The couch is still used today, but only within the psychoanalytic/psychodynamic branch of psychology, and even then the decision of couch vs chair comes down to the individual clinician. These two disciplines are the ones closest to the original Freudian school of thought, with psychoanalytic psychology staying the closest to his original theories, and psychodynamic approaches being heavily influenced by (but still willing to diverge from) Freud. Primarily, the couch serves to encourage free association by directing the patient's attention away from the analyst and the room, thereby reducing the likelihood that the patient will see any reaction from the analyst or stimulus in the room which may interrupt the flow of association. This free association is a critical component of the therapy, as it allows the patient to develop insights into how he/she thinks and feels without getting caught up in internal resistance, such as editing that material for an outside audience or repressing it for being unacceptable. Thus unconscious material is brought up to consciousness, allowing the patient to make more aware and conscious choices in his/her life without the interference of the unconscious.

Other schools of thought in psychology tend to discard the couch for a variety of reasons. For example, the cognitive and behavioral schools tend to take on a more active approach, where the therapist serves as an expert actively guiding the client in evaluating his/her thoughts and behaviors and generating experiments to modify them. Likewise, the humanistic school avoids the couch because it reinforces a power differential between the therapist and client, rather than encouraging a collaborative relationship between them. And since the couch is a vehicle for free association, if the psychologist is not using free association as an important component of the therapy then he/she will have little use for a couch. So we can see a general trend of counseling shifting more to chairs as the other psychological traditions, such as cognitive-behavioral therapy, gain more traction and become more popular than Freudian psychoanalysis.

Personally, I find the chairs more comfortable and less likely to induce drowsiness.