The couch as defense and as potential for enactment.

Use of the couch in psychoanalysis is almost universal because of its many advantages. This paper focuses on situations in which the use of the couch is not beneficial, involving problems of the patient or of the analyst. Interferences with the usefulness of the couch are illustrated by means of vignettes from the analysis of four patients which demonstrate the isolating potential of the couch and the reasons why this may make the couch appeal to some patients and repel others. The distancing potential of the couch may sometimes appeal to analysts, particularly when the face-to-face arrangement is troublesome. The use of the couch for the enactment of conflict is discussed, as are analytic attitudes toward the use or non-use of the couch.