Most people are familiar with the Freudian couch proudly displayed at the Freud Museum in London. If you find its origin interesting, the famous analytic couch was allegedly a gift from a grateful patient … [Madame Benvenisti] in September 1891. (1) This is, no doubt, a typical Freudian joke. Benevnisti means welcome in Italian.
The couch was an important piece of furniture in Freud’s office—so important that it followed him into exile in England and even appeared in one of his fake dreams.
Many patients, notably many Americans, lay on that sofa. Among them - judging by her recollections of her analysis by Freud - the mentally unstable, American poet, Hilda Doolittle (1886-1961). Hilda was 30 years Freud’s junior, unsuccessfully treated by him in 1933 and 1934.
Thus, in his memories of Freud, Hilda recounted the fact that during her psychoanalytical session, the Professor … is beating …with his fist, on the head-piece of the old-fashioned horsehair sofa that had heard more secrets than the confession box of any popular Roman Catholic father-confessor in his heyday. (2)
Little did she know what kind of debauched, even criminal, secrets the worn-out Freudian sofa was hiding.

Just consider the picture to the left. A sexual healer promoting his services. Could it have been Freud?
As he explained in his book about hysteria, at the beginning of his career, he was doing home visits to lonely, rich, and hysterical ladies. Whether Freud was bending the knee, like the doctor in the picture, while massaging the female genitals, is not known, but not impossible.
At the time, this kind of service was in fashion, and Freud jumped on the sexual bandwagon.
Let's check it out, how the ad promoted the doctor's sexual service. Sounding like Freud, the healer states: Here is health through the magic power of fine gentle massage. What kind of massage? Just by looking at the photo, anyone can realise what was being massaged.
Writing in the third person, like Freud used to, the miracle worker explained that, His home treatment ... cures the patient in the privacy of their own home without the knowledge of anyone. Notably, the treatment, is creating a profound sensation because it is curing the hopeless and those pronounced incurable. Hallelujah!
Without a doubt, this was also what Freud, the "snake oil salesman". promised but never delivered.
This was - as the ad explained, mirroring Freud's business idea - Patent cure for hysteria, recommended, for all diseases of the midquarters from neck to kneee. So, unfortunately, it wouldn't work for a headache or for bunions, but every miracle cure has some limitations.
Whether the healer enjoyed himself as much as the patient did, is not known, but not impossible.

As Freud confessed using an innuendo, There was something positively seductive in working with hypnotism. (4)
Beware, the mention of hypnotism being seductive is not an empty metaphor but the real thing.
In his writings, Freud discussed the considerations regarding performing hypnotic treatment. Thus, he emphasised that the hypnotic session should only involve the doctor and his patient because the presence of a woman friend, or the patient's husband, and so on often disturbs the patient. (5) Of course, Freud didn’t want to disturb the patient.
There was another reason for not allowing any witnesses to the procedure since, the subject-matter of the suggestions … is not always suitable for conveyance to other people closely connected with the patient.
Without a doubt, since the treatment involved sexual matters, not only in the form of suggestions, people could easily misunderstand what went on.
This is how Freud explained the procedure: We place the patient in a comfortable chair […]. Any tight clothing is taken off.
The chair was the initial idea, As it turned out, not suitable for the sexualised treatment, thus, the couch would soon follow. Of course, the tight clothing would make it hard to get to the ailing parts of the body. Naturally, it had to be removed.
The room is darkened, silence is preserved. Now the treatment could start. Freud recommended, suggestion accompanied by the passage of a weak galvanic current with the cathode in a band round the wrist [giving the patient] the impression of being tied up (6), and thus at the mercy of the hypnotiser.
And the crux of the matter: Stroking and pressing on the ailing part of the body during hypnosis gives excellent support in general to the spoken suggestion. (6)

By now, it should be apparent which those ailing body parts were that needed stroking. Having the offending clothing removed, and thus unrestrained access to the genital region, Freud would proceed with the massage.
Notably, Freud's initial instructions did not include the use of a couch.
Freud wasn’t hiding what his treatments were about. This is how, in his Studies on Hysteria (1893), he recounted his plan for his female patient’s treatment: I shall massage her whole body twice a day. (7).
The whole body reference is an obvious euphemism for genital massage. After all, Freud wasn't a trained masseur, but he knew how to satisfy a woman.
But it wasn’t always smooth sailing. On one occasion, his patient, in hypnosis ... informed [him] that she had been afraid that her period was going to start again and would again interfere with the massage. (8).
As a matter of course, Freud wasn't massaging the woman's aching feet. And the fact that she was afraid that her period would, again interfere with the massage, confirms that the massage was a recurring thing, lasting weeks, months, rather than days.
Over time, Freud gave up on hypnosis – he wasn’t a good hypnotist – but not on the sexual part of the treatment.

