The Twin in the Transference.

The Twin in the Transference.

Vivienne Lewin

This paper is about twins and twinning, the impact on psychoanalytic work of the existence of an actual twin, and defensive twinship.

The primary emotional task facing an infant is the development of a sense of self, a personal identity, separate from but connected to mother and father. The task is complicated by the presence of a twin, whether mono- or di-zygotic, same or different sex. The twinship is an additional relationship to be dealt with by all members of the family, but most particularly by the twins themselves. They face a unique series of conflicts between remaining enmeshed and separating: a conflict within each individual twin, between the twins, and between them and their parents. The establishment of separateness from a twin is a process requiring parental help that takes place while the twins are working out their relationships with each parent and with the parental couple.

I have worked individually with a number of adult patients who have a twin, and therefore with the implications of twinship for the transference relationship. In working with the individual twin, the twin transference must be addressed in addition to the maternal and paternal object relationships, and the relationship to the parental couple as the creative couple. The twinship may be used as a defence by the patient and may make working through the oedipal situation more difficult. If the twin in the transference is not recognised and analysed, a fundamental aspect of the personality will remain inadequately known and integrated, and development towards separateness in the analysis will be impeded.

A twin shares its mother with the other baby from the beginning of its life, even before birth, though is not clear at which stage of development one foetus becomes consciously aware of the other. Neither baby can ever be alone with mother and each twin is always shadowed by the other.

“The baby at the breast excludes the other both from mother and from itself and, while this might lead to feelings of triumph, it will also engender a fear of attack by the other excluded, envious baby. The baby at the breast will also have been the baby excluded at another time and will identify with the excluded baby, with its feelings of rage and rejection.” (Lewin 1994, p.499).

However, the excluded twin may also identify with the satisfaction of the infant at the breast, and this together with mother’s empathic awareness of the waiting infant may enable it to endure the wait more happily.

In the ordinary process of development, each twin faces a conflict between the twinship, with its lack of true containment provided by the other immature baby, and the relationship with mother, a mature container (Bion 1963) but one which interferes in the twinship. When the mother is the primary object, her maturity and capacity to transform unbearable anxieties into something more benign that can be introjected and integrated, enables the baby to grow and develop.

However, with twins, it is as if the psychic splitting processes have become embodied, leading to difficulty in establishing an identity separate from the twin. “…where the twin is the primary object, the projective and introjective identifications between the two set up powerful interpenetrating forces, creating a confusion of identities that is not adequately resolved by such processing, because neither twin has yet developed the capacity to do so. As a result, the twins create an interlocked state of arrested development where relating depends on projective and introjective identification with the twin, based on splitting. There is a lack of individual ego boundaries and integrity, the “skin” being around the pair rather than the individual” (Lewin 1994, p.501).

The great ambivalence twins face in separating is illustrated by the following example.

A psychoanalyst referred to me a woman whose twin sister was in treatment with him.  Both women were married, leading individual lives, but they thought there were issues to be resolved between them before they could feel more separate. The patient said she wanted to see me at a specific time on a specific day of the week – to coincide exactly with the time and day on which her twin had her session!  When I was unable to offer this, she sought a psychotherapist who could.

The Transference Relationship

Twins often swing between two processes in an attempt to establish an untroubled twinship and to avoid separateness. On the one hand, they may try to establish sameness by denial of difference. Sameness represents an apparently conflict-free state, an illusion of absolute control, and the elimination of rivalry with possible victory for one and consequent humiliation for the other. On the other hand, they may create difference based on splitting and projection, to be rid of unwanted parts of the self, each twin representing different aspects of the twinship.

The struggle between twins may be a potent force in the transference relationship. The patient may attempt to create a twinship with the analyst by denial of difference, especially of generations, or may use projective identification to evacuate the more disturbing aspects of the self. The split off and disowned projections may then be viciously attacked in what seems to the patient to be a fierce battle between the twin in the analyst, and the patient. Interpretations may be felt by the patient as attempts by the analyst to be rid of these unwanted aspects and to force them back into the patient. The establishment of true difference and discrete ego boundaries by working through the processes of separateness and separation  (Quinidoz 1993) will be a major task in the analytic work.

The issue of separateness is, of course, not unique to twins and will be encountered in any psychoanalytic situation. Working with a twin is different, however, in that the transference will, in addition, represent the enmeshed twin relationship consisting of a confusion of aspects of the patient, plus introjected aspects of the actual twin. The possible transference relationships involved are with the actual twin, with the mother as the primary object, with the father as the secondary object, and with the combined parental couple. There is also the recognition of the other twin as different from the self, and in a relationship with both mother and father, and with the parental couple. The awareness of the other twin’s experience of oneself in relation to the parents, as well as to itself, is a further aspect to be recognised. This complex transference twin needs careful exploration and interpretation to enable the patient to be extricated from the twinship towards a transference relationship based on a parental object.

