Psychoanalysis, the treatment originated by Sigmund Freud more than a century ago that requires patients to lie on a couch and say whatever comes to mind, has been battered in recent years by everything from antidepressants to skepticism to managed care that doesn't pay for such long-term therapy.
So who in his right mind would want to launch a company that makes psychoanalytic couches?
It takes an entrepreneur who believes that businesses considered antiquated are underserved niches with perhaps more staying power than trendier enterprises. Randall Scott Thomas, a Seattle furniture maker, knows psychoanalysts are a minority among mental health counselors these days. But thousands are either in training or in practice, and many have trouble finding the appropriate couch.
Mr. Thomas, who makes contemporary home and office furniture, has never undergone analysis himself and didn't know what a classic analytic couch looked like until a few years ago. He was approached by Doene Rising, a Seattle analyst who was starting a private practice and couldn't find a couch to her liking at any furniture store. She was familiar with his work and showed him a picture of one that she had found in a magazine -- an armless, backless, chaise-like bench, with a built-in headrest, designed for reclining, not sitting. She told him she wanted something similar. Instead of traditional leather, she wanted cloth upholstery, and chose a deep blue fabric.
"Leather can be cold, and I wanted something inviting, but something classic that said to my patients, 'This isn't for sleeping on, it's for reflecting on,' " Dr. Rising says. She and other analysts believe that when their patients recline and the therapist is sitting out of sight behind them, patients feel freer to explore their fantasies and talk about their deepest, darkest desires and fears. (The technique, of course, has sparked numerous cartoons of analysts asleep in their chairs, while their patients drone on.)
For the 47-year-old Mr. Thomas, the biggest design challenge was refining the angle of the headrest. "You don't need lumbar support when you're lying down, but you do need your shoulders and head supported well," he says. "And you need to be propped up enough that you don't fall asleep or roll over -- or sink into a too-soft cushion."
The completed couch was a hit with Dr. Rising as well as several of her analyst colleagues, who placed orders with Mr. Thomas. Since then, he has designed five styles, ranging in price from $1,550 to $3,080. Most have the same measurement (29 inches wide by 80 inches long) but different upholstery and leg styles.
The recent launch of his Analytic Couch Co. coincides with the biannual meeting of the American Psychoanalytic Association, which starts tomorrow in Seattle. Recognizing a sales and marketing opportunity, Mr. Thomas persuaded the association, which expects about one-third of its 3,300 members to attend, to allow him to exhibit his couches. Until now the association has limited displays at its meetings to books for purchase, "but I thought we should tell our members about more products and services they need, so it seemed like a good idea," says Dean Stein, the group's new executive director.
Mr. Thomas faces some competition. Prestige Furniture & Design Group in New York City's Queens borough, for one, has been making analytic couches for more than 50 years. During the heyday of psychoanalysis in the 1960s and 1970s, when most residents in psychiatry received some analytic training, Prestige sold thousands of couches to medical-supply companies, which in turn sold them to hospitals and psychiatrists. "We had a factory devoted just to this," says 75-year-old Fred Brafman, one of the company's founders.
Prestige still makes six analytic couch models, some of which have been used as props in theater productions and movies. They range in price from $900 to about $6,000, and must be custom ordered. "The demand isn't what it used to be," Mr. Brafman says.
He also has a list of what design features to avoid. Loud or busily designed upholstery, he notes, can distract patients. "One analyst returned a couch once because a patient was seeing faces of animals in the upholstery," Mr. Brafman says. Prestige also no longer makes couches with buttons, "because anxious patients rip them out," he says, or an adjustable headrest model, because the up-and-down lever mechanism broke frequently.
Unlike Analytic Couch, whose designs are more contemporary, Prestige doesn't have a Web site for online orders and it doesn't advertise much. Many analysts say they haven't known where to shop for a couch when furnishing their offices. "We can help analysts find office space and even patients, but it's hard to know where to send them for a couch -- and we get inquiries about this all the time," says Matthew von Umwerth, the librarian at the New York Psychoanalytic Institute who is in training to become an analyst.
Sigmund Freud's famous leather couch, which he draped in colorful Persian carpets, remains the standard bearer -- and it is on display at the Freud Museum in London. He didn't have to shop for it, however, since it was a gift from a patient. His use of it stemmed from his early method of hypnotizing patients. While he thought patients who reclined on a couch would more readily confront their repressed anxieties, he admitted he had a "personal motive....I cannot put up with being stared at by other people for eight hours a day (or more)," he wrote. "Since while I am listening to the patient, I, too, give myself over to...unconscious thoughts, I do not wish my expressions...to influence what the patient tells me."
A couch is just a couch for some analysts, who say they would rather use an ordinary living-room model. When Prudy Gourguechon, a Northfield, Ill., analyst, purchased a custom-designed analytic couch a few years ago, "my patients wouldn't go near it," she says. "It was way too formal, and they missed my ratty old sofa that had a back and made them feel enclosed." She ultimately gave away the classic couch and purchased a standard living-room leather sofa at a department store.
However much they mull what couch to purchase, a bigger decision involves the chair analysts themselves sit in. Anticipating this need, Mr. Thomas has designed a leather armchair that retails for $1,899 and offers, he says, solid back and neck support. "You're sitting all day long, so you better find something very comfortable," says Leon Hoffman, a New York analyst.
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