This is how Freud, in his An Autobiographical Study (1925), explained how he progressed from hypnosis to psychoanalysis:
I abandoned hypnotism, only retaining my practice of requiring the patient to lie upon a sofa while I sat behind him, seeing him, but not being seen myself. (9)
Notably, rather than referring to a female, the most common sex of his patients, in his statement, Freud used the male pronoun, him, presumably to distance himself from being a vaginal doctor only.
Moreover, in his earlier statements about hypnotic induction, there's nowhere a mention of Freud using a sofa for his hypnotic treatments - no hypnotist did - instead, also Freud recommended utilising a chair for this purpose.
When Freud started as a hypnotist, in most cases - since Freud wasn't treating his female victims in his office, but in their homes - the sofa wouldn't have been used.
The sofa was acquired first in the 1890s, when Freud abandoned his ten-year-long dalliance with hypnosis. It undoubtedly had a different, more hands-on purpose.

 At the time, there were lots of sex-starved women in Vienna, and Freud, who knew nothing about medicine, but lots about sex, chose the easy path. For a fee, he would give women satisfaction, taking a cab when visiting them in their homes, and pleasuring them on any available pieces of furniture or none.
The psychoanalytic talking cure came much later when Freud was both impotent - this is what cocaine will do to a man - and orally, but not digitally, disabled.
Freud didn’t hide how he was earning his daily bread from his boyfriend Fliess. Thus, he explained to Wilhelm on October 6, 1893, that,
The sexual business attracts people; they all go away impressed and convinced, after exclaiming: "No one has ever asked me that before!’ (10)
But asking sexual questions was only the initial stage.

As Freud’s biographer, Clark, pointed out, many of his patients were women … to some degree mentally unstable and …  sexually repressed. Oddly, even though Freud’s sexual monomania was the talk of Vienna, Clark claimed that, it is only the prurient who have asked … what happened on the couch, (11) even though it is a perfectly reasonable question to ask. So, what did happen on the couch? As  the authors of a biography of Freud suggestively titled, Freud's Women (1992) point out,
    So the wish to cure sexually abstinent patients could be realized quite simply: Freud could give his patients sexual satisfaction. ... [thus] the role of the doctor and the role of the lover are combined together. (12).
In other words, Freud was acting as a gigolo providing sexual services to sexually starved women for a suitable fee.
  Yet another more recent Freud biographer, rather perceptively, pointed out that. Freud, was encouraging unfulfilled women to put him into the role of a surrogate lover. (13)

Freud liked to brag about his sexual exploits in the open view of naive readers. Thus, in An Autobiographical Study (1925), he recounted the unexpected reaction of one of his female patients, while he was busy tracing back her attacks of pain to their origins. The gullible readers, as well as no less gullible, scores of psychoanalysts, never understood what Freud was saying.
Since, as he claimed, the origin of all human ills was sexual abuse, Freud was applying his sexual cure, consisting of helping the woman to recall her long-forgotten sexual past by working on the patient's private parts.  Unexpectedly, As she woke up on one occasion, she threw her arms round my neck, Freud complained. (17)
"Please don’t stop, dear doctor, almost there."
Again, oddly, most readers never paid attention to what Freud was telling them. For the woman to be able to throw her arms around Freud's male neck - assuming she was reclining on the sofa - Freud must have been on top of her. Had he sat behind the couch, which he claimed was a normal procedure during hypnosis, to be able to throw her arms around his Freudian neck, the patient would need to have arms a couple of meters long. She didn't. Thus, this Freudian confession only confirms that Freud's couch was primarily intended not for psychoanalysis, but for sexual pleasuring of hysterical women.
There's another, somewhat different version of this event. As one of Freud’s most famous patients, the Wolf-Man recalled, Freud had told him that in his early days as an analyst he had sat at the opposite end of the couch and that he and the patient could look at each other. Notably, there's no mention of a hypnotic trance. Allegedly, one female patient ... made ... attempts to seduce him. To avoid the repetition of the event, Freud moved ... to the opposite end of the couch.
Notably, there's no mention of how the seduction attempt was performed. Freud was never careful with the truth.
Again, according to an unspecified, male patient ... Freud told him of one seduction attempt - but rather gilds the tale by claiming that this was the start of Freud’s sitting behind the couch rather than at its foot. Notably, Clark, who reported the tale, commented tantalisingly: Beyond that, silence. (18)

