Why do people lie on a couch when they see a psychoanalyst?

'It’s not terribly different to what we do when we fall asleep at night... thoughts just come to you'

It’s a scene often found in films and TV shows: a character lying down on a couch while talking to a psychoanalyst about their issues.

Writers on question-and-answer website Quora have been wondering why this is the case. Why do they not sit at a desk, or on a sofa facing the psychoanalyst?

The question "Why did people use to lie down at a psychoanalyst" prompted several responses from counsellors and clinical psychologists.

Professional counsellor Carol Baldridge wrote: "The short answer: Sigmund Freud believed his patients would talk more openly and honestly while relaxed and lying down, with the analyst behind, out of sight, and not interfering with the patient’s mental and verbal meanderings.”

Another writer, John Geare, added that Freud also “grew weary of patients staring at him all day", but said the main reason was because the couch helped to establish a relaxed state of the recumbent patient, known as “free association”.

"It’s not terribly different to what we do when we fall asleep at night," he wrote. "Thoughts just ‘come to you’. And so, today's analysts still (often) use a couch."

Steve DeBerry, a retired clinical psychologist based in Asheville, backed Ms Baldridge’s comment, writing: “It started with psychoanalysis which at first was the only type of psychotherapy available. 

"The idea was to avoid the contamination that looking at another person might induce on memories and free associations. To some extent, this was true. But it did not work the same for everybody."

He adds that by the time he went into psychotherapy, "face-to-face interaction" was more common. 

"My office was set up to offer both options, you could lie on the couch or sit and face me," he wrote.

"For some people this made a big difference: some found it much easier to talk about trauma or sexual matters if they were not looking at me. They also found it easier to cry."

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