Twinning is not limited to actual twins, but may also be used by a singleton through the creation of an imaginary twin. In the transference, the imaginary twin may be used in a search for greater understanding, by splitting off and projecting unknown parts of the self, as in the early infant/mother relationship. Or it may be defensively used to avoid knowing these split off parts of the self. It may also be used for the splitting off known and unwanted aspects of the self that are then projected into the transference twin. Twinning, either as a defence or in a search for greater knowledge, has to be dealt with before the patient can re-integrate the split-off parts of the self, which have been located in the imaginary twin.

There is a “…common fantasy that any one of us might have a clone, a doppelgänger, someone who is not only a human mirror but also an ideal companion; someone who understands me perfectly, almost perfectly, because he is me, almost me” (Wright 1997, p.33).

Klein (1963) addresses the issue when she writes of the common phantasy of having a twin in order to try to deal with loneliness. She suggests that this internal loneliness is a result of “…a ubiquitous yearning for an unattainable perfect internal state” (p.300). The “…unsatisfied longing for an understanding without words” (p.300) derives from the good early relationship between mother and baby, when there is close contact between the unconscious of the mother and that of the child. “…the universal phantasy of having a twin .… represents those un-understood and split-off parts, which the individual is longing to regain, in the hope of achieving wholeness and complete understanding; they are sometimes felt to be ideal parts.  At other times, the twin represents an entirely reliable, in fact, idealised internal object.”  (p.302).

Wishing for a twin is a narcissistic affair, a defence that brings the narcissistic mirroring closer. Britton (2000) describes a narcissistic state that is not simply a withdrawal from external objects to an internal object. It is a particular kind of internal object relationship in which the separate existence and particular qualities of the internal object are denied and an internal narcissistic relationship is created by projective identification.  An internal twinning is set up between the self and the ego ideal, denying the ego’s need for love from the super-ego. “Twin internal souls united by a narcissistic love” (p.3). Such a narcissistic relationship, where the superego is evaded, is realised externally in a relationship with an idealised twin.

The narcissistic patient builds up a phantasy of an omnipotent self and an omnipotently created object  (a twin); the analyst is regarded as a threat to this relationship. Such patients have difficulty establishing an ordinary transference relationship with the analyst, either remaining aloof and detached, or “…adherent, clamorous and concrete in their transference attachment but in neither situation is the analyst experienced as both significant and separate.” (Britton 2000, p.2, his emphasis).

Bion (1967) describes the defensive emergence of an imaginary twin in the transference, to cover up and avoid meeting an un-understood part of the self. On recognising and interpreting the twinning rhythm set up by the patient, access to the oedipus complex was unblocked, as was the patient’s ability to think.  With the emergence of the imaginary twin in the transference, the patient changed from using the processes of splitting and personification to disown a bad part of himself from which he wished to be dissociated, to a recognition of the analyst as a non-identical twin i.e. as separate, a person in his own right, not just a thing created by him.

Bion notes that prior to this recognition, his interpretations generated immense anxiety in the patient, not only from the content of the associations, but because he was drawing attention to the intra-psychic processes.

He explains that  “…the imaginary twin goes back to his very earliest relationship and is an expression of his inability to tolerate an object that was not entirely under his control. The function of the imaginary twin was thus to deny a reality different from himself. With this denial of external reality, there co-existed his inability to tolerate the internal psychic realities and a great deal of work had to be done before any increase in tolerance occurred.” (Bion 1967, p.19).

In actual twins, there may be collusion between them to confirm a permanent identity, in order to cover up rivalry and difference. The idea that twins are “identical” is a defence against acknowledging difference. Many studies concentrate on the identicalness of twins and extraordinary similarities have been observed, e.g. in their movements, mannerisms, and even life events. Studies on twins separated at birth and re-united as adults are quite startling in the convergence demonstrated (Wright 1997). The biological/genetic dimension of physical and psychological identity in twins is a factor, but even monozygotic twins differ both emotionally and physically.

As Bion describes, it may take time for the twin relationship to emerge into the transference. The twinship, its specific nature in each patient, including the difference between an actual and an imaginary twinship, is at this time, at the core of the work to be addressed. Until it emerges in the transference, is recognised and analysed, progress towards the establishment of separateness through the transference experience of a parental relationship with the analyst is limited.  When the patient leaves treatment before this has happened, there is a sense of lack of resolution and unsatisfactory outcome, as shown by the following example.

