How this couch changed everything
There's a new exhibition about the work of Sigmund Freud. It features an extremely important couch.
You lie back and stretch out, close your eyes or look straight up at a white ceiling. Behind you, but out of sight, a small owlish gentleman with a thick central European accent asks you questions about your parents.
And there's a couch.
For many people this is the first image that comes to mind when they think of psychiatry. Think Ben Stiller's sinister therapist in There's Something About Mary, or the early therapy session in Good Will Hunting. The term "psychiatrist's couch" has become synonymous with the treatment given by any therapist.
There's the black leather one in Annie Hall. Woody Allen's Alvy Singer lies on this couch. The New Yorker's cartoonists have imagined Freudian couches in various amusing situations.
Real consultation rooms don't look like this. But there was a real couch that started the stereotype.
The first psychoanalyst's couch was a Victorian day-bed - reportedly given as a gift to Austrian neurologist Sigmund Freud by a grateful female patient, Madame Benvenisti, in around 1890.
It is sturdy and solid, draped in a multi-coloured, rich Iranian rug and scattered with well-worn cushions. "It's a piece of furniture that you more readily associate with poorly Victorian women, like Florence Nightingale, or Elizabeth Barrett Browning," says Freud Museum curator Ivan Ward. "The idea that a cured patient gave it to him was like his patient saying 'I'm better, I don't need this anymore'."
This piece of furniture started its journey into popular culture during a trip taken by Freud to America in 1909, says psychiatrist Dr Trevor Turner.
"The idea of the psychoanalyst's couch really took off. You can even see Freudian references in American films as early as the late 30s," says Turner. "The term 'on the couch' became accepted as a symbol representing what psychiatrists do."
What is psychotherapy?
- Type of therapy used to treat emotional problems and mental health conditions
- Involves talking to a trained therapist - allows you to look deeper into your problems and worries
- Grew out of the work of Josef Breuer and Sigmund Freud, who drew a link between mental illness and damaging experiences in childhood
- From these discoveries grew the theory and practice of the first modern "talking cure," psychoanalysis
Freud had used the couch in his medical practice before the days of psychotherapy. He had experimented with everything from electrotherapy to massage and therapeutic baths, eventually abandoning those techniques because there was little evidence of success in his patients.
It wasn't until his idea of "free association" took hold within Freud's theories of psychoanalysis that the couch really came into its own.
Freud believed that this technique - asking a patient lie down, without making eye contact, to say whatever readily came to mind - could provide new insights for the psychoanalyst.
The couch helped create an environment that was clinical yet intimate, allowing a patient to freely explore ideas that could build a picture for a psychoanalyst to work with.
"The one rule of psychoanalysis was that the patient should say anything that came to mind. It's like private discourse - but there's someone else there, listening," says Ward.
It was also in Freud's office that the idea of the therapist sitting behind the patient was born, says Ward.
Freud experimented by putting his chair in various different positions but is supposed to have eventually moved his chair behind the couch after one encounter where a female patient, lying on the couch and facing him, had attempted to seduce him. He is also reported to have said that he did not like to be stared at for nine hours a day.
But the typical assumption that this layout meant the psychoanalyst was disengaged is untrue, says Ward. The analyst must be in an almost meditative state, Freud believed, and should not readily intervene.
"Freud believed that the analyst should tune in to a patient, like a telephone receiver. It is a form of unconscious communication."
Nowadays psychiatrists working in hospitals are likely to use less furniture, says Dr Farhana Mann, a NHS psychiatrist who practices in London.
"You want to build a trusting, working relationship," Mann says. "We take the lead from the patient as to whether or not they wish to make eye contact, but we tend to sit in chairs, and desks are no longer between client and doctor in the consulting room."
So what's happened to the couch?
Freudian psychotherapy remained the prevailing wisdom in psychiatric treatment until the 1970s, says Edward Shorter, professor of the history of medicine at the University of Toronto, but the profession experienced a pivotal change as cheaper and less drawn-out methods arrived, such as cognitive behavioural therapy.
"As the great pivot away from the psychoanalytic principles began," says Shorter, "the couch fell into disuse."
There are still couches in older centres, but the staff "tend to use them to pile their printouts on".
More from the Magazine
The words and phrases popularised by Sigmund Freud are deeply ingrained in popular culture and everyday language. How did Freudian jargon become so widespread?
Subscribe to the BBC News Magazine's email newsletter to get articles sent to your inbox.