Questioning the couch: Historical and clinical perspectives.

Since the beginning of the last century, when Freud introduced the couch in the psychoanalytic room, a number of “objects” have been removed or renovated, yet the couch has almost always remained in place, at least officially. This article has two distinct aims. The first is to offer a reconstruction of the psychoanalytic history of this element of the setting. The second is to rethink the couch, saving it from being reduced to a mere icon. Recent contributions coming from affective neurosciences, infant research, and psychotherapy research seem to question the utility of this element and the nature of the very mechanisms of its therapeutic action. The authors wonder whether the use of the couch is primarily protective for the therapist rather than necessarily helpful for all patients. Taking into account these observations implies bringing the couch out from a silent dimension and reflecting on its role in the conception of therapeutic action and mental functioning.