A small robust middle-aged woman, with a twin brother, sought help because she had difficulties with relationships in a number of areas of her life, but she regarded her main problem as her mother. She experienced mother as possessive, intrusive, dominating and demanding. While father was regarded as more distant and unimportant, mother was seen as powerful, well educated and a high achiever. Identifying with mother, the patient saw herself as the source of power and resources, and felt those around her, including her mother, flocked to her for help. Her twin brother, in contrast, was seen as always sick, weak, and in need of her protection. She felt she had always to look after him, to rescue him from difficult situations, and although she hated the forced intimacy and sharing, she felt she could never rid herself of her brother, as they were never allowed to be separate.

The patient felt rather guilty about her twin, as she was the healthier baby at birth; her twin was substantially underweight. She felt she had taken more sustenance than was her due. At birth, when her twin was put in an incubator, the patient was placed alongside him to help him in his struggle for survival. As a child when she heard her asthmatic brother struggle for breath, she thought (wished and feared) he would die. With her feelings of both guilt and fierce resentment she felt painfully entangled with her twin. It is as if only one of the twins can survive, while the other is half-dead.

Her experience of being in the incubator with her twin would be an unconscious one enriched by parental comment, a birth narrative. It also represents the relationship with the mother  – an incubator mother, hard, impenetrable and intrusive, a high-achiever mother making enormous demands on her. While longing for a non-demanding, non-intrusive mother, she identified with the incubator mother and colluded with achiever-mother to denigrate warm soft mothering that tolerates vulnerability, both of them being contemptuous of the weaker twin brother.

She felt she gave too much of herself, was experienced as overwhelming, but not receiving much in return. In contrast her twin was a pale needy figure. She saw him as a split off bad self that tormented her, containing the buried feelings of which she was so afraid, the hated needy twin self. This needy twin was an ever -present shadow, torturing her with his existence.

As I listened to her angry outpourings, I found myself feeling dominated and rather helpless (no doubt like her twin). She seemed to have a clear view of herself and little interest in anything I might have to say. It was as if I was the twin in the incubator whom she had to look after. When I did intervene, she felt I was like her intrusive dominating incubator-mother. When I interpreted this, she understood this as confirmation that I was indeed behaving like her mother. She found it intolerable that I might be able to provide insight that she lacked, all the while complaining that she never found any of her relationships, including that with me, rewarding.

As she became more aware of her relatedness to me as someone who could think separately and whom she did not control, she started missing sessions, and then left precipitately, without again making contact. As long as I accepted being the helpless twin whom she would look after, she tolerated me. But with evidence of my separateness, she abandoned me, as she wished to do with her twin. I was the one to be left high and dry while she made off with all the resources. She was unwilling to tolerate owning a needy-twin aspect of herself, helped by a productive mother.

Defensive twinning and symbolisation

The successful working through of the complex issues of need and dependency in relation to a mature container, the acknowledgement of difference and the envy and rage this stirs, and all aspects of separateness and separation, will depend on the capacities of the patient to use symbolic thinking. At times of difficulty, the patient will frequently regress to former patterns of coping – the twin relationship.

Both patients Bion (1967) describes use the twin transference defensively. Patient A initially uses an imaginary twin to alleviate anxiety by preventing the birth in the analyst of someone who is different and separate, and has freedom of thought. The patient has created a relationship much like that with an enmeshed actual twin.  When this is interpreted, the patient is able to use this personification of the split-off portions of his personality for reality testing, like play therapy. He is able to use the twin material for phantasy, to symbolise. However, patient B, who has an actual twin, remains unable to phantasise about the material of the imaginary twin, and he is unable to develop insight about his psychic processes. We don’t really know why his ability to symbolise is so limited, though Bion describes him as a more disturbed personality. In this paper, however, Bion does not explore the difference in the transference twin where an actual twin exists or how it will affect the twin transference.

As Bion describes it, the movement from using the processes of splitting and personification to deny the existence of an object not directly under his control and to deny a reality different from himself, to the use of these processes to make contact with an outer reality, represents a move from a twinning relationship towards a parental one. The development of insight through the analysis increases the investigative capacities of the patient and this reactivates emotions associated with early advances in psychological development. For patient A, this was a relationship between father and child.  “With ‘A’, the change from a perfunctory and superficial treatment of the oedipus situation to a struggle to come to terms with an emotionally charged oedipus complex was extremely striking.” (p. 21).  Patient B, however, on encountering another patient, showed some development in becoming aware of a “…by no means identical twin that had a relationship with a mother” (p. 21), but was unable to use this material symbolically, and Bion still remained only an identical twin to him.

Kohut (1984) distinguishes between normal and pathological twinning in the transference. He regards normal twinship as a need based on the experience of the presence of essential likeness, the self-affirming and self-maintaining experiences of early childhood which are important in enabling us to feel human amongst humans, to have a sense of belonging and of participating. He regards pathological twinning in the transference as an attempt to repair structures that were damaged early in life, as in borderline patients. He describes a patient who told him shortly before a break, that from the age of 6 years, she had kept a stoppered bottle in which she imagined a person living, a little girl, a twin, someone like herself but not herself, someone sufficiently like her to understand her – an imaginary twin created by her to compensate for unbearable loss and loneliness.

