Brief Notes on Using the Couch

The couch has become the analyst's trademark and logo. The conflation of analyst and couch into the sanctioned semblance of psychoanalytic treatment appears to have been accepted by psychoanalysts as much as by the public. It is exceedingly rare to see the routine use of the couch either challenged or affirmed in the psychoanalytic professional literature. The use of the couch seems to be taken for granted when psychoanalysis is the treatment of choice. To be sure, not every analyst does in fact position every patient on the couch regardless of other considerations. There are some psychoanalysts who occasionally, but rarely, will analyze their patients in a sit-up, face-to-face position when this seems indicated. Except for omitting the use of the couch, such analyses may be technically indistinguishable from the traditional analytic methods.

The origin of the recumbent position in psychoanalysis is derived from hypnosis, its ancestor in medical practice. The procedure of having the patient lie on a sofa while the analyst sat behind the patient out of sight was thought by Freud (1913) to be a ceremonial and historical remnant of the hypnotic method. He thought it deserved to be maintained for a number of reasons, some of which he listed. They bear repeating.

First, Freud said he could not put up with being stared at by other people for eight hours a day or more. Second, he did not wish the expressions on his face to give the patient material either for interpretation or to influence him or her. Third, he was trying to prevent an imperceptible intermingling of the transference with the patient's