"If the nineteenth century was the age of the editorial chair, ours is the century of the psychiatrist's couch." - Marshall Mcluhan
Jokes are often made about that couch upon which people pour out their life stories, though the purpose of the couch dates back to Freudian times when it was found that an element that was lacking in the analysis procedure was the calming influence of lying down. Not only was the patient more relaxed, but they could close their eyes, avoiding eye contact with the psychiatrist that made them ill at ease, and add another dimension to the psychiatric experience, combining thought with relaxation. The possibilities offered by the couch were these:
*Relaxation of the body.
*A less confrontational way to discuss personal issues.
*An element of privacy away from eye to eye contact.
In many situations, couches are not used in the initial stages of psycho analysis. At this point in time when a patient is new to a psychiatrist, what is needed is a rapport between the professional and the seeker of help, and until this rapport or trust is experienced, the couch will do nothing to enhance the patient's ability to open up and talk about those things that trouble them.
With the introduction of innovations like hypnotherapy and taking patients back in time to those traumatic experiences that they need to let go of, the couch was seen as a tool to be used to calm and relax the patient going through hypnosis. The element of relaxation is important, and here it was used to not only attempt to open up the mind, but to relax all the parts of the body in an attempt to take away the distraction of discomfort that a patient experienced from being hunched up in a sitting position.
If you can imagine the doctor's surgery in a normal doctor's office, this is used for the examination of the patient. It's thought of as a relatively normal concept, and here, if you can take the logical route of thinking the same way about a psycho analysts couch, this is simply a table for examination of the mind. In many case studies, notes are taken, and the patient being away from a confrontation of face to face communication is able to discuss those areas of their lives that cause problems, just as a patient would discuss with a doctor about part of the body that hurt. There is no mystery surrounding the use of the psycho analyst's use of a couch, other than the relaxation factor and giving the patient distance from confrontation, while allowing the psycho-analyst the time to take notes.
When a psychiatrist or analyst thinks you are ready to use the couch, the idea of it's use is to relax a patient with a stressed condition and to produce an atmosphere where the patient feels comfortable and able to express themselves.
One of the areas that was discovered historically was that patients were better able to express themselves, having built up trust with their psycho-analyst in advance, if not confronted with the expressions of the analyst or the body language that acts as a negative or positive influence in the amount of information that a patient will impart.
Many of the patients who seek analysis have complex pasts which hide behavior patterns that perhaps others may find disturbing. Face to face confrontation makes the patient more inclined to say very little about deep rooted problems. Here, using the couch to take away the confrontational level of interview, it was found that patients responded by being able to talk about areas of their lives that were too complex or distressing to talk about face to face. If you can for a moment imagine the anonymity of a confessional with the added bonus of relaxation thrown in for good measure, what the couch supplies to the person with inner struggle is a safe haven in which to explore those areas of their lives that are too painful to discuss under normal circumstances.
Those couches know more about the history of patients than they can ever reveal, and although their form may have changed somewhat since the days of Freud, what hasn't changed is the very purpose that they serve, as a calming influence to those with mental turmoil in an attempt to reach that point at which the patient is able to accept and face their demons.