The role of the couch in Psychoanalysis and its implications in the clinical setting: a Scoping Review.

Background and aims: The couch has been part of the psychoanalytical setting since its origins. Despite its relevance, empirical evidence on the use of the couch are limited and sparse. This scoping review aims to map existing research the use and this and the implications of the couch and its implication as a setting’s element for both the patients and analysts. Methods: This scoping review was conducted following the PRISMA-ScR guidelines and the Joanna Briggs Institute Manual for Evidence Synthesis. The a-priori protocol was registered at https://osf.io/7evpx/. We searched PubMed, EBSCO/PsycINFO and Web of Science databases for research articles written in English and of any type of study design, including grey literature. There are no restrictions about context or geographical location. Results: Eight studies were included in this scoping review. The findings were organized into five key concepts: 1) Impact on Therapist-Patient Communication; 2) Facilitating Free Association; 3) Influence on Therapeutic Technique; 4) For Which Patients and Why?; 5) Therapists’ Attitudes on Couch Use. Conclusion: The main findings indicate that better-educated patients are more likely to be engage in therapy within a couch setting. Additionally, therapists are more inclined to use classical therapeutic techniques, and patients exhibit more free associations when the couch is part of the psychoanalytic setting. However, it is noteworthy that no studies have yet investigated the effect of the couch on psychotherapy outcomes, with existing research focusing solely on the psychotherapy process. Further research is necessary to explore the clinical implications of incorporating the couch in therapeutic environments.