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Sine qua non means literally “without which not” and is usually translated as “indispensable” (Mawson, 1975). In the course of the history of psychoanalysis, the use of the couch has moved on a continuum from incidental adjunct, to helpful facilitator, to “without which not.” Each such shift has marked a change in our understanding of psychoanalytic technique and of the place of the couch within it.
As Freud pointed out in 1913, the use of the couch was almost accidental at the outset—an accident of history in the hypnosis heritage of psychoanalysis and an accident of history in Freud's personal distaste for being looked at for long hours each day. As Freud (1913) put it in “On Beginning the Treatment”:
Before I wind up these remarks on beginning analytic treatment, I must say a word about a certain ceremonial which concerns the position in which the treatment is carried out. I hold to the plan of getting the patient to lie on a sofa while I sit behind him out of his sight. This arrangement has a historical basis; it is the remnant of the hypnotic method out of which psycho-analysis was evolved. But it deserves to be maintained for many reasons. The first is a personal motive, but one which others may share with me. I cannot put up with being stared at by other people for eight hours a day (or more) [pp. 133-134].