This chapter examines projective identifications as it occurs in inpatient treatment and discusses the several complementary lines of thought concerning analytic inpatient work. It presents the case material which demonstrates the value of the concept of projective identification as a framework for organizing and dynamically formulating the complex interplay between the intrapsychic and the interpersonal sphere. The chapter discusses the two additional facets of projective identification as they relate to hospital treatment: projective identification occuring in a group setting and the accessibility to action in inpatient treatment. Several overlapping and complementary lines of thought have developed over the past 50 years that deal with the application of psychoanalytic principles to an understanding of interactions occurring in the context of a psychiatric hospital. The training subsystem placed value on training psychiatric residents even if it involved a limited inpatient training period.