Let's consider Freud's so-called analytical couch. Notably, the so-called couch - yet another Freudian deception - doesn't look like a conventional couch, a sofa, or an ottoman.
This is a bed with a raised head part intended for reclining, with the patient lying on her back, face up with easy access on all sides. Most certainly, this is a comfortable sexual position, but not particularly suitable for hypnosis or oral confessions.
An author who was interested in the couch, and its uses, reported that,
In her catalogue to the exhibition Die Couch: Thinking in Repose, Lydia Marinelli writes that Freud’s choice of “examination bed” “opens a wide spectrum of experience between dreaming and waking, dissoluteness and moral control. And Marinelli further explained -what is common knowledge - what couches, including the Freudian one - are often used for:
From a prone position, “the clear certainties of thought can be diverted from their course into a twilight state of drowsiness and further into the anaesthetized state of sleep or into the depths of illegitimate sexuality.” *
As she revealed, Freud called the couch an ottoman or, at other times, his examination or consulting bed, but it is referred to now as “the analytical couch.”' Why a need for renaming the couch? Maybe, a qualified guess, to distance its use from the obvious sexual option?
* Warner Maria, Freud's Couch: A Case History, Raritan 2, (2011), pp. 146-163. (p. 148).
** Warner, (2011, p. 149).

There's no doubt that for a large part of his career, Freud employed the couch, not to listen to the confessions of the reclining hysterical female patients, but for more erotic treatments.

In On Beginning the Treatment (1913), Freud explained his psychoanalytical procedure:
I hold to the plan of getting the patient to lie on a sofa while I sit behind him out of his sight. Now comes the big lie. This arrangement is the remnant of the hypnotic method out of which psycho-analysis was evolved. (19) 

But, as Freud himself stated earlier, a subject to be hypnotised was placed on a comfortable chair, not on a sofa, with the hypnotiser in front, or on the side, of the subject not behind him or her.

Again, Freud was trying to distance himself from his sexualised treatment of women on the couch. Thus, notably, when talking about the sex of the subject, Freud used the masculine pronoun. his, rather than the feminine "her", even though almost all his patients were female.

Freud also treated on occasion, though fewer, male patients. So, what kind of treatment could Freud offer a male reclining on his sofa? One of Freud's more knowledgeable biographers, Peter Gay revealed that, in the letter to Jung about Leonardo da Vinci, Freud added tantalizingly ..., "I recently encountered his likeness (without his genius) in a neurotic."'
Considering that the Leonardo study, authored by Freud, like most, if not all, of his writings, was autobiographical, the neurotic, no doubt, was Freud himself.
Since Freud was drawing on his knowledge of his own life, that is why he was so confident that he could reconstruct Leonardo's ,,, youngest years ... heavily laden with clinical associations.

As Gay observed, Freud's couch and his desk were, physically and emotionally, very close to each other. He had no doubt that Leonardo's recollection represented ... the passive homosexual sucking on a penis. (20)

There is no doubt either what Gay was insinuating. A step or two was enough for Freud to arrive at the couch on which the patient would await the treatment. As it is apparent, Gay's innuendo cannot be misunderstood. 

When it came to men, Freud would be acting as, the passive homosexual sucking on a penis. Freud not only put his money where his mouth was, he also put his mouth where his money was, and not only symbolically.

So, did Freud always sit behind the couch? Not likely. As it's been pointed out, 

The Freudian analytic couch, with its reclining, usually female, patient, is an artefact not specifically of the practice of hypnosis … but also of massage and electrotherapy. So, the couch was not needed for hypnosis. but for "electrifying" or massaging a patient's private parts. As a matter of course, this kind of treatment was not possible while sitting behind the couch.

Thus, Freud’s mention of hypnosis as his primary motivation for using the couch for his treatments, obscured his association with, massage, electrotherapeutics, and … genital stimulation. (21) 

In other words, from the start, Freud’s sofa was intended exclusively for pleasuring the patient. It was the kind of treatment that not only was in high demand, and paying well, but that also didn't demand medical knowledge, which suited the dilettante Freud like a glove. No wonder, that the impecunious Freud, in his practise, used genital stimulation.

Besides using a combination of oral, manual, and genital pleasuring methods, as Freud recalled in his Autobiographical Study, (1925), he initially also used electric stimulation to treat the patient.
As Freud honestly, for a change, admitted, his limited, knowledge of electro-therapy was derived from W. Erb's text-book [1883). (22). Notably. Erb claimed that -  which Freud somehow forgot to mention - that,
the majority of cases of [of nervous diseases] also require direct electrical treatment of the genitals, (23)
This suited Freud just fine.