The creation in the transference of an imaginary twin that is used to exclude a maternal object is, I think, akin to a borderline state (Steiner 1993). The imaginary twin represents a psychic retreat from the development towards the depressive position, and is used to avoid the pain of relinquishing phantasies of omnipotent control, and of loss of the illusion of possession of the good object.

Movement away from the twin as the primary object, towards the separate maternal primary object, depends on the recognition of the primary object as one not like self. Tolerating this move involves recognition of the “supremely good breast”  (Money-Kyrle 1971) as the primary object and understanding that, in contrast, both twins are in the same position and face the same predicament. For each, the good breast is shared not only with the other twin, but also with father and all siblings. Neither of the twins is or possesses this good breast. The recognition of the parental couple, and not the twin couple, as the “supremely creative couple” (Money-Kyrle 1971), is also necessary to disentangle the twin relationship. Where this three-person relationship can be established for each twin, boundaried by the relationship between the parents, an internal space is created, a third position, a capacity for observing and being observed, i.e. for thinking (Britton, 1989).

Rivalry in twins

There is always rivalry in twins and any apparent non-rivalry is a powerful defence and should arouse suspicion (see Engel below). Where twins are enmeshed and a maternal object does not sufficiently mediate the intense rivalry between them, the only possible resolution is via triumph and vanquishment – of one over the other. In this situation, the rivalry is not predominantly for the attention of mother, but for the omnipotent possession of the (pseudo-) breast. Where a maternal object is recognised, there is rivalry for the dominant position and possession of mother. The sibling rivalry is increased because of the special nature of the twin relationship.

If the mother has the capacity, and if the twins have the capacity and will allow her intervention, a place can be created for each infant to grow and develop with tolerance of the other and of the maternal relationship with the twin, and with father. Mediating in this way and with love for each infant in its own right allows movement towards the depressive position and greater maturity. But it may be that either the mother, or the twins, or one twin more than the other has a limited capacity for such development, and then the twins may remain enmeshed.

The Gibbons twins, (Wallace 1996), are an example of the most damaging sort of development. “Identical” twins, June and Jennifer grew up in an apparently caring and communicative family, but kept themselves isolated from their parents and siblings. From childhood, they shared a secret language and spoke only to one another, and to a younger sister. At school they remained frozen in their silence. As teenagers, they became even more reclusive. “Ever since they left school….they had shut themselves away in their bunk bedroom, never coming down to meals, never even smiling at other members of the family or acknowledging their presence in the house.”  (Wallace, p.2).

The twins would sometimes dress up and go out together. They exhibited rather bizarre and delinquent behaviour and at 17, were jailed for repeated arson and theft. In jail they were separated. Wallace describes her first interview with June, in prison.

“I could see June’s eyes flickering and her mouth edging into something resembling a smile. But her words were torn whispers, her whole being was strung between a desperate need to speak and some destructive internal command which forbade her such freedom. She would start to tell me something, then suddenly gag as though an invisible presence had put its hands around her throat. Who or what could hold such power over a human being, to compel her to lifelong silence and immobility? What inner force gave her the strength to reject everything and everyone offering help or affection? What had happened to allow a potentially attractive young girl to waste her youth, not just behind the walls of a prison but behind her own private defences?“  (p.5).

A poem by June describes her mortal entanglement with Jennifer.

“Without my shadow would I die?Without my shadow would I gain life?

Be free or left to die?”  (p. 255).

In 1993, as they were released from Broadmoor and just reconciled, Jennifer suddenly died. Wallace tells of June dictating a poem to the dead Jennifer, describing how

“…like a blind Delius to her Emanuensis, [she] spoke, staring into space.

Like the closing of an autumn door,

another door opens.

Somewhere in the deep dark room,

an old wound has reopened.

Somewhere in this muddled world,

a tiny child is crying,

reaching out to hold its heart.

The wind dies, then it starts.

When I look up to the sky,

I see the aftermath within your eye.

You left me stone-cold and broken

and I never asked you why.” (p.272).

Jennifer’s death was sudden and mysterious. She died of acute myocarditis, but such a sudden onset and deterioration is apparently unusual. She had binged and starved herself for many years in her rivalry with June. Perhaps she had weakened her immune defences so drastically that she “…succumbed with all the resistance of a sacrificial lamb.” (p. 274). Wallace speculates about whether there was a pact between them “…that June, the first born, the stronger, would finally gain her birthright.” (p.274).

