Working with dreams in psychotherapy can be an effective vehicle for accessing feelings and conflicts in metaphoric form, enhancing the collaborative alliance, and facilitating important insights that may help assess psychopathology, personality styles, and patient responses to psychotherapy. Caution should be used in making literal or fixed interpretations of dream symbols from a theory-based expert model. Clinical and ethical considerations favor an individualized and collaborative approach that respects the culture, beliefs, life experience, and emotional sensitivities of the dreamer and considers multiple levels of meaning by forming and testing interpretive hypotheses. Deferring quick interpretations, psychotherapists and patients engage in a creative process of exploring the feelings and associations triggered by the dream and subsequent dreams. This leads to discovering connections between the dream narrative and the dreamer’s past experiences, relationships, family of origin, and trauma and to presenting conflicts, issues of identity, mood regulation, developmental challenges related to life passages and crises, and possible cultural, existential, and spiritual dimensions of the dream.