Will This Case Count? The Influence of Training on Treatment

Mandated use of the couch—whether specifically stated or tacitly communicated by supervisors and colleagues—to fulfill requirements for graduation or certification is a significant disservice to candidates and their patients. In its training standards, it is argued, APsaA and its member institutes should state explicitly that a treatment can qualify as a psychoanalysis, regardless of whether the patient is using the couch, as long as the process is analytic and the candidate's thinking is demonstrably analytic. The mandate, however conveyed, that one must use the couch interferes with candidates' optimal analytic functioning, jeopardizing their patients' analyses. Data from infant observation, neuroscience, and facial expression studies—unavailable to earlier generations of analysts—support a more nuanced view of use of the couch. Each analysis is unique, and some analyses might well benefit from use of both the couch and the chair at different phases of treatment, but unless this is spelled out by ApsaA and its member institutes, candidates and junior analysts will be prevented from freely contemplating the clinical benefits or detriments of their use in specific cases.