The Couch Has Changed

Psychoanalysis has a long-held reputation as old-fashioned, expensive, and time-consuming, as in multiple times a week, lying on a couch. Yet psychoanalysis has and continues to change with the times.

Many therapists, like me, who train to be analysts do what’s called modern psychoanalysis. Among this mode’s distinguishing features: You don’t have to come every day, or even several times a week. Good and productive depth therapy, including therapy for trauma can happen even if you come just once or twice a week. You can be sitting up, or you can be lying down.

“Being on the couch” has changed, because the couch is no longer a given. Though it’s sometimes looked-upon as old-fashioned, the couch remains a handy therapeutic tool.

Why the couch?

What is the deal with the couch? Freud famously wrote that he preferred that patients recline because he couldn’t cope with being stared at for eight hours a day. He acknowledged that his reasons were entirely personal. He was more able to attend to a patient if they weren’t looking at each other. (Freud was a celebrity, but he was no scenester. He spent long periods in solitude, writing and working through his ideas.)

People have different reactions when presented with the option to recline. Some feel awkward lying on the couch; they prefer to see their therapist face-to-face. This can be true, for example, if you’ve come for trauma therapy or if it’s your first time in therapy. Eye contact may help anchor you.

Sometimes patients progress to the couch after an extended time working with a therapist. Others decide to use the couch occasionally. Still others prefer to be face-to-face, whether in person or on video. In modern analysis, any of these three options is okay.

Reclining can help you focus

Whether on video, in person, or on the phone, lying down can help you focus on your thoughts and internal world. Reclining can help you give voice to all that’s going on in your head.

If your therapist is sitting out of sight, their facial expressions are no longer a distraction. If you identify as a people-pleaser, maybe there’s less pressure to be polite. You’re free to focus on your own mind and what’s coming to mind that hour. The session is yours.

Lying down can take the pressure off

The goal of talk therapy, including trauma therapy, is to say everything. Again, the chances of doing this increase when your mind is free to roam. You start to feel more able to say things that might not make any sense until you utter them out loud. You may begin to be more at liberty to share thoughts that seem embarrassing or shameful. In my experience, saying everything inevitably leads to fruitful discussion and progress. The act of discovering this freedom to be you is an important part of treatment.

That’s different than what happens during a regular social conversation, where social niceties are expected. It’s different than a work conversation, where there’s obligation to respond to what the other is saying and stay within the bounds of the discussion. 

Lying down, on the other hand, can encourage you to let your mind wander. Therapy can be intense, and your relationship with a good trauma therapist needs to be a close one. Yet it’s different than a social connection. Lying down can relieve you of the pressure to respond.

Making silence helpful

Even if you understand that silence exists in therapy as a means of making way for your thoughts and feelings, it’s common to feel awkward when silence occurs. What should I say? Why is no one talking right now? How do I fill the gap?, you may wonder.

Silences in therapy are useful. They let what’s happening sink in. They’re part of the treatment itself and can encourage closeness and trust. Lying down can help you to feel more at ease with all that.

What about telehealth?

Telehealth has changed therapy in lots of ways. Yet the couch remains an enduring element of therapy.

You and your therapist can each tip your screens so that you’re no longer in view. You can simply set your laptop or phone down beside you and make sure the audio is still working. If you do therapy by phone, you’re already having a couch-like experience. Any way you do sessions, the couch can be a valuable tool for making the most of psychotherapy.

If you’d like to know more about therapy for trauma, call or text 213-807-6021 to arrange a free consultation.

References
Freud, S. (1913). On Beginning the Treatment, in Gay (Ed.). The Freud Reader. W. W. Norton & Company, Inc., New York, 1989.
Gay, P. (1988). Freud: A Life for Our Time. W. W. Norton & Company, Inc., New York.
Spotnitz, H. (1976). Psychotherapy of Preoedipal Conditions. Jason Aronson, Inc., New York.

 (Photo: Vitaly Gariev/Pexels)