Conversion from psychotherapy to psychoanalysis and the differences between the two have been the subject of discussion and controversy in recent years. The theoretical and technical questions that have been raised suffer from the lack of detailed clinical accounts that might help to elucidate the processes involved. The author presents a case of a woman whose refusal to use the couch for three years became a central organizing resistance and took on the structure of a phobia. It is argued that the case, rather than a conversion from psychotherapy to psychoanalysis, was one of psychoanalysis from the beginning, with the conflicts about the couch analyzed as are any other resistances.