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If there is a universal symbol for psychoanalysis, it is the couch. And if there is a part of psychoanalysis that is most ridiculed, it is the use of the couch. Perhaps there is a reason for the ridicule.
It appears that Freud began to use the couch for psychoanalysis as a carry-over from its use for hypnosis. He started off, as we all know, doing hypnosis before he started psychoanalysis. Apparently it was simply an accident, a continuation of an old habit, that started him using the couch for analysis. And then he is said to have continued it partly because it made him uncomfortable to look at patients and to have them look at him. Gradually this sequence led to free association, an exploration of the patient's unconscious with as little contact as possible between patient and analyst. Again, this was a kind of accidental development, given the use of the couch as a carry-over from hypnosis. Of course, free association in this manner came to be very useful as a research tool—an excellent way of discovering what was going on in an unconscious. So far, so good. However, the carry-over continued into psychoanalytic therapy. At this point the good ceased. While a wonderful research tool, the couch and free association have been in the main very poor therapeutic instruments.
The main therapeutic agent of any form of psychotherapy is the emotional impact of the personality of the therapist on the patient.