The letter 'was couched in' polite terms.
a psychiatrist's 'couch'
(..) The last thing l need... ..is another picture of me looking like a porcelain doll. As a paying customer... ..l expect to get what l want. Over on the bed... the couch. Go... lie down. Tell me when it looks right. Put your arm back the way it was. Right. Put that other arm up... (..)1997 Titanic