Use of the Couch in the Psychotherapy of Borderline Patients

Apologia pro vita mea: an intellectual odyssey. Part One

“…I found right away that three types of patients could not be placed on the couch under any circumstances: adolescents, borderline patients with obvious depressive, suicidal or paranoid tendencies, and severely affect-starved or anxious borderline patients [91]. In the series of 14 patients that were transferred to the couch a definite improvement occurred in 6, no detectable change in 2, and a worsening in 4.…”

Questioning the couch: Historical and clinical perspectives.

“…Seen in this way, the couch can be a crib (Waugaman, 1987(Waugaman, , 1995Winnicott, 1954a) or a coffin (Frank, 1992;Guntrip, 1961;Winnicott, 1954b); it can evoke experiences of abandonment, fear of dirtying the couch (Frank, 1995), and fear of being attacked (Chessick, 1971). The couch, as well as the setting in general, can also become a battlefield for control, where there is an imposition that can be accepted or rebelled against (Ferro, 1996;Meissner, 2005).…”

The Role of the Couch in Psychoanalysis: Proposed Research Designs and Some Preliminary Data

“…It may be essential for these patients to see the analyst in order to minimize further regression and trauma. The psychoanalytic literature also cautions against using the couch where there is danger of "severe regression" that could lead to "a disintegrative process that affects the cohesion of the self " (Wolf 1995, p. 321; see also Haak in Chessick 1971). Some analysts believe that if the patient exhibits intolerance to use of the couch, this issue must first be recognized and understood before a psychoanalytic process can develop (Lichtenberg 1995).…”