Paranoia and Psychotic Process: Some Clinical Applications of Projective Identification in Psychoanalytic Psychotherapy

The concept of projective identification has, since its introduction by Melanie Klein over half a century ago, caused much controversy amongst psychoanalysts and psychotherapists. In this paper the author traces some of the key theoretical developments of the concept since its introduction in 1946, including: normal and pathological projective identification, aspects of symbolisation and projective identification as an intrapsychic mechanism. An extended case report of a patient in weekly psychoanalytic psychotherapy is offered in order to expand upon some of the theoretical ideas previously considered. Emphasis is placed on the patient’s use of intrapsychic projective mechanisms and the emergence and mutation of such mechanisms in the therapeutic relationship.