Wallace wonders what will happen to June: “When the first flush and relief of her loss fades, will she find life without her shadow intolerable? Or will she find that without her ‘dark sister robbing her of her sunlight’ she can enter a new era of her life, carrying Jennifer with her, confident that she, June can live for both of them.” (p. 274).

June wanted a banner to fly in the sky on the 1st anniversary of Jennifer’s death, to read, “June is fine, she is fit and well and her own person. She has come into her own.”  (p.273). She told Wallace, “At long last I am all June, not a part of Jennifer. Somebody had to break the vicious circle. We were war weary. It had been a long battle. We were both a burden to each other.” (p.273).

The twinship myth of shared identity

Where there is insufficient separation of the twins, neither develops a clear sense of personal identity. In this situation so much of the “self” is split off and lodged in the other, that each is uncertain what belongs where, and who is who.

A woman patient with an “identical” twin felt she had no identity separate from her twin. She was the second born, and was regarded as a “total shock”, not a lovely surprise, from which the parents never recovered. The parents were experienced as denying the separate existence of the second twin, dressing both twins exactly alike, insisting on absolute equality between them even if this meant depriving one of them of a hard-won scholarship. They were seen as two halves of one whole.  Both twins were usually referred to by the name of the older one, and the younger one was regarded as the shadow or reflection of the other. Unlike her twin, my patient was not named for some time after birth, as her parents thought she might die. She felt as if she were like a charcoal and chalk portrait that could be rubbed out.

She was told she suffered from projectile vomiting as an infant, and was apparently fed in a room covered in plastic sheeting and with all carpets removed. A more bleak and unloving scenario would be hard to describe, and one that suggests particular difficulties with projective and introjective processes, as if they were felt to be violent experiences. This is not too surprising for an unexpected and apparently unwanted baby denied a separate existence from her twin. With such seemingly forbidding and denying parents who had little compassion for her, her only developmental refuge was her twin.

While I felt very moved by her story, she experienced me as cold and ungiving. She appeared to be bound up with her twin, to be smug and self-contained. She seemed to have no real communication with me but to be excluding me and talking to herself. Her primary relationship was with her twin and she did not hold me in mind nor believe I did her. She regarded sessions as seamless, held together by a thread and without any gap, as if I did not live a separate life from her. After the start of each session, I had to intervene in this imaginary twinship to establish my separate existence.

She described her relationship with her sister as “almost like Siamese twins” .She believed her twin was the loved child with all the good memories. She also, however, felt her twin was an intolerable burden, the carrier of her unwanted feelings and she wished her twin were dead, thinking that was the only way to be rid of her. She thought that her sister handled her all over and experienced her twin as trying to get right inside her like a parasite, and that she had to get her out of her. She believed I would invade her also and distanced herself from me. She hated mirrors, as the reflection seemed to be her twin, the preferred child with all the good memories, and the hated parasite.

As children the twins had a private language, and as adults there were still secret ways in which they communicated. The wish for secret and perfect communication was reflected in the therapy by her frequent demands that I should explain to her what I had understood of what she had said, as if to prove that like a twin, my understanding of her was complete. She was angry with me for using my words, not hers, as it meant we were not identical twins.

 As children they fought violently and were mutually filled with both hatred of each other and a fear of separating, which felt like being torn apart. Some years before my patient entered therapy, her twin had become disabled and extremely disturbed emotionally. My patient became obsessed with her hatred of her twin, but was burdened with keeping her twin alive through several attempted suicides, and against the expressed wish of her sister to die. Her twin became extremely demanding, which led my patient to feel desperate in her wish to be separate, although she believed her twin would not survive alone. This belief was reflected in our work where she felt I denied changes in her as if I was a twin unable to bear her growth and development away from me.

As her sister’s health declined, my patient gained in strength, as if magically robbing her sister of her vitality. With the development of greater understanding of herself, she reported feeling noticeably different outside sessions. She became more reflective and separate from her sister and realised she was not responsible for her sister’s illness. This understanding led to a temporary fear of freedom and backsliding in the work. With the development of some feelings of separateness, she felt she had got her sister out of her, and this led to feelings of both emptiness and relief. She could see how intertwined she and her twin had been and recognise the basis of her fears of madness.

Towards the end of the therapy, it became apparent that both father and her twin sister had bullied her as a child and that it felt safer to be her sister’s shadow and therefore not really seen and punished. She sometimes felt she had brought her sister into the consulting room with her and that she could not speak freely, because there were things she had never told her twin and she would be punished for this. The twinship represented both power and anonymity.

As her sense of a separate identity increased, the patient described how she had seen a video of herself and could see for the first time ever that she was different from her twin. Her twin kept asking her if they were the same, and when my patient said no, the sister expressed her fear that she was losing her twin and clung to the twinship. Others saw the changes in her, and her twin told her she was horrible. My patient then became afraid that I would not allow her to leave the therapy when she was ready or that I would end the therapy prematurely.

