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How a patient responds when we explore whether the couch or the chair should be used in the course of psychoanalytic treatment is “of prognostic significance and a clue to the potential duration of treatment. In general the patient's attitude toward the couch is a rich source of knowledge about his problems and therapeutic needs” (Spotnitz in Stern, 1978). I had occasion to give much thought to these two statements in the course of the three and a half years that I treated a defiant young man who refused to use the couch. But as I grappled with trying to understand why, a new element kept intruding itself—my part in this refusal and the effect that his resistance had on me. In other words, my interest in this case came to encompass not only transference and resistance issues but also countertransference issues. I had a great need to have the patient use the couch because when he avoided the couch I felt that I was not a “true” analyst.
Freud (1913) established the basic rules for the position of analyst and patient: the patient was to recline upon a sofa with the analyst sitting behind him, out of sight. The reasons for this “ceremonial observance” are multiplex: it is “the last vestige of the hypnotic method out of which psychoanalysis evolved” (1913); it makes it possible to conduct analytic sessions for eight or more hours a day in relative comfort; and it enables the analyst to be in freer contact with his unconscious thoughts as he listens to the