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In recent years, Freud's theoretical and clinical propositions have been challenged or reformulated by a number of psychoanalytic scholars and clinicians. The changes represent a shift in the focus of psychoanalytic investigation, both clinically and conceptually, from the oedipal to the more archaic, from the verbal to the nonverbal, from the intrapsychic to the interpersonal and to the intersubjective, and from the study of the patient apart from the analyst to the study of the patient-analyst dyad in which both participants receive more or less equal attention. This change in focus has provided a very different perspective of the journey into the unconscious from the one that Freud had originally conceptualized.
The traditional analytic setup, in which the patient lies on the couch with the analyst sitting behind it, was designed by Freud as an intrinsic part of the journey into the dynamic unconscious and the recovery of the repressed. Given the much wider scope of many contemporary psychoanalytic theories, it is rather surprising that practically nothing new has been proposed to replace or modify the traditional psychoanalytic setup in general and the use of the couch in particular.
Regardless of the school(s) of thought within the boundaries of which the analyst conducts the analysis, the use of the couch remains the common denominator about which there seems to be very little open controversy among psychoanalysts. Thus, the use of the couch seems to be one of the most enduring of Freud's recommendations.