Projection

Projection is another common defense mechanism by which people unconsciously reject an unacceptable emotional feature in themselves and ''project'' it onto someone else. It is the major mechanism involved in the development of paranoid feelings. For example, hostile patients may say to interviewers, ''Why are you being so hostile to me?'' In reality, such patients are projecting their hostility onto the interviewers.

Patients commonly project their anxieties onto doctors. Patients who use projection are constantly watching a doctor's face for subtle signs of their own fears. For example, a 42-year-old woman with a strong family history of death from breast cancer has intense fears of developing the disease. During the inspection portion of the physical examination, the patient may be watching the clinician's face for information. If the clinician frowns or makes some type of negative gesture, the patient may interpret this as ''The doctor sees something wrong!'' The clinician may have made this expression thinking about the amount of work still to be done that day or what type of medication to prescribe for another patient. The patient has projected her anxiety onto the clinician. The clinician must be aware of these silent ''conversations.''

In some instances, projection may have a constructive value, saving the patient from being overwhelmed by the illness.

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