Projective identification and projection are defined, described, and contrasted. Projective identification is seen as an early or primitive defensive operation, and projection as later or more advanced and derivative in nature. The developmental origins and adaptive functions of projective identification are examined with an emphasis on the cognitive preconditions for the operation of this defense. The varying functions of both defensive operations are described within the context of psychotic, borderline, and neurotic personality organization.

Case material is presented to illustrate the diagnostic approach to and the clinical functions of projective identification, particularly its importance in contributing to complementary identification in the countertransference. Also illustrated is the technical management of severe transference regression under the impact of projective identification. Finally, alternative approaches to the diagnosis and interpretation of projective identification are discussed.