As Freud claimed in The aetiology of Hysteria (1896): The great majority of severe neurosis in women have their origin in the marriage bed. (24)
Thus, he would "cure" sexually starved women by providing them with the sexual satisfaction they so desperately needed.
Having sex with, or masturbating, a patient while standing or lying on the hard floor, is not convenient. Without a doubt, it is the "convenience", that explains the true origin of a couch. It was, simply put, for Dr. Freud, the tool of his erotic trade.(

 One of Freud's closest disciples, Theodor Reik - once he freed himself from his former master and benefactor, - felt like spilling some of the Freudian sexual beans.
This is how he recalled his visit with Freud to one of Freud's psychoanalytical followers, who, apparently, like Freud, for a sizeable charge, was willingly providing sexual services to his female patients:
We once visited the newly furnished consultation room of one of our colleagues, Reik recalled, Freud, pointing to the very broad couch, said smilingly to me, "That is rather for group analysis. (25)
      Even though Freud's couch was narrower, it served the same purpose. But, since Freud, as far as it is known, provided sexual services to one woman at a time, there was no need for a broad one.

In his Magnus opus, The Interpretation of Dreams, (1913) Freud recounted, the following short dream, which every reader will read with disgust. The dream is indeed short, disgusting, and, like most of the dreams in the book,if not all, a fake..
The dream features, a very long bench, at the end of which is a wide aperture. ... covered with little heaps of excrement of all sizes and degrees of freshness.
In the dream, Freud springs into action.
I urinate upon the bench ... the patches of excrement come off easily and fall into the opening.
This is a disgusting dream, indeed, if it is a dream at all, a product of the disgusting imagination of the disgusting man. But how is this dream related to Freud's couch? This is Freud's explanation:
The bench (omitting the aperture …) is the faithful copy of a piece of furniture of which an affectionate female patient has made me a present.
The affectionate patient was allegedly one Madame Benevisti.
What is the dream about? If the bench corresponds to Freud's couch, then the excrement on top of it corresponds to Freud's patients of all sizes and varying degrees of lunacy.
According to Freud, the patients he's dealing with constitute, the museum of human excrement is susceptible of a gratifying interpretation. And the gratifying interpretation can only be the fees Freud collected from his victims (the rabble, as he used to call them).
Confirming this guess, Freud explained that, However much it – the bench – disgusts me, it is a souvenir of the beautiful land of Italy, (26) thus the gift of the Italian lady. So, the couch disgusted him for obvious reasons. The bench was a symbolic couch, on which Freud’s paying excrement, pardon me, patients, reclined.
Considering that her name, Benevisti, means welcome in Italian, it is doubtful, there was ever a Madame Benevisti. This is, no doubt, yet another Freudian joke, his idea of making a fool of the gullible reader of the dream book, and not for the first time.
This is not all, since there's a hidden message in the nationality of the benefactor.  As Freud explained in the dream book the name Italian has for him sexual symbolism. Since Italy in German is being spelled Italien, Freud associated Italien with the German name for genitals, Gen-Italien. Freud loved playing with words enjoying making fun of his readers.
So what is Freud saying? Simple. Welcome to my genital business.

Freud's attitude toward his patients in other contexts confirms this interpretation. Thus, talking about an American patient Freud, referred to [him] as his “negro".
This wasn't the only time he disparaged his patients. As Jones recounted also other, patients were referred to as “negroes.” (27)
Before his close followers, Freud wasn’t hiding his contempt for the patients. 
Thus, writing to his crown prince Jung, on October 1, 1910, Freud called his patients a batch of nuts. (28) Freud's assessment of his patient didn't change over time.
Thus, writing to his boyfriend, Ferenczi, Freud informed him on December 16, 1917, that he was working with nine fools. (29) clarifying - as Ferenczi recounted in his diary - that the neurotics are rabble (30).

Freud the neurotic  

Funnily enough, also Freud was a self-professed neurotic, thus rabble. Thus, writing to his boyfriend in Berlin, Flliess, on June 22, 1897, aged 31, Freud explained that he had, been through some kind of neurotic experience, (31)
Having attempted an unsuccessful self-analysis intended to cure his insanity, six months later, on November 14, 1897, Freud reported to Fliess that, True self-analysis is impossible; otherwise there would be no [neurotic] illness. (32)
And he confessed to Fliess, on January 4, 1898, only a couple of months later - a huge understatement - I am in part neurotic myself. (33) Freud's neurotic symptoms weren’t improving, since a couple of years later, Freud recounted his, neurotic swings of mood. (34) As it is apparent, Freud belonged to the very rabble he so much despised.
And to a Swiss psychologist, Binswanger - revealing his hatred of the patients - Freud proclaimed that he could wring their necks, all of them. (35). And, in some cases, he did.
Without a doubt, since he was a neurotic himself, Freud's comparison of his neurotic patients to excrement did apply to him, too. In the name of logic, shouldn't Freud have wrung his own neck?