"Lying" and "Lying"—A Case Report of a Paradoxical Reaction to the Couch

THIS CASE HISTORY ILLUSTRATES HOW ASPECTS OF THE ANALYTIC setting—particularly the use of the couch—interacted with constitutional and early experiential factors in a way that seemed initially to result in a stalemated analysis. When the treatment was switched to psychoanalytic psychotherapy, the patient was able to work in an analytic mode, and it turned out that the stalemate had been due to an altered state of consciousness related to her feeling about lying on the couch. Lying on the couch had mobilized in the transference conflicts that were based in early preoedipal trauma. When she was sitting up, free of the specific anxieties associated with lying on the couch, we were able in retrospect to understand not only the patient's difficulty in communicating from the couch but also to recover memories which revealed the genetic roots of the problem.

In early spring a garden may still look like a piece of barren ground, although extensive work has been done in spading, fertilizing, and seeding. Similarly, the first work on the couch in this case ended with little signs of real growth. The garden requires cultivating, weeding, watering to bear fruit—so too in this case the harvest came later after additional work. The later work done in the psychoanalytic psychotherapy with this patient, however, built on and depended on the understanding of intense transference feelings from the previous epoch of analytic work on the couch.