Les recherches freudiennes concernant le destin des pulsions conduisent Freud à retrouver un mécanisme commun découvert dès les premiers temps de sa pratique clinique : la projection. Les différentes acceptions psychanalytiques de ce concept, développées par Freud et ses prédécesseurs, ainsi que la découverte d’une dialectique perception/projection organisatrice de toute situation projective incluant un médium ont participé à l’élaboration des paradigmes de la psychologie projective, caractérisée par sa transversalité théorique et clinique. Notre étude clinique et projective consiste à montrer en quoi la projection apparaissant dans ses rapports au transfert et au contre-transfert dans un contexte médical constitue une stratégie éminemment efficace pour contrer la désorganisation patente générée par deux pathologies somatiques graves (diabète et insuffisance rénale), dont souffre Loïc, 60 ans, et leur traitement (insuline et hémodialyse). Bien que cette défense soit profitable au patient, elle n’en reste pas moins coûteuse du côté du clinicien-chercheur qui, devenu objet persécuteur par le simple fait d’être une « femme savante », doit composer avec son contre-transfert négatif envers son patient. Quelle est la position à tenir pour ne pas être happé par un tel ouragan de violence et de haine, et comment procéder afin de trouver un équilibre transféro-contre-transférentiel dans ce qui permet au malade de supporter l’épreuve de maladie mais dans ce qui tend paradoxalement à mettre à mal le thérapeute ?

Our review of the literature supports on the psychoanalytical theories about the concepts of transference, counter transference and projection. For our analysis, we privilege Sigmund Freud's works resumed by Michel Neyraut as for the definition which they propose of the transference, understood as a displacement on “the person of the doctor” and repetition of the unconscious feelings of a primary's object relation. In the psychotherapy frame, the transference massive can express itself with strength (freely or at the price of resistances) thanks to the identification and to the projection (of love or hatred). When a negative transference that Thierry Bokanoswki translates into terms of hatred of the transference and the hatred in the transference is at stake, it is well-to-do to understand that the counter transference is affected… But the question is: How? This process which adorned us inseparable of the transference, is understood by Sandor Ferenczi and Paul Denis as an obstacle to be overcome by the therapist to reach better the psychic life of his patient thanks to their relation. Runner of the psychoanalytic considerations according to which one counter transference is a brake for the good progress of the psychotherapy but also a lever allowing the psychic elaboration and the creation of sense, we chose to register the dynamic of the transference in the clinic of the serious illness to better encircle the echoes of physical burglaries and the psychic impact of binding treatments. Besides, it generally admitted that the trauma of the somatic achievement reveals an unconscious raw engendering various psychopathologic demonstrations. The term of projection comes to illustrate this idea of a psychic disorganization and its consequences. The various psychoanalytical meanings the concept of projection and the discovery of a dialectic organizing perception/projection of any projective situation including a medium participated in the elaboration of the paradigms of the projective psychology, characterized by its theoretical and clinical transversally. Beyond the analysis of the transference and counter transference movements thanks to clinical consultations, we also chose to use Rorschach and TAT and the psychoanalytic interpretation inspired by the university of Paris 5 method. Our research appears under the form of a clinical case report built following the meeting with a patient at the beginning of dialysis. Loïc, 60 years old, reached by two severe somatic pathologies taken care medically: diabetes treated by insulin and a renal insufficiency treated by dialysis. Our clinical and projective study shows in what the projection appearing in its relationships to the transference, forms an eminently effective strategy to counteract the obvious disorganization generated by the chronic diseases from which Loïc suffers. The exploratory perspective of this research joined of our previous works, by highlighting the interest of the analysis of the transference and counter transference in medical context. Although the projection was profitable to the patient, it not less nevertheless remained expensive on the side of the clinician-researcher who, became persecutor object only because of being a “learned woman”, had to compose with the feminine maternal persecutive transference which was attributed to her. The transference movements and the paranoiac projections nevertheless allowed Loïc to support the event of disease in what put temporarily the therapist in trouble.