Why People Lie on Couches During Therapy

Have you ever wondered why Freud had his clients lie down on a couch? I stumbled onto this question after my colleagues and I had been conducting research on how lying down (the supine body posture) influenced psychophysiological responses.

Freud's Answer

As far as I could discover by reading his writings, Freud (1913) had “the plan of getting the patient to lie on a sofa while [he] sat behind him out of sight” because it was “the remnant of the hypnotic method out of which psycho-analysis was evolved.” He further stated, “I cannot put up with being stared at by other people for eight hours a day (or more).”

He wrote, “I insist on this procedure, however, for its purpose and result are to prevent the transference from mingling with the patient's associations imperceptibly…” Freud apparently was concerned about being out of sight from the patient rather than about the body posture of the patient. But might this body posture itself improve the therapeutic process?

Our research has suggested that a supine body posture may reduce psychological defensiveness and open up the mind. Below, I will explain how our research suggested this conclusion.

Research Suggests Supine Body Posture Reduces Anger-Related Brain Activity

We had already noticed that fMRI results don’t always replicate findings from EEG research, and wondered whether the posture people assume for each measure could be the reason why. fMRI research typically has research participants lie flat on their backs, whereas EEG research has research participants sit upright. We wondered if this difference in body posture could affect the person’s motivation to take action.

In our first study, some participants sat upright and others were lying flat on their backs while they listened to interpersonally insulting feedback on some work they had done. The insulting feedback was intended to anger the participants. We suspected that angry participants would have less motivation to lash out aggressively if they were lying down than if they were sitting upright.

Participants who sat upright and were angered showed a pattern of EEG activity that had been found in several previous EEG studies (Harmon-Jones & Peterson, 2009). This pattern is referred to as relative left frontal cortical activity, which is associated with approach motivation, the urge to go toward (Harmon-Jones et al., 2013). In contrast, participants in the supine posture who were angered did not show this pattern of EEG activity, and their EEG activity looked similar to participants in a neutral feedback condition.

After we published this research, I received several emails from individuals who are Muslim. They basically said that they were grateful that we had found scientific support for something Mohammed had said over 1,400 years ago. He said, "When one of you becomes angry while standing, he should sit down. If the anger leaves him, well and good; otherwise he should lie down." [Abu Daud; Book 41, No. 4764]. Circling back to Freud, perhaps lying on the couch during analysis helped his clients to be less angry and defensive in response to upsetting memories and thoughts.

Supine Body Posture Reduces Approach Motivation

Because of these encouraging results, we then tested whether the supine body posture would influence other emotive responses. In one experiment, the supine posture reduced relative left frontal cortical activity to photographs of delicious desserts (Harmon-Jones, Gable, & Price, 2011). In another experiment, the supine posture reduced other physiological and brain responses to erotic photographs (Price, Dieckman, & Harmon-Jones, 2012).

These results, along with the former, suggested that the supine posture reduced approach motivation, or the urge to go toward. Regarding Freud’s couch, the reduction in approach motivation may have allowed his clients to pause and reflect, instead of immediately pursuing pleasures and temptations.

Supine Body Posture Broadens the Mind and Decreases Dissonance

In other research, we found that the supine posture, coupled with a facial expression induction of smiling, broadened cognitive categorization, or the extent to which rare concepts were considered part of a category (Price & Harmon-Jones, 2010). Later research found that this supine posture also reduced cognitive dissonance reduction (Harmon-Jones, Price, & Harmon-Jones, 2015).

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Cognitive dissonance is the uncomfortable feeling people get when they hold two ideas that conflict with each other, for example, if they have acted contrary to an important value that they hold. We found that when participants were in a supine compared to an upright posture, they were less likely to show effort justification (enhance the value of a reward they had worked for) and they were less likely to increase their ratings of something they had chosen compared to the thing they had rejected.

Taken together, these results suggest that the supine posture leads to a broadening of the mind and less psychological defensiveness. This mental broadening and acceptance of conflicting information may have also helped Freud’s clients during analysis.

Supine Body Posture Decreases Neural Indices of Cognitive Conflict

More recently, we examined the effect of a supine posture on event-related brain potentials associated with cognitive conflict. In one experiment, when participants were in a supine posture, as compared with an upright one, they had reduced neural activity associated with cognitive conflict during a Stroop task (Sun & Harmon-Jones, 2020). Then, in another study, when participants were in a supine posture, they had reduced neural activity after making an error (Harmon-Jones & Sun, 2021).

Taken together, these two studies further suggest that the supine posture reduces cognitive conflict at the neural level just a few hundred milliseconds after the conflict occurred.

Conclusions

All told, this research suggests that perhaps Freud’s unconscious may have influenced him to have his clients lie down when in therapy so that they would be less motivationally attached to their pre-existing preferences, less defensive and conflicted, and thus more open to new ideas. Even if his unconscious wasn’t that smart, the research certainly suggests that a supine body posture may have these consequences.

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