You are doing everything right. The cat does need a vet check, although the problem is more than likely behavioral.

It could be that you need to use an enzyme cleaner on the couch to really get rid of any scent. Try Petastic or Heaven's Own. Nature's Miracle works pretty well too. Ask at a local pet supply store what they recommend for that purpose.

If you haven't tried the Feliway spray or Comfort Zone plug-in with Feliway this too might help.

If the problem is behavioral, you may want to consider some sort of anti-anxiety drug which you can get from your vet.
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Smile, it will make them wonder what you are up to!

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