Fifty years ago, no self respecting psychiatrist would be seen without the most important tool of their trade, the couch. I have no idea whose idea it first was, whether it was Freud or some one else, but for sure the couch was an important necessity. Is an important tool of the trade. It serves many purposes.
I suspect the biggest one is that patients cannot see the effects the words have on the doctor, since the doctor is seated at the patients head. Nor could they be seen taking notes. This would have been distracting to the patient. They would of course watch the doctor face to see what effect 'the story' was having on them. That would be prohibitory to getting as much of the truth out of the patient as he was able to give.
That, in a nutshell, is the real reason of the couch. The patient reclines on the couch (he does not lie on the couch) and is advised to get comfortable. The doctor then asks questions. Or they would ask the patient to talk about whatever he wanted to talk about. It is reasonable to assume that after a few minutes and after the doctor's encouraging words, the patient will loosen up and start to talk.
Although a lot of fun was and is made of the psychiatrist's couch, it has a good and wholesome purpose. That of trying to get an accurate picture of how the patient's mind works and how to help them make it work in ways that will heal their illnesses, or phobias, or hangups.
And too, this is to be factored in: after what an hour of their time costs, why not get an hour of rest and relaxation out of the ordeal. Bravo for the couch. Bring it on. There is no better way to relax than to lie down on the couch with the window shades slightly darkened and the whole atmosphere being one conducive to thinking. This of course is one of the reasons psychiatrists like to have a well place couch in their office. It allows the tormented patient to relax.
This will take a few minutes and with the gently understanding and not accusing voice of the psychiatrist listening and gently guiding the thoughts of the patience it is often surprising to them how much they learn about themselves in the their alloted hour. I bet if you ask those who have spent time on that couch and who talked out their frustratrions to a knowledgeable and caring psychiatrist will tell you it was worth every dollar spent. And it is expensive.
For this very reason the couch is often downplayed and some psychiatrist no longer consider them necessary, but I for one feel they have their place. They have their place in every serious meditation room as well as a professional doctor's office. At home alone on a special couch in a quiet room with one's shoes kicked off and when one is resting and at ease with one's self, the most amazing thoughts of peace and harmony as well as many answers to life's problems just naturally surface. This is my favorite way of thinking of my God and just talking to him and watching for the amazing insights that often come floating by out of apparently thin air.
What is happening is we are at rest and the body is at a slower pace and relaxes its hold on immediate actions and there is room for these little extra delights to come forward and let us know kindly what we have been doing wrong. Maybe we have been trying to do too much of the wrong sort of things and it is at times like these when we are at complete rest we can be completly honest with oursleves. A couch is wonderful invention. What could we do without them?