Projective identification is sometimes recognised in counselling and therapy. Projective Identification is when a patient's unwanted feeling is projected out to someone or something else. Some examples of this in an every day situation would be perhaps a son who is late for a birthday party is feeling rushed and anxious he is late for the festivities. His anxiety is then projected to his mother who is dropping him off, resulting in her feeling similarly anxious. In therapy, if a counsellor is seeing a patient who has a history of being violent then the counsellor may similarly have a sense of impatience and "violently" direct therapy in a more confronting manner.

In some situations the projective indentification involves splitting the self and projecting this onto an external object and the patient identifying with these disowned parts of the self. In most cases the patient does not recognise that they are projectively identifying with the external object/person. In extreme cases projective identification can lead to depersonalisation and confusional states. An example of projective identification when splitting the self occurs would be when someone sneezes and another person covers their own nose as if they had sneezed themselves. Also if someone falls over and cuts their knee and another person feels a similar pain in their knee.

There are two important reasons why projective identification is used. One, it is commonly used to evacuate the unwanted self so it can be used as an attack against others. Second instance why projective identification is used is as a form of communication, to let someone else know what is unbearable and to seek their sense of understanding.

However, projective identification should not be thought of as pathological. In some cases it is useful rather than harmful. For instance, empathy is a form of projective identification. Empathy is defined as being "in someone elses shoes", feeling what it is like in someone else's situation and to be sympathetic and understanding of their sitaution.

Essentially, what is important in regards to mental health and counselling is the extent of projective identification. If a patient is completely lost in another person then this may lead to confusional and delusional states.