Although the twinship resurfaced as the ending approached, with her insistence that I knew what she thought without her having to tell me, and wanting to get right inside my mind, she was able to tolerate the loss of the illusion of possession of me, to see my separateness, and her loss of me in parting. She emerged as a sexual woman with her own thoughts and feelings and relationships. She felt the world had opportunities for her.

She recognised that for much of the therapy she had brought with her the burden of another, her twin sister, and now that they were separate she could see her twin as childish in her vulnerability, fearsome in her anger, but not part of her. She was also able to stand up to her formerly terrifying parents and be different and say she was. She felt she could respect their difference and saw them as less persecutory. With her separateness from me, she welcomed the fluidity of her thoughts.

This work does raise issues about working with one twin only and the effect on the other, as described by Sheerin (1991). My patient’s twin was clearly a very ill woman. The separation as a result of my work with the patient exposed the illness even more clearly. Did it also exacerbate it?

The idea that twins are “identical”, as in the case above, and that the other is already known, as in the patient who is described below, is based on a belief that the other is like me. Known parts of the self are split off and attributed to the other. This twinning defence leads to a cover-up and collusion, and unlike the situation described by Melanie Klein regarding loneliness, is not based on the splitting off of unknown parts with the hope of understanding and recovery of those parts in a more familiar form. The common twinship myth of a shared identity, the idea of identical personalities, is a narcissistic way of framing the other like the self. One sees oneself in the other in order to avoid something else, something different. It is when there is a breakthrough to unknown material that difference can be recognised and established.

A middle-aged man with a twin brother thought, immediately on entering my consulting room for the first time, that he had met me before, i.e. that he already knew me. This twin transference was evidence of an entangled twinship projected into me. His wife also served as his emotional twin, and like his twin brother, she expressed feelings for him.

His twin had required surgery immediately after birth and with mother’s attention to his twin, the patient felt that mother had robbed him of his twin by separating them and leaving him in the care of father. He felt he was always the bad twin, never able to do right, while his twin was the good one, much favoured especially by mother. But he always had to look after his twin, rescue him from fights at school. He believed he had to speak for his twin from a very early age, partly because of the surgery the twin had undergone, but also because they were so entwined it was as if they shared a personality. In turn, he used his twin to get what he wanted from mother.

He felt mother was dominating and attacking and if I said anything that touched his feelings, he likewise experienced me as a persecuting mother. He was able to recognise that he placed his twin between him and me; that he created an imaginary twin in me with whom he communicated, and that if I intervened in this with an interpretation, I became the mother who separated him from his twin, thus robbing him of those parts of himself carried by his twin. He felt he needed my exclusive attention as a twin and became very angry if he did not get it. It left him feeling as if he did not fully exist.

The twin relationship, birth narratives, and death:

Each twin I have worked with has an individual story of birth that reflects a perceived relationship with the twin, but common themes emerge. The sense of being enmeshed has been described, for example, as the twins being interlocked at birth; intense and murderous rivalry as one twin being left aside as dead. It is common to feel that one baby has taken too much, with the result that the other twin was deprived of life-giving sustenance and has been sickly ever since. How much more disabling, then, when one twin dies at birth while the other has a good birth weight.

When a twin dies, the omnipotent control of the phantasied and remembered dead twin is unchecked by opposition of a live twin, or by the intervention of the mother in the twinship, as she may be quite unaware of the infant’s memories of its twin.  The shift to the acceptance of a maternal container, rather than the dead twin self in a psychic retreat is therefore more intense and difficult. Not only has the survivor not been freed from a possibly difficult twinship, but an additional burden has been added in that the dead twin carries, in the phantasies of the survivor, very powerful projections linked with life and death, survival and revenge.  These become active in the transference. The complexity and conflict of feelings generated by this situation make it especially sensitive and difficult to resolve, and will play an important part in the ending of the analytic work.

For enmeshed twins bound in a rigid structure of intense rivalry, to relinquish omnipotent control of the other in a developmental move, will expose feelings of vulnerability, and unleash fear of attack and annihilation by the other twin, seeking revenge.  Where one twin has died, the phantasied twin carries such intense projections that its imagined revenge will seem even greater.

The pattern of relating observed between twins in utero may persist after birth (Piontelli 1992).  Where one twin dies, the surviving baby will experience the absence of its twin and a profound feeling of loss. The parental reaction to the surviving baby is likely to be mixed. The birth is not only an event to be celebrated; it is also laden with loss and mourning. The surviving baby may seem more precious to the parents, but there is also ample scope for idealisation of the dead baby and the consequent difficulty in accepting the survivor wholeheartedly.

