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Use of the Couch in the Psychotherapy of Borderline Patients

Richard D. Chessick, MD
Arch Gen Psychiatry. 1971;25(4):306-313. doi:10.1001/archpsyc.1971.01750160018004.
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The arguments in the literature regarding the use of the couch and experiences from private practice in the psychotherapy of borderline patients are discussed. Fourteen patients diagnosed as borderline (excluding adolescents and those who showed serious depressive tendencies, paranoia, or chaotic anxiety) used the couch during twice weekly psychotherapy sessions. Four patients became much worse and had to sit up after a few sessions. Two patients showed no detectable change. Six showed definite improvement. Two left therapy after a couple of months but it was not possible to attribute the departures to the use of the couch. It is not the use of the couch that is important but the psychotherapist. If he is properly trained and experienced the couch can be a useful tool in the treatment of some borderline patients.

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