to
their process of bereavement.
This finding has clear implications for bereavement coun-
seling. As suggested by Worden, dreams of the bereaved hold
therapeutic value in assisting to understand the individual’s
process of mourning through the identification of mourning

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Wright et al
Figure 3. Impact of dreams of the deceased on bereavement
processes.
tasks, including tasks that represent challenges and hence areas
for therapeutic focus.1 Dreams may facilitate new insights and
provide a ‘‘safe place’’ in which the dreamer identifies links
between waking events, thoughts, feelings, and behaviors—a
process that mirrors that of psychotherapy.13
Although the use of dream work in counseling may be as old
as the field itself, the body of evidence supporting the efficacy
of this therapeutic tool has grown in recent decades.11,14 There
are also limited yet promising reports on the therapeutic value
of dream work in bereavement therapy specifically. Hill et al
conducted a study of dream interpretation with 14 participants
who had recently lost a loved one and were reporting troubling
dreams. When compared to supportive therapy alone, clients
whose therapy focused on troubling dreams reported higher
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5
rates of therapeutic benefit with respect to achieving insight,
understanding, and ability to take actionable steps and were
more likely to have a greater number of positive dreams after
treatment.15 Two small qualitative studies have found prelimi-
nary support for the use of dreams in group counseling with
bereaved parents.16,17 Discussing dreams was found to assist
group participants in processing the emotions related to the loss
of their child. These studies suggest that dreams, especially
troubling ones, may warrant special attention in bereavement
counseling.
Despite the apparent usefulness of working with dreams in
therapy, relatively few therapists are comfortable using them,18
possibly due to misconceptions and negative connotations. For
example, many therapists assume that dream work is inherently
unscientific and inextricably associated with psychoanalysis.12
However, some researchers postulate that dream work is con-
sistent with an empirically based cognitive paradigm. Hess11
developed a new theoretical foundation for using dreams in
counseling with the bereaved by synthesizing the Tasks of
Mourning model with Hill’s Cognitive-Experiential Model of
Dream Interpretation,12 which is based on the principles of cog-
nitive psychology. This empirically supported theory of dream
work suggests that dreams are the consequence of the mind’s
attempts to integrate discrepant waking experiences into preex-
isting cognitive schemata. The 3 stages of dream work under
this model are (1) exploration, in which the therapist assists the
client in identifying the significance of dream symbols through
an associational process, (2) insight, in which the client is
encouraged to link these symbols to waking thoughts, feelings,
and experiences to develop a collaborative interpretation of the
dream, and (3) action, in which the client is encouraged to take
concrete steps based on the interpretation. Hess provides exam-
ples of how all 3 stages in the cognitive–experiential model can
be applied to a dream associated with any of Worden’s four
Tasks of Mourning.11
We did not assess the tasks or stages of mourning, but it is
interesting to examine how dreams reported in our survey can
be accounted for by each task. Some examples follow, using
the framework established by Hess in her application of Hill’s
model. It is important to note that according to this model, no
dream can be interpreted in isolation from the dreamer. Thus,
the following examples are not intended to model the process
of interpretation.
One participant wrote:
I’m searching for mom in my dream but I cannot seem to find
her. When I awaken I realize it is a dream.
This dream may reflect the dreamer’s struggle to accept the
reality of their loss (task 1) and their mind’s attempt to integrate
this highly discrepant experience into cognitive schemata. The
repeated jarring experience of awakening to find that the
deceased is, in fact, no longer present can force the dreamer
to slowly accept the finality of what has occurred. A bereave-
ment counselor’s task in working with someone at this point in
the process might involve using the dreams to promote insight
6 American Journal of Hospice & Palliative Medicine® 00(0)
into the reality of the situation and to assist them in processing
the implications and ramifications of that reality.
Another participant noted:
When I awaken from my dreams of mom I find myself crying
uncontrollably. Mom was my life. Losing her has affected me
as far as my life seems so empty at times. At times the pain
is unbearable.
Here, it seems that the dreamer has accepted the fact that
her mother is not returning and is experiencing the incredible
pain associated with grief (task 2). For a counselor presented
with this client, dreams may serve as means for facilitating
expression of feelings, exploring the sources and meaning
of pain, and facilitating a discussion of coping skills
development.
