Making Use of the Couch

A patient lying down on the couch has become a cultural trope for psychotherapy in media, despite most therapists primarily working face-to-face.

In psychoanalytic therapy, lying on the couch is a tool that can facilitate important parts of the therapeutic process. It allows for freer association, both for the patient and therapist, and therefore deepens access to unconscious thoughts and feelings. In everyday social interactions, there are pressures to be present to a concrete sense of the world and to the reactions of the other. On the couch, dreams, ideas, fantasies and more may feel more present in one’s mind. This openness provides space to see one’s inner world with greater clarity.

Typically, the therapist positions their chair close to the couch, but behind the patient and essentially out of sight. This communicates the therapists’ attentiveness and holding of the patient, without impinging on the space, to keep focus on the patient’s mind.

Each patient who makes use of the couch finds it in their own way. Sometimes the comfort of laying down can be an appeal; other times, a patient may have a dream involving laying on the couch. A therapist might raise the idea when they feel it will be helpful. However someone ends up there, the experience can be enriching.