How Therapy Works Part III

What’s with the couch?

How Therapy Works Part III

In this next part of the series of posts on ‘How Therapy Works’, I wish to say a few things about the couch.  There is a long tradition in therapy to have a couch available for the client to lay upon while the session is conducted. While there are several reasons for this, the most important of these is that the couch allows someone to look away while they talk with the therapist (who sits behind the client and out of their direct field of view) because it can help facilitate the client’s ability to say everything that occurs to them during the session.

If a fundamental aspect of therapy is to encourage a process of reflection and introspection and assist the client in accessing thoughts and feelings about themselves in an open and honest way, it can be helpful to not have to hold the gaze of the therapist while doing so.  If you think about this idea for a moment, it is rather obvious and why, typically, when we are engaged in a conversation with another person for an extended period of time, it is a natural tendency to break eye contact regularly and look off in another direction.  Holding the gaze of another can inhibit and influence the process of ‘free association’, the basic rule in traditional psychoanalysis, to speak aloud whatever it is that comes into your conscious purview at that moment in time.

The use of the couch is believed to help a person free associate and facilitate their access to thoughts and emotional experiences that they may not otherwise be able to identify.  Studies have demonstrated that our minds filter huge quantities of information but what we ultimately become aware of in our conscious minds is the result of that filtering process.  Some of what becomes filtered is controlled by psychological defense mechanisms that attempt to protect us from anticipated discomfort, tension or pain.  The technique of free association has been thought to be effective in allowing a person to, at least partially, circumvent those unconsciously operating defense mechanisms and to access other information about their subjective experiences.  Laying on a couch and not having to hold the gaze of the therapist can further facilitate this access to the information because a client may be less distracted by some of these concerns and the defenses connected to them.