Lying down on the couch in therapy

My therapist caught me off-guard recently by suggesting we "discuss the possibility of using the couch." He says I might find it comforting and productive to lie down and not be aware of his facial expressions or have to make eye contact, and that it might allow me to speak more freely about difficult topics and access my feelings more easily sometimes. I’m considering it, but I'm also having a strong reaction to the suggestion!

It's not a complete shock--I’ve obviously noticed that my therapist has a psychoanalytic couch in his office, and I’m aware that he has patients who use it in psychoanalysis. But I wasn’t expecting him to suggest the couch as a part of twice-weekly psychotherapy. I’m curious about what it would be like to try it, but also a little concerned it will feel extremely strange and overly vulnerable, worried it will change how my therapist and I relate, and wondering if it will make it harder/weirder to bring up simple logistical stuff like scheduling and medications (my therapist is also my psychiatrist).

I’m curious, has anyone ever used the couch in therapy before, or had your therapist suggest it? Did you take them up on it, and if so what was it like? Did it change things about therapy, and did you think it was better or worse?

I used the couch (actually more of a love seat) when doing guided meditation. I felt extremely vunrable at first but I got used to it. I eventually found it comforting. We don’t do that kind of work often. You could always try it just once to see how you feel

I use a couch and I like this. I have never wanted to rely on eye contact because it doesn't help me much. I feel myself much more sensitive to tones of voice and while lying on the couch I guess I spot different voice nuances even better.

I never do and he says none of his clients have lied down on it..... however, my dog uses it every session LOL

Interesting! Thanks for this. Have you always used the couch, or did you start off face to face?

I basically started on the couch. We had first few introductory sessions face to face and after that I went straight to couch. We have had periods when I've been sitting up (I got very dysregulated but because I couldn't express feelings verbally I started to act out heavily and then my T forbid me to lie down) but it wasn't better for me, I think this way it was just easier for my T to understand what was going on with me. When he allowed me (i.e. he thought I would be better able to control myself) then I went immediately back to couch.

But as I said, I'm probably quite different than "normal" people because I find no value in eye contact and looking at facial expressions.

My T doesn't have a couch, but I lie down on my chair as much as I can, plus I rarely look at him. I used to sit up straight, but I can't feel any emotions when doing that, I just turn them off. My T is actually kind of bothered by the fact that I don't sit up straight, but he doesn't mind too much. I like it more this way because I can feel what I am feeling, instead of just shutting down. You can always try for a session or two and then go back if you don't like it, that might be an idea?

I used to use the couch and like you, I was having twice weekly sessions. I think it did help me to open up more. I felt very vulnerable though and I missed being face to face with him. I felt he took on a more paternal role for me, while I was using it.

well, my therapist and I used to both lay on our backs next to each other on the floor and prop our feet up on her couch. Does that count.?

Interesting, thanks. And good to hear that it eventually felt comforting. I think it would seem less daunting if the couch had been proposed as an occasional thing like you're describing in your therapy, rather than a permanent long term shift, so that's an aspect I'm thinking about now as well.

I'll very likely try it and see what happens, but I also know my therapist will probably want me to stick with it for a bit if I try it, so I'm trying to think through the implications using others' experiences.

Thanks so much, this is exactly the kind of thing I was wondering about. Weird question--when you used the couch, did it seem strange to handle routine things like scheduling from that more vulnerable position? How did you decide to switch to (and then presumably back from) the couch?

Yes, I found the scheduling/admin a bit weird, I just used to sit up to do that stuff. My appointment has always been at the same time, so scheduling only happened every now and then. It got easier as time went on.

At the time, I felt that because I'd made the choice to lie down, I couldn't change my mind but I now I think that I could probably go with the flow a bit more and swap around. I don't know what he would think about that though. It's probably wise to give it a bit of time at the start as you say.

I experienced some very early body memories from laying down, which I'm sure I wouldn't have, had I been sitting in a chair.

