Projection — MRCPsych Paper B MCQ

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ModeratePsychotherapyProjectionMRCPsych Paper B

A 30-year-old woman in psychodynamic psychotherapy repeatedly describes her therapist as hostile and critical, despite the therapist's consistently warm and supportive manner. During the sessions, hostility is evident in the patient's own tone and comments, but she experiences it as belonging to the therapist. Which defence mechanism is operating?

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Correct answer: E — Projection

Projection is the unconscious attribution of an unacceptable aspect of oneself—here, hostility—to another person. The patient's hostile affect is experienced as if it belongs to the therapist, despite the therapist's supportive behaviour. Denial would involve refusing to acknowledge an external reality or internal experience without specifically relocating it in another person. Reaction formation replaces an unacceptable feeling with its opposite; intellectualisation uses abstract reasoning to avoid affect; and sublimation redirects an unacceptable impulse into a socially constructive activity. The vignette establishes projection, not projective identification: it does not describe the therapist being induced to feel or behave in accordance with the projected hostility.

Reference: Gibbons R. Someone is to blame: the impact of suicide on the mind of the bereaved, including clinicians. Table 1: Definitions of terms. BJPsych Bulletin, 2024. https://www.rcpsych.ac.uk/docs/default-source/members/workforce-wellbeing-hub/if-a-patient-dies-by-suicide/rachel-gibbons---someone-is-to-blame---the-impact-of-suicide-on-the-mind-of-the-bereaved-including-clinicians.pdf