The Couch: Reflections From an Interactional View of Analysis

Part of the human condition is the need for structure. The couch, integral to psychoanalytic technique, is part of the structure of psychoanalytic treatment. Its use sometimes provides the psychoanalyst with the sense of knowing what should be done, how it should be done, and how best to observe the unfolding transference.

The psychoanalyst's respect for the structure of the psychoanalytic situation distinguishes psychoanalysis from countless other therapies. Yet, at times, the analyst's respect for this structure overrides other considerations dictated by logic and common sense. When this occurs, psychoanalysis is defined not by its essence but by technical considerations such as the number of sessions per week, duration of treatment, and whether the couch is used. I strongly believe that ultimately what is analytic can only be defined by the particular analytic process related to it.

Some would argue that whether a treatment is considered “analytic” is immaterial, and certainly that is true for the patient. But for organized psychoanalysis, for being certified, promoted, and graduated, those issues can be crucial. An example occurred when an analytic candidate's graduation paper was refused because the patient was seen only three times a week; this factor and because the patient sat up were said to disqualify the treatment as analytic, yet the patient and analyst were engaged in a clear analytic process.