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Dr. Robertiello's article “The Couch” 22 is of considerable interest, and my following remarks are written at the request of the Editor of this Journal.
His article makes several points, the most important of which appear to me to be the following: (1) The couch in analytic practice is an anachronism. (2) The personality of the analyst is the main agent in therapy. (3) The couch interferes with the full utilization of this agent because real feelings and real affective interplay are replaced when using the couch by a game-like atmosphere which carries with it the implication that nothing of personal import is going on between patient and therapist. (4) By removing the couch, the patient and the therapist will be forced into a true confrontation and thus a genuine interaction will be established through which the therapist's effectiveness will be enhanced.
In speaking of the personality of the psychoanalyst as an effective instrument and in describing analytic detachment as a kind of dissociated gamesmanship, Dr. Robertiello raises some well accepted and genuine issues. However, proposing the removal of the couch as a cure-all for the problems raised by these issues is to both oversimplify and distort them. No change in technique will affect a problem that by Dr. Robertiello's own agreement resides in intrinsic properties of very specific people, the analysts.
But first let us, for the record, make a historical point. Freud12 writing under a pseudonym15 and talking of himself in the third person, describes in part the development of the use of the couch: