Taking the Ouch Out of the Couch

Why lay on a couch in therapy? Isn’t talking face-to-face more natural?

In the beginning, lying on the couch does feel odd; there’s nothing natural about it. Yet it serves a very important function: it gives you greater access to your internal life. For example, when you isolate certain senses, other senses become amplified. The moment you close your eyes, sounds and smells become more intense. With hearing gone, you become more alert and depend more on your vision.

Lying down on a couch works in the same way. With as few external distractions as possible, your attention naturally drifts inward; you get in touch with your feelings in the moment. For example, when you sit and talk face to face with the therapist about difficult experiences or emotions, you’re bound to feel tense or edit yourself. You may avoid eye contact, become focused on the other person’s reactions, work for approval, fear criticism, or misinterpret body language.

All these distractions trigger anxiety that wrenches your attention away from yourself. Instead of looking within, you look outward. To relieve your anxiety you seek easy advice, quick-fix solutions that don’t endure, or you develop an unhealthy reliance on your therapist to solve your problems for you. Under such conditions, lasting change is rarely achieved.

There are no shortcuts. The solutions you seek can only be realized through the hard work of introspection and self-analysis. With a skilled therapist as your guide, your confidence in yourself will strengthen, and the self-realizations, personal discoveries, and breakthroughs that you realize will last. (See “How Does Your Therapist Feel About You.”)

How Lying on a Couch Helps

The moment you lie down on the couch, you become aware of feelings you didn’t notice before. These often are uncomfortable feelings you tend to push out of your conscious mind. Are you filled with distrust? Do you suddenly feel lonely or isolated? Are you frustrated? As you direct your gaze inward, your therapist encourages you to experience these feelings, put them into words and investigate them. Do these feelings seem familiar? Do they have a historical place in your life? Are they residue of a recent conflict or the source of new fears?

You begin to discover trigger points for these feelings. As memories surface, insights and realizations start to materialize. Relaxing on the couch you slowly you begin to recognize how past insecurities reveal themselves in your daily life and how unresolved anxieties from the past still pester you today.

Vivian’s Sleepless Nights

Everything in Vivian’s life is going quite well. She has a loving husband, two wonderful children. She enjoys her work managing a local art gallery. So why can’t she sleep at night? She tosses and turns like a boat on the sea, often feeling nauseous and tense. She’s had medical exams, blood tests, etc. As far as her doctor is concerned, she’s in perfect health.

Vivian explains that sleeplessness was never an issue in her adult life. As she speaks, I notice she seems impatient and edgy. I imagine that her doctor told her that all her troubles were in her head and it really bugs her. And it should. She’s consulted sleeping specialists, tried self-help solutions and herbal remedies. She even contacted a hypnotist. Nothing worked.

Since Vivian has no conscious understanding of what’s bothering her, the solutions lie in her psyche, just outside of her awareness. To help her, I need to access her unconscious. I can see that talking face to face is making her tense and not helping her make contact with her uncomfortable feelings.

“Lie down? Why on earth would I do that?”

I explain that it could help us get to the root of her trouble sleeping.

“Well… I’ll do anything to solve that.” She lies down and immediately sits back up.

“I don’t like it.”

“Give it a chance. If it doesn’t work, we won’t do it again.”

Grudgingly she lies down again and sighs.

“Am I cured yet?”

“I’ll need a little more time. What are you experiencing?”

“I can’t see you.”

“I’m still here.”

She takes a deep breath, and says, “I feel alone.”

“Is this a familiar feeling?”

Vivian reports that this was a common feeling she had as a child. Growing up during a depressed economy with two working parents, she spent a lot of time alone. When her folks came home after sunset, she often felt frightened.

“Where do these feelings live in you?”

“My stomach. I use to get stomachaches a lot when I was a kid. I would hide under my bed with my dolls until my parents came home.”

In just a single session, we have a world of new information. Something in her present life must have triggered these childhood fears again; something was making her feel unsafe.

In the next session, she reports another realization. “I couldn’t sleep the other night. When I asked myself why for some reason I thought of my daughter.”

Vivian’s son was in his final year in college, but her daughter had just started her freshman year. What’s more, her husband had accepted a promotion to regional supervisor for his sales company. This provided them with the added income they needed for college bills but there was one major drawback: it required him to travel.

For the first time in over twenty years, Vivian was alone in her home.

It was a perfect storm for Vivian’s unconscious; childhood fears were roused from their slumber. The unconscious has no sense of time. Unresolved anxieties from our childhood, unless successfully worked through, have the power to resurface at any occasion and dramatically impact our lives.

The more Vivian explored these feelings and understood their source, the less anxious she felt. She also realized that, unlike when she was a child, she has more options. She could do more than hide under her bed.

For example, she came to realize that social isolation was terrible for her. Staying home alone made her feel anxious and depressed. So she joined a book club that met on weeknights. She loved it and as a result, she got up the courage to take a writing class and revisit her dream of writing a novel.

When childhood feelings resurface, we tend to make an error in time. We experience them as we did earlier in our life. As a child, you may have been powerless to overcome these obstacles but as an adult, you can make different choices. Making new choices and challenging old repetitious patterns is essential to making progress. Vivian’s experience in therapy was perfect proof that by understanding and overcoming her old fears, she found fresh energy to try new things, develop new friendships, and explore new learning possibilities. Everything she couldn’t do as a child, she could do now.

In no time, Vivian was back to her old self. In fact, she was better.

To use the couch or not to use the couch?

Therapists have different training and orientations and not all of them use the couch. In my practice, I’ve found it to be indispensable for resolving unconscious conflicts like Vivian’s. In fact, I find that patients, who most resist lying down, often benefit the most. They also discover that they’re able to resolve troubling issues their previous therapy sessions left untouched.