Whatever happened to Freud’s famous couch—the one on which his patients used to recline and "free-associate"? It is alive and well in 20 Maresfield Gardens, London, England. That is the house where Freud and his family lived after they fled Austria and the Nazis in 1938 and is now the Freud Museum.

But at the dawn of the 21st century, couches in general are no longer the centerpiece of psychoanalysis that they used to be, Kerry Sulkowicz, M.D., a New York psychoanalyst, reported at a press briefing at the American Psychoanalytic Association meeting in New York in January.

According to prevailing psychoanalytic philosophy, he explained, the analytic perspective and the analytic process—not the couch—are the most important tools in analysis. The couch, like the frequency of analytic sessions, is considered a device that can foster a greater depth of exploration of the patient’s mind. Hence an analyst today will sometimes use it and sometimes not. Of course, patients have a choice, and sometimes whether a patient feels like reclining during a session becomes a takeoff point for discussion.

Still another couch-related trend, Sulkowicz added, is to use the couch at times for dynamic psychotherapy, since analysts these days spend most of their time doing dynamic psychotherapy, not traditional analysis.

"But is the couch left in the analyst’s office when it is not in use?," a reporter asked. "Or is it folded up or stowed somewhere else until it is again needed?"

"It stays in place," Sulkowicz replied with a chuckle. "We do not use a Murphy-bed type of couch." ▪