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Of 46 cases of psychodynamic psychotherapy, 23 clients presented at least 1 dream, with discussions averaging about 13 minutes in length; only 5 clients discussed dreams in 3 or more sessions (case studies are provided). The clients who discussed dreams, as compared with those who did not, had more positive attitudes toward dreams and lower attachment anxiety. Encouragement to discuss dreams did not have an effect on the amount of dream work. Therapists primarily listened and asked for description of images when working with dreams. Greater use of exploration activities during dream work was associated with higher client and therapist ratings of session process/outcome. Clients who talked about dreams indicated that they did so because they wanted insight or had troubling dreams; ultimately, they found the dream work to be helpful. Clients who did not talk about dreams tended not to remember dreams and thought other issues were more important to discuss in therapy. Evidence for the effects of dream work was mixed. Implications of results for practice and research are discussed.