A third participant described her dreams of her mother:
I have had dreams of my mother on special occasions (eg,
mother’s day, birthday, etc) and her indirectly relaying a
message to me and helping me in life generally.
This series of dreams may reflect the dreamer’s process of
adjustment to life without her mother (task 3), which includes
the realization that her mother is no longer around to give
advice or to assist her. This represents what Worden termed
an external adjustment, involving a change in one’s functioning
in the world. He also identified internal and spiritual adjust-
ments, relating to one’s sense of self and assumptive world-
view, respectively.1 A counselor working with this client
might make use of dreams in exploring the ways these changes
are reflected through dream symbolism. One possible insight
gained from these ‘‘advice’’ dreams in particular might be the
realization that the dreamer possesses the necessary strength
and wisdom to manage her life with in herself, as evidenced
by the helpful nature of these dream messages.
A fourth participant wrote:
I dreamed that my husband was there and I asked him to come
back, but he wouldn’t come back. He told me he was leaving
me for someone else. I had this dream several times. Then, after
I began dating someone I had the same dream, but at the end he
said he would come back, and I told him I didn’t want him back.
He got into his truck and left.
This dream may reflect the entire process of working on the
tasks of grief beginning with the dreamer’s repeated attempts to
bring her husband back into her life. The changed ending in the
final dream seems to reflect that the deceased’s role in the drea-
mer’s life has changed, and that she is moving on with her life
(task 4). The dreamer’s decision to date someone new is
reflected in her attitudinal shift in the dream. It is possible that
such a dream may raise feelings of guilt in the dreamer, and one
task for a grief counselor would be to assist her in understand-
ing the ways her relationship to the deceased has changed. As
Worden suggests, this task is not about ‘‘forgetting’’ the
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deceased but rather about reinvesting one’s energy in new
relationships and life experiences.
Limitations and Suggestions for Future Research
There are several limitations to this study. In spite of the overall
high survey completion rates, many respondents did not com-
plete the section indicating the impact of their dreams on grief
responses (34%-39% of participants left various parts of this
section blank). It is possible that these respondents did not feel
that they could identify the impact of their dreams with that
degree of specificity. In fact, most who did complete this sec-
tion reported that their dreams had ‘‘no effect’’ on the specific
emotions related to bereavement. This reflects a stark contrast
to the 60% who indicated a general impact of their dreams on
their bereavement. A second limitation was that the current sur-
vey instrument did not include all dream content categories as
suggested by other researchers. This limited our ability to
assess the relative validity of these models. A third limitation
was that date of death information was not included in the
survey, preventing analyses between elapsed time, content, and
impact on bereavement. Furthermore, cross-cultural analysis
was prevented by the sample’s cultural homogeneity.
Future research could solicit more open-ended information
regarding the impact of bereavement dreams on the process
of mourning over time by inquiring about elapsed time since
death, expanding dream categories, and assessing the respon-
dents’ current tasks of mourning as described by Worden.1
Because this study was retrospective, its results are subject to
recall bias on the part of participants who may only have
remembered or reported their most striking and memorable
dreams. Future research could utilize dream diaries to facilitate
dream recall and a prospective design to capture dreams as they
occur. Further research may also be warranted to determine the
efficacy of bereavement therapy that includes dream work
based on the approach described by Hill12,19 and Hess.11
Conclusions
This study achieved its four goals. First, the relative prevalence
of dreams of the deceased was found to be high among recently
bereaved hospice caregivers, congruent with earlier studies.
Second, we found some small differences in age and length
of relationship between those who dreamed of the deceased and
those who did not, suggesting that these variables might have a
relationship to dreaming. Third, this study quantified major
dream content categories, providing validation for earlier mod-
els. Finally, and most importantly, this study demonstrates that
many bereaved persons consider their dreams to be important
features of their bereavement. This suggests that dreams
deserve increased clinical attention from counselors who work
with this population, in spite of the widespread reluctance of
counselors in general to address dreams. Empirically validated
approaches to dream work such as the Cognitive–Experiential
Model may prove a useful tool for bereavement counselors.
Although working with dreams is clearly not a panacea for the
Wright et al
pain experienced by the recently bereaved, the present study
provides initial justification for further inquiry into this
approach.
Acknowledgments
We would like to thank William D. Riemer for his technical assistance
with developing a database for the study.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship,
and/or publication of this article.
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