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The Use of the Couch

Following Freud’s practice, many psychoanalysts recommend the use of the couch for their patients in psychoanalysis. To some onlookers, the practice appears arcane or puzzling. Why the use of the couch?

Most psychoanalysts find that the couch is helpful because it takes analytic patients’ focus off the external. Instead, patients turn their attention inward, to fantasies, daydreams, feelings. Dr. John Munder Ross (1999) notes that, in lying down, peoples’ perspective changes. They focus less on objects in the environment and more on images that arise from their own minds. Not bound by an awareness of the analyst’s facial expressions and gestures, the analytic patient is more readily able to imagine what the analyst is thinking or feeling, too, which enriches the experience of analysis.

In addition, many analysts find that they, themselves, work more productively when their patients use the couch. Not constrained by social conventions— maintaining eye contact, for instance— analysts can relax more fully. Therefore, they can focus better on what the patient is saying and feeling and resonate more fully with the patient’s spoken and unspoken communications. The couch, in essence, helps analysts and their patients immerse themselves in the extraordinarily rich world of the mind.

Here are two readings of interest regarding the use of the couch in psychoanalytic treatment:

1. Ross, John M. (1999). Once more onto the couch. Journal of the American Psychoanalytic Association, 47: 91-111.

2. (1990) The Future of Psychoanalysis: The Past, Present, and Future of Psychoanalytic Theory. Psychoanalalytic Quarterly, 59:347-369 (PAQ) Arnold D. Richards, M.D. Here's an excerpt:

"Here we touch on an issue integral to any discussion of the future of psychoanalytic theory,thestatusofthe psychoanalytic method. For a century this method, along with the related notion of the psychoanalytic situation (Stone, 1961), has sustained the field. The method has never become obsolete, though it has been subject to continuing refinement. By method I refer to an analysand's attempts to free associate in a context maximally conducive to the procedure. What is essential about the context has long been subject to debate. It has recently been argued that certain features of the traditional psychoanalytic situation, such as the analysand's recumbent position and the frequency of sessions, are "extrinsic" to the mental processes engaged by the method (Gill, 1982). But what is beyond dispute is that the psychoanalytic situation makes free association possible, and free association informs us about unconscious mental processes."