A struggle to know

The author uses Meltzer's discussion of technical issues involved in working with claustrum dwellers to think about her work with a patient who proved to be a claustrum dweller. In particular, she explores his manoeuvres to prevent the development of a transference relationship and the consequent failure of the work to get him to emerge from the claustrum so that an analysis could take place. She considers the factors in both the therapist and the patient which militate against, and facilitate, their making contact. Various elements, such as narcissism in patient and therapist, the strategies of the claustrum dweller to sabotage contact, the fear of catastrophic change and the difficulties for the therapist of holding on to countertransference experience when there appears to be no foothold in the patient's mind for such thoughts are explored in relation to the author's experience with her patient. Copyright © 2005 British Association of Psychotherapists