Elements of dynamics III: the face and the couch

In this article the therapeutic and scientific advantages of face-to-face psychoanalytic treatment are contrasted with the symbolism, power, and mystery of the psychoanalytic couch. Beginning with recent commentary on the meaning of the couch, I consider some problems associated with its use, such as regressive irretrievability of learning, paucity of affective and empathic connection, preservation of shame, and coercive aspects. Compromises between couch and face are offered, and more clinical and research focus on facial affective expression is encouraged.