The stories about the birth and death of the babies will influence the surviving twin’s sense of acceptance or rejection by the parents, and its feelings of guilt and anxiety in relation to the death of its twin.  The surviving baby can only deal in a very primitive way with the triumph of its survival and the loss of its twin, and it is greatly dependent on the parents for enabling it to emerge from this situation without feeling extremely persecuted and perhaps fragmented, in a situation inherently fraught with difficulty.

Steiner (1990) describes the difficulties faced by borderline patients in mourning their lost objects, their inability to relinquish control over objects and consequent failure to experience true separateness. The rigid organisation created by binding the projected parts of the self with the object containing them in a complex structure, as in twins, requires gradual dismantling before the object can be recognised as separate, and relinquished and mourned. Guilt and mental pain have to be borne as disowned parts of the self are regained and the ego is enriched.

I referred earlier to Kohut’s description of the creation of an imaginary twin to try and deal with loss (the twin in the stoppered bottle). Phantasies that the dead twin is still alive and present are common. Surviving twins have described the feeling that if only they could turn quickly enough to look behind them, they would see the dead twin, secretly still alive. Sometimes the surviving twin believes they are keeping the dead twin alive – and in a way they are, in phantasy.

There is commonly a belief that the surviving twin lives on for both of them, as described earlier in the Gibbons twins. Case (1993) quotes from a number of letters about the feelings generated by the death of a twin. One writes, “A major part of my life and of me was laid to rest when Kathy died. For 23 years one-half of me was her, and I think it always will be. Just as a part of me is gone, a part of Kathy lives on through me.” (p. 18).

Some seek to maintain the twinship through spiritual union with the dead twin, in denial of loss. One year after the death of her twin, a woman writes:

“Since Mary’s death my whole world has become clouded. I have become overwhelmed with fears of isolation and abandonment. In a sense, I search for her. I surround myself with pictures, talk about her constantly, relive memories, and share every thought and prayer with her. Despite my efforts to survive, I feel that it is not natural to be physically separated from her. In fact is seems terribly wrong. I keep thinking, “I am going to die because Mary and I must always be together”. I feel a separation from Mary that causes physical pains in my chest, On the other hand, I have never felt closer to her, as we are now joined by a spiritual bond which is unique to us.” (p.50).

A woman whose twin died in utero writes, “One moment, I can feel devastatingly lonely and not be able to wait for the day when I can die to go meet him in heaven. Just to hug him and tell him how much I love him. Yet at the same time I feel so incredibly guilty for being alive, like I don’t deserve it….”   (p. 63)

Denial of the loss of the twin will be at great cost to personal identity. However, mourning may resolve this, with consequent enrichment of the life of the surviving twin.

A bereaved twin writes, “Seventeen years have passed. As long without Karen as with her. I now realise that I’ve been running instead of dealing with the pain of the loss. I stopped denying the loss and I’m able to be aware of my body, opinions and thoughts. I’m now developing a life that includes Karen as a fond memory. I’m not forsaking Karen, instead I’m honoring myself and the life I have to live.” (p. 28).

Another discovers the value of separateness after the death of her twin.

“And now? Finding oneself. Knowing one’s capabilities. Finding sudden joy in knowing that I could attempt something: an assignment at work, writing poems, accomplishing a new weight-loss program, all without the twin-oriented dependence. Laughter coming easily (it never did before). A new person discovering capabilities and potential never known before.” (p. 42).

The conjoined twins, ‘Jodie’ and ‘Mary’ have been much in the news recently and have stirred intense debate about the ethical and moral issues involved in separating them, as one twin would inevitably die as a result. Less has been expressed, however, about the emotional impact of the separation on the surviving twin. At a time when so much of the experience of the infants is somatically based, the effects of the loss of a conjoined twin must be profound, even when they both live. A documentary on the separation of another pair of conjoined twins showed how, immediately after coming round from the anaesthetic, one twin reached out for the other. When one twin dies in order to allow the other to live, the survivor will experience not only the guilt engendered by this situation, and parents deeply affected by it, but a profound sense of loss of part of the self, as well as of the twin.

Persistent issues in twinships:

Even with effective psychoanalytic work that addresses the developmental processes faced by twins, the importance and depth of mutual identification can play a long-term role in the life of the patient. George Engel (1975) movingly describes the intensity of identification with a twin, and how this continues after the death of the twin (even in adulthood). His “identical” twin died of a heart attack at the age of 49. When, 11 months later, he too had a heart attack, his initial reaction was one of relief  – he no longer had to anticipate a heart attack, “…the other shoe had fallen” (p.25).

He used self-analysis of dreams and notes of events, particularly with regard to anniversary reactions to the death of his twin brother. With disarming honesty, he traces his development over those years with particular reference to the relationship with his twin. He suggests that one of the distinctive features of twinning is the “…pronounced tendency toward persistent confusion of identities in the unconscious” (p.32).

