Danielle Benvenuto, LCSW

Some patients prefer to lie on the couch while others prefer to sit face to face with the therapist. There is no “right” way and what works best for each person varies.

One advantage of using the couch is it can decrease the anxiety one may be experiencing associated with seeing and being judged by the therapist’s reactions. This decrease in anxiety most often enhances the ability to express whatever is on one’s mind. For example, some patients have stated that they have held back on disclosing important experiences that were too shameful to articulate because they were too focused on looking out for how I might respond non-verbally.  When these same patients switched to using the couch, they stated it was easier for them to focus on their internal world thereby, not only increasing their ability to talk about things that were humiliating, but to also get in touch with their thoughts and feelings on a deeper level.  In essence, these patients thought using the couch expedited the analytic process.

On the contrary, some patients prefer sitting face to face with the therapist. These patients have stated being able to see me was important for them due to their fears around not being listened or paid attention to. Using the couch created more anxiety and in effect, served as a source of distraction and hindered them from accessing important experiences. 

Either way, I encourage discussion around both avenues of “being” in the room an as mentioned earlier, think both modes are equally as effective depending on the individual.