Does the Use of the Couch Facilitate the Analytic Process? An Empirical Investigation

The use of the couch has been thought to be integral to the facilitation of a psychoanalytic process and an essential component of the therapeutic frame. Yet, the observed therapeutic differences between sessions conducted on the chair and on the couch have not been adequately examined. Thus, we aimed to compare differences in observed therapeutic process (patient behavior, analyst behavior, and their interaction in sessions) between sessions in which the patient lies on the couch and sessions in which the patient sits on a chair. We also examined if the patient's position (couch vs. chair) predicts the extent to which the therapeutic process reflects an ideal psychoanalytic session. Based on the observer codings on the Psychotherapy Process Q Set (Jones, 2000) in a sample of 287 sessions from 27 psychoanalytic treatments, we compared the most and least characteristic aspects of the therapeutic process in the 197 sessions conducted on the couch and the 90 sessions conducted on the chair. We then compared the level of resemblance to the expert prototype of the ideal analytic process (Psychoanalytic Prototype of the Process Q Set; Ablon & Jones, 2005). The analytic process in chair and couch sessions largely overlapped. We did not detect significant differences in the analytic process between sessions conducted on the couch or chair nor differences in resemblance to the Psychoanalytic Prototype of the Process Q Set prototype. A more flexible approach to analytic work would be supported in the light of our findings. There may be a variety of ways in which either the couch or chair may facilitate analytic work.