Fantasy Lives: Why Patients Hide Their Fantasies from Their Therapists

September 28, 2025

Abstract
How do we deal with  mental experiences that fall into the gaps between our diagnostic categories, things that have perhaps not  yet been adequately named or categorized, things for which neither patient nor therapist have clear or common  language? 

“Psychosis “is a word that evokes so much fear in most patients that they hesitant to share experiences that might invite the diagnosis. An example is Immersive (IM) or Maladaptive Daydreaming (MD, Somer, 2002, 2017). Research suggests that while the ability to engage in extended “real-as-real” fantasy scenarios may be present in 2.5% of the normal population and rise to 9-14% in a traumatized population, most patients who have this ability report that they have told no one about it, not even their therapists, for fear being hospitalized or being deprived of their comforting “secret lives”. While some of these patients mention excessive fantasy in passing, the relevance of the admission may not be recognised by a therapist who does not see fantasy as a potential problem. Few therapists have received any specific training in identifying or managing disordered levels of conscious fantasy. There is currently a gap in clinical knowledge of  how to evaluate fantasy using  empirically tested scales and how to work with it therapeutically. 

Researchers have long understood that fantasy serves adaptive functions including self-soothing, self-esteem repair and creative problem solving. Highly imaginative but traumatized, lonely or neurodivergent children and adults may privately, but intensely, invest in fantasy companions as emotional attachment objects and draw on them as sources of reassurance, guidance and support while avoiding or neglecting real relationships. For a “fantasy-prone personality” (Wilson and Barber, 1983) who is capable of profound absorption (Tellegen, 1974) and vivid visualization, immersive fantasies may become a defensive refuge or an intractable behavioral addiction, disrupting work, social-life or studies. 

This presentation will explore current research on MD,  introduce the empirical assessment scales and relate MD to current studies of attention, mind-wandering and the default-mode network (DMN) of the brain which suggest that fantasy in the form of loose associative thought and more-or-less coherent stories make up a significant part of our conscious waking hours (Killingsworth and Gilbert, 2010). 

Phenomena such as  the imaginary friend of childhood, lucid dreaming, mediumship trance, “past lives”, “reality-shifting” and “tulpamancy” will be considered as fantasy-based experiences related to IM and MD.

Distinguishing characteristics and common denominators between DID and MD will be briefly outlined and MD’s frequent comorbidities with neurodivergences such as ADD, ASD and intellectual giftedness will be discussed.  Case presentations will suggest avenues for clinical work and treatment.

Potential to Distress: No

Target Audience

Beginning/Introductory

Learning Objectives

At the conclusion of this session participants will be able to:

  • Identify common indicators of maladaptive daydreaming (MD) in adults and children
  • Differentiate Maladaptive daydreaming from normal daydreaming or psychotic hallucinations      
  • Administer and interpret the empirically validated screening instrument the 16 Item Maladaptive Daydreaing Scale (MDS-16)    
  • Screen for MD as a rarely disclosed  or considered comorbidity in some ADD, ASD and intellectually gifted individuals
  • Describe the main current treatment directions for Maladaptive Daydreaming
Course summary
Available credit: 
  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Course opens: 
07/01/2025
Course expires: 
12/31/2050
Event starts: 
09/28/2025 - 4:30pm EDT
Event ends: 
09/28/2025 - 6:00pm EDT
Part of: 
Minding the Gaps: Listening for the Unspoken and Seeing the Unseen - Day Two
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Susan Meindl, MA
Susan Meindl is a licensed Psychologist and clinical supervisor in private practice in Montreal. She is a graduate of the McGill Counselling Psychology program and the Argyle Institute Psychoanalytically Oriented Psychotherapy program. She is a member of the Ordre des Psychologues du Quebec, the Ordre des Conseillers et Conseillères d'Orientation du Québec, and a qualified member of the Quebec, Canadian and International Psychoanalytic Associations. 

Available Credit

  • 1.50 APA
    The International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
  • 1.50 ASWB ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
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