Projective identification is a clinical enactment and part of the common currency of the psychoanalytic process that occurs especially around the difficult nodal points at the deepest levels of our psychic organization that seem resistant to change. Neurophysiological studies of pre-symbolic, unconscious emotional systems offer a biological explanation for the clinical experience of resistance to change. In addition, recent findings in affective neuro-science and infant research help us to understand how the spontaneous matching of emotional states between patient and analyst that occurs in projective identification and the system of mirror neurons that is fundamental to the observation and communication of intention contribute to change. Furthermore, the capacity for self-reflective thought, embedded in feeling and language, offers the potential for consolidating change. Thus, change at the deepest, affect-laden levels of psychic organization involves both pre-symbolic and symbolic levels of self-organization that neuroscience can help us to understand and ground in empirical research.