The first dream reported in a psychoanalysis was once expected to reveal the patient's central psychopathology and predict treatment outcome. The author reviews several studies, according to which hardly any correlations facilitating diagnosis or prognosis were found. However, the first dream report is not without significance in the analytic relationship. It is an initiative of cooperation on the patient's side and strengthens the working alliance. It sheds light on the patient's reactions to the analyst and to beginning analysis. Interpretations of apprehension by starting analysis, disguised in initial dreams, may greatly relieve the patient. The initial dream may include information about the patient's psychopathology, but it is not possible to use this knowledge without a sustained analytic process. Some examples of initial dreams are offered, for instance, a dream of the undisguised analyst, a dream reflecting the developing working alliance, and an initial dream understood at the end of the analysis.