Psychiatrists use their feelings to empathise with patients. But sometimes love, hate, fear, rage, horror overwhelm, leading to bad decisions. Projective identification helps theorise this. Babies expel difficult feelings into a ‘bad mother’, who then ‘detoxifies’ what the baby cannot tolerate. But sometimes, especially with an unresponsive caregiver, projective identification represents the child's only means of affective communication.

Treating people with borderline personality disorder, distracted mental health workers may enact patient's feelings rather than detoxifying them, with consequent chaos. Awareness of projective identification counteracts splitting and boundary-breaking, helping psychiatrists see their countertransferential feelings as manifestations of the patient's inner world.