Projection is an ego defense mechanism where an individual attributes their own unacceptable thoughts, feelings, or motives to another person. In this scenario, the client has romantic and sexual feelings for her physician. To cope with these potentially unacceptable or overwhelming feelings, she unconsciously projects them onto the doctor, believing that he is the one in love with her. This distortion of reality protects her from acknowledging her own desires. This specific manifestation is also characteristic of an erotomanic delusion, which can be a symptom in clients with schizophrenia.

A. Displacement: This involves shifting feelings from an original, threatening source to a less threatening substitute. The client's feelings are still directed at the physician, not a different target.

C. Reaction formation: This is the process of behaving in a way that is the exact opposite of one's true, unacceptable feelings. The client is not acting opposite to her feelings.

D. Suppression: This is the conscious, intentional act of pushing unpleasant thoughts or feelings out of one's mind. The client's belief is a delusion, an unconscious process, not a conscious choice.

1. Townsend, M. C., & Morgan, K. I. (2018). Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (7th ed.). F.A. Davis Company. In the chapter on "Mental Health and Mental Illness," projection is defined as "attributing feelings or impulses unacceptable to one’s self to another person" (Table 2-2, Ego Defense Mechanisms, p. 20).

2. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th ed.). Wolters Kluwer. Chapter 4, Section 4.5, "Defense Mechanisms," describes projection as a defense in which what is emotionally unacceptable in the self is unconsciously rejected and attributed to others.

3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). The clinical picture described aligns with an erotomanic type delusion, defined as the delusion that another person is in love with the individual. This delusion often involves projection of the individual's own feelings (p. 90). https://doi.org/10.1176/appi.books.9780890425596