Projection prevention and control

Although I was delighted to see him referred to in a recent cover of BJPsych Bulletin, Robert Burns was not at his most ambitious when he asked: ‘O wad some Power the giftie gie us/ To see oursels as ithers see us!’ To see ourselves as others see us is not really the fundamental problem. The difficulty is rather in seeing what of ourselves we see mirrored in others, yet cannot own. ¹

In the multidisciplinary ward round, I usually see an overwhelmed person. It feels slightly irritating when they are too overwhelmed to make the interview lead to decisions. That may be telling. Perhaps we are the overwhelmed ones. After all, it is often plain that our efforts will not be enough to make things go just the way we and they would prefer them to.

And so, we treat what is really a rich, stressful small group interaction as though it were an individual interview – a forum for demonstrating psychopathology then coming to decisions.

Perhaps Dr Black's suggestion ² of a closed-circuit televising of the individual interview to the multidisciplinary team offers just the right level of projection prevention and control to make the interview work for patient and team.