Encounters in the Claustrum: An exploratory study of the Claustrum in contemporary Psychoanalytic Child and Adolescent Psychotherapy

Clinical encounters involving the Claustrum are complex, elusive and often feel almost impossible to decipher. This qualitative study explores how Child and Adolescent Psychoanalytic Psychotherapists experience clinical situations in which they feel that Meltzer's concept of the ‘Claustrum’ (1992) is helpful in understanding the patient’s internal world. The literature review explores the place of the Claustrum within contemporary Child Psychotherapy and the experience of clinical encounters with hard to reach patients. The study’s methodology is Thematic Analysis. Data was gathered from semi- structured interviews from members across the Association of Child Psychotherapists. Four themes were devised relating to the participant-clinicians’ clinical experience and thinking. These were Symbolic Representations of Phantasy, The Therapist’s Experience, Knowing How to Respond, and Clinical Practice and Clinical Theory. Clinical experience is viewed as paramount in making sense of Claustrum encounters. These clinical experiences include the counter-transference as containing a particular quality of inclusion and exclusion, the Claustrum as one aspect of the patient’s presentation, clinical theory as helpful but secondary to clinical experience and its integration within one’s clinical thinking. This study includes various examples of Claustrum-like clinical encounters which may facilitate further discussion amongst colleagues about this clinical phenomenon. The Nowhere Place featured as an aspect of the both the patient and therapist experience of the Claustrum. The clinical implications of the study include that a sensitivity to clinical technique is paramount until more sophisticated stages in a treatment, and how dream analysis can help illustrate the Claustrum experience. The study also captures an experience of an aspect of the Tavistock’s tradition of Child Psychotherapy training regarding Meltzer’s continued influence on it. Personal experience as a Child Psychotherapy trainee and working with Claustrum-like patients allows reflexivity as a clinician-researcher.