He writes: “A central developmental issue for twins concerns the fact that separation and individuation must ultimately involve the twin as well as the mother. Indeed there is an indication that the intimacy and intensity of the interaction between the twins may actually accelerate the separation from the mother… only to be replaced by a prolonged symbiosis between the twins whose separation and individuation from each other may be consequently long delayed.”  (p.32).

This “twinning reaction” is based on diffuse ego-boundaries, on the one hand, and complementarity on the other, as a consequence of the prolonged struggle between unification and individuation of the twin pair. The twins develop complementary ego capacities to enhance the effective operation of the twin unit in relation to outsiders. Engel suggests that twins might exploit the narcissistic advantages of twinship precisely to avoid negotiating the oedipus conflict.

He believes that three features may particularly affect the character of the grief response on the death of a twin, even after a degree of separation and independence has been achieved, as a result of the unique developmental features of twinning. These are “…the enduring diffuseness of the ego boundaries between self and object representations, the narcissistic gains of twinship, and the delicate balance of the defences against aggression” (p.34) that have been developed between the twins.


Twinning in psychoanalytic work with either a twin or a singleton, may be used either in the service of hoped for greater understanding, or to avoid knowledge of aspects of the self, and of separateness and difference. If, as Engel describes, the nature of the response on the adult death of a twin is affected by the unique developmental aspects of twinship, even after a degree of separation and independence has been achieved, then it is clear that in any work with twins, the twinship in the transference must be recognised and worked through.

Only proper attention to the developmental processes faced by twins, including the unique and special nature of the relationship, can help twins to free themselves from the more primitive states of mind of an enmeshed twinship. Without sufficient intervention, twins cannot develop individually towards separateness and maturity, and may remain in an entwined identity capsule, a skin enclosing the pair. This will affect all their relationships, most notably those with a spouse or their children.

In analysis, if the twinship is not addressed, a core aspect of separateness will have been avoided and the ending will be unsatisfactory. When the twin transference is recognised and worked through, the patient can establish a sense of personal identity and be able to recognise the analyst as a separate person from whom he can take his leave with due mourning.

It may well be that through such work, both twins are helped in separating. But this may not be the case, and especially where there is a greater degree of disturbance, the situation of the twin not in treatment may be adversely affected by the development of the twin in treatment. This raises difficult issues about the psychoanalytic treatment of twins requiring careful thought.


 Bion, W. R. (1962).  Learning from Experience. NY: Jason Aronson.

 Bion, W .R. (1967). The imaginary twin. In: Second Thoughts (pp.3-22). NY: Jason Aronson.

 Britton, R.  (1989). The missing link: parental sexuality in the Oedipus Complex.  In: J. Steiner (Ed.), The Oedipus Complex Today (pp.83-102). London: Karnac.

 Britton, R.  (2000). What part does narcissism play in narcissistic disorders?  (Conference Paper at the Rosenfeld Conference, 18 April 2000.)

 Case, BJ.  (1993). Living Without your Twin. Portland, Oregon: Tibbutt.

 Engel, G. L. (1975). The death of a twin: mourning and anniversary reactions. Fragments of 10 years self-analysis. International Journal of Psychoanalysis, 56:23-40.

 Klein, M.  (1963). On the sense of loneliness. In:  R. Money-Kyrle (Ed.), Envy and Gratitude and Other Works (pp.300-313). London: Hogarth Press, 1980.

 Kohut, H.  (1984). How Does Analysis Cure?  Chicago: University of Chicago Press.

 Lewin, V.  (1994). Working with a twin: implications for the transference. British Journal of Psychotherapy, 10: 499 – 510.

 Money-Kyrle, R. (1971). The aim of psycho-analysis. In: D.Meltzer (Ed.), The Collected Papers of Roger Money-Kyrle  (pp.442-449).  Perthshire: Clunie Press, 1978.

 Piontelli, A. (1992). An Observational and Psychoanalytic Study.  London: Tavistock/Routledge.

 Quinodoz, J-M. (1993). The Taming of Solitude. Separation Anxiety in Psychoanalysis.  London: Routledge.

 Sheerin, D.F.  (1991). Fundamental considerations in the psychotherapy of an identical twin. British Journal of Psychotherapy, 8: 13-25

 Steiner, J. (1990). Pathological organisations as obstacles to mourning: the role of unbearable guilt. International Journal of Psycho-analysis, 71: 87 – 94.

 Steiner, J. (1993). Psychic Retreats. Pathological Organisations in Psychotic, Neurotic and Borderline Patients.  London: Routledge.

 Wallace, M. (1996). The Silent Twins. London: Vintage.

 Wright, L. (1997). Twins. Genes, Environment and the Mystery of Identity. Great Britain: Phoenix.

23 November 2000.