Is It Time to Dump the Psychiatrist’s Couch?

There has been some debate about the need for a couch as part of a psychiatric consultation. Freud, apparently, had a definite view of this; he was convinced that lying on the couch fostered “regression” on the part of his patients, allowing them to become more childlike and distance themselves from the doctor.

At the recent American Psychoanalytic Association meeting, Dr Lable of Harvard defended the use of a couch, based on his study of two patients. These two patients had psychoanalysis lying down and sitting up in different phases of their therapy. The interaction between patient and psychotherapist was evaluated using a recognized scale – the Psychotherapy process Q-Set (PQS). There were slight differences for both patients in favor a “greater analytic process” when the patient was lying on the couch, according to Dr Lable. He believes the use of a couch frees the patient from social interaction; the patient doesn’t feel forced to look at the analyst. The latter “can listen very carefully and remain impassive . . . and the patient comes to know that your silence is generated from empathy” he said.

Only two patients aren’t really enough to evaluate the usefulness of a therapeutic tool like the couch. However, Dr Lable has sentiment on his side. Who wouldn’t prefer to think of his analyst in a Victorian drawing room setting, wearing a frock coat, and positioning you on a comfortable couch?  Of course, you may care to question the overall value of psychoanalysis as a useful therapy . . .