The plot centers on an anonymous exchange of apartments between a successful New York psychoanalyst (William Hurt) and a young woman from Paris (Juliette Binoche).

Henry Harriston is a psychoanalyst whose patients are driving him crazy by constantly leaving him messages during his off hours.

Béatrice Saulnier (Juliette Binoche) a Parisian dancer responds to his ad and without meeting the two switch apartments.

When they begin calling the apartment telling Henry how helpful he was and how they want to talk to him again he turns tail and returns to New York.

Instead of confronting her however, he keeps up the ruse of being a patient, but is unable to talk and the session consists of Béatrice and Henry saying "Yes" back and forth at one another.

Janet Maslin of The New York Times wrote, "It takes a while to get past the strained, wide-eyed ingenuousness of A Couch in New York, in which [Akerman's] solemn side and Mr. Hurt's own gravity are never out of reach", but added that "once the film moves past its initial vapidity, it takes on a reasonably blithe aura of romance", concluding, "Coming from Ms. Akerman, this is pleasant but unaccountable fluff.

"[1] David Rooney of Variety criticised the dialogue and felt that "Akerman attempts to create a magical atmosphere akin to that of a musical, with blithely improbable narrative shortcuts and fairy-tale skies, but the result is flat and labored", while stating that "Hurt and Binoche appear awkward in their roles".