The Significance of Lying on the Couch in Psychoanalysis

Being a therapist, this writer recognizes the debate in the mental health profession about the use of the psychoanalyst's couch. Having had offices with couches over the years, the only patients this writer ever had who chose to use them were teenagers. Interestingly, the couch "worked". That is to say, teens who lay back on the couch did relax more during therapy and opened up about their difficulties to reveal what was troubling them.

Early Use of the Couch In Psychoanalysis and Why-Sigmund Freud

So, what is the supposed significance of the psychoanalyst's couch? Sigmund Freud, the father of Psychoanalysis was the first to utilize it in his practice. One theory is that Freud did not like it when patients looked at him--it made him feel uncomfortable in some way. As a result, he figured out a way to avoid eye contact with patients-he had them lie back on a couch. He sat slightly to the side and behind them.

Freud's reasoning for the psychoanalyst's couch was that he believed that when no eye contact was made, patients felt freer to express themselves. No facial expressions or reactions would interfere between doctor and patient. He maintained that patients could better use "free association" techniques to reach the root of their distress when lying on a couch. The patients would, in essence, be liberated to delve deeply into their own psyches with no "outside" distractions.

Other Reasons for Using the Couch in Psychoanalysis

Another school of thought on the psychoanalyst's couch is that patients tend to view it as an item of comfort and safety. It has been likened to a crib and a womb. When patients are encouraged to regress into their childhoods, it is more likely they will be able to identify the sources of their anxieties and unhappiness, according to some psychoanalysts. They see the couch as an important facilitator to the process of regression, which ultimately aids in the development of insight and awareness.

Arehart-Treichel's Ideas Regarding Use of A Couch in Psychoanalysis

Arehart-Treichel (2004), on the other hand, believes the psychoanalyst's couch places the patient in a "one down" position from the psychoanalyst, thereby increasing the power of the analyst in the therapeutic situation. She reported that David Forrest, M.D., professor at Columbia University thinks the couch may actually inhibit some patients from addressing "their deepest sexual secrets."

Arehart-Treichel advocates for psychoanalysts to throw out the couch and use chairs instead, placing them strategically to avoid eye contact and facial views. She maintains these two factors (eye contact and facial views) are distractions to the therapeutic process.

Summary

Having a couch and a few chairs available in the psychoanalyst's office assures patients will be comfortable. If a patient wishes to lie down and not have eye contact with the analyst, she can. If a patient wants to sit across from the professional and have eye contact, this choice is also open to her. The unique needs and desires of the patient must ultimately determine the significance of the psychoanalyst's couch.

Note: This author, a Licensed Mental Health Counselor (not a psychoanalyst), no longer has a couch in her office.

Sources

Arehart-Treichel, J. (2004). Analysts Urged to Consider Couch Replacement (Online). Available at PM Psychiatry Online website. Accessed on 8/18/2007 and 4/18/2010.

Feinberg School of Medicine, Northwestern University (2007). Psychoanalysis-Couch and All-Still Going Strong. Available at Northwestern University's website. Accessed on 8/18/2007. Webpage no longer active.

The Significance of Lying on the Couch At A Psychoanalyst's Office, Helium website (Original version of this article), August 28, 2007.