Circumstances changed and it wasn't suitable for me anymore (I was heavily pregnant). I missed the closeness and intimacy of lying down but it was really nice to see him again.

I've never lied down on my t's couch, to me that would leave me feeling too vulnerable and I think I'd talk less.

I currently lay down on a couch. And I see my T 4-5x/week.

I spent the first 2.5 years sitting up, so I have a pretty good internal idea of my T’s facial expressions. Eye contact was really challenging and so not having to make eye contact has been helpful. I also used to have really rigid body posture, and laying down helps me relax a little bit sometimes. I think it has also increased certain periods of regression, or allowed younger feelings/states to come out.

It’s easier to find my internal feelings and affects usually.

I try to handle logistics sitting up - before I lie down. It is more vulnerable in some ways, like sometimes I feel watched or scrutinized. It’s all part of the work though.

I did it for the first time and it was very weird but I didn't feel as anxious as I normally . Actually felt my t was more distant. Is that common? I have very confusing feelings about it.

I've been seeing my t for like 7 years and this is the first time I'm trying the couch. I'm going through a lot in my life right now and am kind of stuck in therapy because I am unable to get the words out. Is the couch right for me? I M so con fused

I also miss the face to face compassion and faceoial expressions.

My T doesn't have a couch, just a comfy recliner-type chair. (I don't know if it reclines or not, but there's no room in the office to recline it anyway.) Most of the time I just sit in the chair "normally" and speak with her face to face. But sometimes when I am feeling especially awful I don't want to make eye contact so I will kind of slump over in the chair or pull my legs up or rest my head on the arm rest and stare at the floor.

[QUOTE=waterlogged;6126326]I currently lay down on a couch. And I see my T 4-5x/week./QUOTE]

4-5x a week! Well I could not afford that as insurance would not pay for that.

Is your T doing a specific therapy modality or are you two just talking and hanging on things that come up?

Sounds like an interesting experience! For me I think using the couch would be worthwhile if it made it easier to say what I was thinking, but I can definitely imagine running into the same problem with missing facial expressions. I often look away, but there tends to be a reason I need/want to when I do look at my therapist's face.

Funny you should mention that. I haven't ended up trying the couch at this point, but I do spend the vast majority of most sessions looking anywhere in the room besides my therapist. I've gotten to know his power outlets and filing cabinets pretty well!

And since the chair I sit in is also a recliner, with enough room to recline it at least partway, I've recently taken to kind of turning sideways in it and reclining the chair a bit, so that I'm either somewhere between sitting up and lying down, or am more curled up into myself.

[QUOTE=MoxieDoxie;6190527]Luckily I have pretty good insurance. It is indeed a specific modality - it’s object relations psychoanalysis, and we focus a lot on trauma and attachment.

Do you mean to say you take your DOG to therapy???? This would be a dream come true for me!!

This is interesting to consider. I do think the therapist I saw when 16 offered that I could sit or lie down, whatever made me feel comfortable. I never did lie down that I recall. I think I would feel awkward doing it personally, and that it would be too paternal/maternal. I would want to feel on an equal level with my therapist if that makes sense. But, I guess I could see it also being useful since I get uncomfortable and turn away from the eye contact anyways a lot of the time. I almost think I need to get better at making eye contact and connecting with my therapist in a way, though. Interesting post, I clearly don't know and am just rambling about my thoughts.

Your thoughts seem spot on to me. Those are the same things I've been mulling over in terms of benefits and downsides to lying down--weighing the potential awkwardness and power imbalance against the possibility of it being useful.

Well, I still haven't tried it but my therapist suggested lying down again today. I was having trouble saying anything, which has been happening a lot recently, and he asked again if I thought trying the couch might be an option. My immediate response was that it would probably help, but that the prospect seems too terrifying. But I'm starting to think I'll inevitably lie down at some point, it"s just a question of when.

i like this idea im gonna ask, lol