difference between projection, projective identification, & countertransference

[ClinPsycMasters]

Can someone provide an example that illustrates all three clearly?

I know the basic difference but when it comes to actual work with patients, I get confused.

I think it gets easier after several sessions with the same patient. I think it's very difficult with people who are disorganized or borderline because they are so out of touch with their own emotions/thoughts and causes behind them that you have to be very mindful of your own reaction, of how much of it is yours and how much is theirs. Constant reality testing!

Helpful book/article recommendations also appreciated.

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[Doc Samson]

In a (very small) nutshell:

Projection: ED pt is angry with you because you won't refill their Xanax early but instead of acknowledging their own anger, they project it onto you: "You won't write the prescription because you hate me."

Projective identification: ED pt is angry with you because you won't refill their Xanax early so they project it onto you AND ALSO actually do something to make you angry: "You won't write the prescription because you hate me so now I'm going to throw my coffee all over you. See, I knew you hated me!"

Countertransference: Your feelings about the patient regardless of whatever defence they are employing: "Yeesh, this reminds me of that girl I dated in sophomore year of college. I have to get out of this room ASAP."

 

[ClinPsycMasters]

Thanks. Sometimes you get into this whole thing with someone, it's projection after projection and projective identification there too for good measure, it's hell to deal with.

Edit: projective identification is often not as straight forward as the "I'm going to throw my coffee all over you." I know you used a simple example for illustrative purposes. In my limited experience, it is sometimes the repetitiveness of a projection that induces identification in the therapist. In addition, I have made the mistake of assuming that a person who can not regulate her emotions or hold down the most undemanding job, is not intelligent. Yet, some are amazingly good at finding therapist's weakness, the one place around his ego where his defenses are inadequate, and enter there.