Psychoanalysts are a specialized group that receive training well beyond their doctoral degrees, and that makes them an expensive group of professionals. The "couch", is still used today, and has its purpose and significance in the relational dynamics that develop between the psychoanalyst and the patient.
Many psychoanalysts, admittedly, have turned from Freud's primary focus of the unconscious mind, but the couch remained to advance the dynamics of the sessions.
Psychoanalysts see patients, who require intense therapy, in as many as 4 to 5 sessions per week. They see patients with long standing problems and whose deep-seated issues clinical counseling, psychotherapy or medication has not helped.
It's natural to predict that a close relationship will form between the patient and the psychoanalyst. The psychoanalyst gets to know the details of the patient's thought life, and indeed, knows even more intimate details than the patient's own spouse or family members.
The couch is used to as a tool to relax the patient and allow him to feel safe, and it's the positioning of the couch and psychoanalyst that steers the dynamics of the sessions.
Sessions are conducted using free association, where the patient says whatever comes into his mind. The analyst may from time to time, offer interpretations, but most of the verbiage comes from the patient.
The psychoanalyst is positioned behind the couch and out of the sight of the patient. The theory is, that face-to-face sessions inhibit the communication, by the reading of non-verbal language of patient and psychoanalyst. The couch and it's positioning, effectively, depersonalize the talk therapy sessions allowing free association to take place.
Cost and Time:
It's important to note, that unless you're independently wealthy or successfully self-employed, the odds are that you'll never see a psychoanalyst or the couch.
The time investment is remarkable, requiring 45 to 50 minute sessions daily, or at least 4 days per week. If you miss a session, you'll still have to pay for it.
If you have the time for daily sessions, you'll still need to be wealthy or have a hearty income to see a psychoanalyst. Medical insurance will not pay for psychoanalysis because; they don't view it as cost effective. Pharmaceuticals clean up in this situation.
Psychoanalysis is costly and is a great commitment of time, and for that reason most of us will never see a psychoanalysts couch. However, I believe the use and positioning of the couch and patient away from the psychoanalyst makes good professional sense for conducting intense therapy sessions.