You know the one — black leather, you’re lying face-up, with your psychiatrist sitting behind you. You’re silent. No thoughts are coming to mind.

“So what are your thoughts?” the doctor asks.

“Nothing. My mind’s a blank… I didn’t feel like coming in today and knew it would be a waste. I’m all blocked off. You know numb. The way I was when I first visited you two months ago.”


“I feel like you’re sitting back there criticizing me. You probably think I’m a real loser.”

“Why do you think that?”

“I don’t know why.”


“I know you like me. You smile when I come in. You’re always kind and try to accommodate my schedule. Christ, am I back to blocking off my feelings? Didn’t I do that when I got into a fight with my wife?”

“Are you fighting with her again?”

“No, we’re really doing much better, but I’m in such a crappy mood!”

“Any other ideas why?”

“It’s not home. It’s not work…or maybe it is. Damn, I got into it at work again with my boss. She’s such a bitch!”

“What did she do?”

“Just the way she looks at me. Her criticism is intolerable.”

“What kind of look?”

“It’s hard to describe… Just something about her that pushes my buttons.”

“Are your feelings similar to the way you felt when our session started? The way you thought I was criticizing you?”

“Maybe? You know what’s so interesting. Just as you were talking, I pictured my boss. There’s something about her that’s familiar. Not good familiar, but uncomfortable familiar.”


“You’re going to laugh. My boss reminds me of my mother. That’s it! That’s the trigger. That’s why I felt she was criticizing me. Maybe she wasn’t. Maybe that mother-thing we’ve been working on is still plaguing me?”

The unconscious part of our mind is like the hidden part of an iceberg. Compared to the conscious part, it’s huge and drives so much of what we say and do. Most times we’re not even aware of its existence.

One reason why the couch works so well, is that the patient isn’t getting direct feedback from the doctor. He can’t see facial expressions and is forced to let his own fantasies of what’s going on in the mind of the psychiatrist run wild. It’s the opportunity to freely associate that’s so helpful. In this case, the patient is very psychologically minded and is able to experience the connection between his thinking that his doctor is criticizing him and then connecting it to what happened with his boss.

As expected, most people can’t afford 4 or 5 times a week on the couch (which is what a psychoanalysis entails). In the real world, the principles of psychoanalysis are applied in once-a-week psychotherapy. A patient can still learn from all we know about the science of the mind and benefit greatly.

Interested in more? See you next week.

Don’t forget to subscribe to Inside the Mind of a Psychiatrist.

One thought on “IS THE PSYCHOANALYTIC COUCH THE FASTEST WAY TO REACH YOUR UNCONSCIOUS? by Art Smukler, author & psychiatrist

  1. It’s difficult to receive knowledgeable people through this matter, nevertheless , you is very much you know what happens prepared working with! Many thanks


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