The Significance of Lying on the Couch at a Psychoanalysts Office

“After eight years, I got up from the couch one day and offered my analyst a draw. We shook hands.”
– Woody Allen

The use of the psychoanalyst’s couch during a counselling session originated with Sigmund Freud, who felt that where no eye contact or other non-verbal interaction could exist, the patient would find it easier to “open up”, free of external distraction. It has also been speculated that Freud himself may have felt uncomfortable with the idea of eye contact with his patients.

While the modern use of the couch is intended to allow clients to relax and make it easier to “open up”, sidestepping the potentially confrontational nature of the face-to-face interview, it has not escaped modern practitioners that the couch also reinforces a power hierarchy between analyst and client at the very basic levels of height, one-way perception, and implied control. The relationship betwen analyst and client requires trust: but the couch almost demands it, and that in one direction only. While a few clients can and do feel more comfortable in placing such complete trust in their therapist right from the beginning, more find themselves feeling vulnerable, and perhaps unnecessarily defensive. Thus, although lying down normally triggers lowering of blood pressure and a slowing of the pulse rate, the couch interaction in and of itself can quickly escalate to exacerbate existing trust issues and control anxieties.

Some therapists prefer to view the couch as a kind of medical examination table, only for the mind instead of the body. Ironically, this view has arisen in parallel to a movement by alternative medicine providers away from the traditional examination table, feeling that it does not promote an optimal healing environment.

Consequently, many modern therapists choose to give their new clients a choice between couch or a comfortable, chatty chair; or to eschew the couch entirely in favour of an easy, conversational environment.

In the end, the choice remains with the client: whether to accept a particular therapist’s style and trust that therapist to work with them toward a desired end; or to reject both couch and chair, shake hands, and call it a draw.