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The evolution of the meaning and use of the couch in analytic treatment is examined by the author, a practicing psychoanalyst and founder of the Philadelphia School of Psychoanalysis. Stern creatively pursues theoretical and clinical aspects of the use of the couch in order to gain an understanding of “how the process of symbolization has seized upon the couch both to obfuscate and highlight its true significance” (p. 13).
Stern reviews the cultural implications of the use of the couch from the perspectives of various psychotherapeutic modalities and patients. In our culture, the patient who “lies down” is symbolic of a passive attitude toward authority. Stern suggests that by choosing the couch as a clinical tool, Freud invited a passivity associated with the feminine personality, while at the same time providing access to the patient's mind undistracted by visual stimuli. Passivity and protection from stimuli may be seen as recreating the physical conditions for the rebirth of the mind.
In discussing the significance of jokes about the couch, Stern points out the relationship of humor to the direct expression of aggression and sexuality. The unconscious expectations of the passive, reclining patient are disappointed by the inactivity of the analyst who merely listens when the patient expects he will actively “do something” to effect a cure.