Working with a Twin: Implications for the Transference

Working with a Twin: Implications for the Transference

Working with a Twin: Implications for the Transference

Vivienne Lewin

SUMMARY. The relationship between twins is based on primitive mechanisms which need to be mitigated by a containing and processing mother for adequate emotional development to take place. Where this fails, the twins remain in an arrested state of development dependent on splitting and excessive projective identification, and unable to separate. This is reflected in the transference relationship, the psychotherapist being experienced as a twin, a reflection of the patient, rather than as a container. Through intervention in the twinship via interpretation of the transference relationship, the patient may be enabled to find the psychotherapist as a processing mother and to develop a sense of self, a separate identity.  


Over the past ten years, I have worked and supervised work with a number of patients who are a twin and I have become aware of the particular difficulties this work involves, most specifically in the dynamics of the transference. I have tried to formulate a framework for understanding the dynamics of twinships and what this means for their relationships with others. I will describe what I understand the framework to be and will illustrate these ideas with examples from my work with patients who are a twin.

For twins, from the very beginning of life, another baby is ever present. Before birth, where there would normally be one baby in the space inside the mother, responding and relating to mother’s sounds, movements etc, with twins two babies occupy this space. Whereas a singleton is alone with mother at the start, a twin not only shares mother with another baby from the very beginning but also interacts with the other baby in the womb.

Piontelli (1989) describes such interactions, observed via ultrasound scanners, and notes that the babies interact from a very early age within the womb, in a way specific to each individual baby. The pattern of interacting between the babies persists after birth, e.g. the active twin seeking to touch the other while the passive one withdraws from this approach.

This ever-presentness of an other is very important – the baby is NEVER alone with mother and never has mother’s exclusive attention. Even if one of the babies dies, it is ever present in the mind or memory of both baby and mother. 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. So the situation arouses feelings of triumph mixed with rage and anxiety, and it is difficult for the baby to establish a comfortable relationship with mother where satisfaction and containment can be experienced.


Athanassiou (1986) refers to this as a ‘parasitization of the relationship with the maternal object’:

“The normal projective identification and incorporation of the mother’s breast is mixed with this parasitic element which prevents him from living the experience at the breast with all due plenitude…” (pp. 330/1).

Thus the relationship between the twins creates specific difficulties for them in their development. Where there is only one baby, and a mother with an adequate capacity for containment, the baby can develop and separate from her, using the relationship with mother as a vehicle in the formation of its own identity. With twins, the presence of the other baby complicates this process and each baby will face a conflict between the twinship and a need for development through identification with mother.

When apart, there is a pervasive sense of incompleteness in twins, a constant searching for and preoccupation with the other, whether they are mono- or di-zygotic twins. The yearning for the other twin can be intense as can the hatred, and some literally wish for the twin to die as the only apparent means of ridding themselves of the hated parasite. Where there is extensive mutual projective identification between the twins, any sense of separateness is weakened and there is a resultant confusion between self and object, between twin and twin.

I would like, now, to reflect on the process of emotional development and the specific difficulties faced by twins. The primary developmental task for an infant is the introjection of an `integrative good object’ (Hinshelwood 1989):

“The first internal good object acts as a focal point in the ego. It counteracts the process of splitting and dispersal, makes for cohesiveness and integration, and is instrumental in building up the ego.” (Klein 1946, p. 6, quoted by Hinshelwood)

The establishment of such a good internal object is dependent on the availability externally of a good `container’ (Bion 1962). This `container’ is the mother who, in a state of `reverie’, i.e. available to accept the infant’s projections, can understand and so mitigate the infant’s intense anxiety, allowing the infant to introject its feelings in an altered and now bearable form. The infant will also introject the structure for making sense of its feelings – the ability to think.

It is thus through a process of repeated projective and introjective identification that the infant develops a capacity to think and a sense of self. However, the internal processes which aim to protect the infant from the fear of annihilation and/or persecution may be so powerful that they result in the fragmentation of the mind. Such splitting may lead to excessive projective identification with a resultant depletion of the ego and difficulty in introjecting, and may be the result of either excessive destructive forces within the infant, or the lack of availability of an adequate container.

The mother, with her maturity and capacity to think and to process the infant’s projections, can function as a container who will transform unbearable anxieties allowing the introjection of an integrative good object. However, omnipotent phantasies of projection and introjection are felt by the infant to be real and they may be used defensively to avoid experiences of separateness and envy. They may thus create confusion between self and object, and hence the belief that the object is the same as itself, and a difficulty differentiating between the internal and external world. The mother’s containment will modify these phantasies and, as the confusion between self and object decreases, the baby can start to separate from mother, to develop an apparatus for thinking and, hopefully, move towards whole object relationships.

As I have already suggested, the twin baby’s primary identification may not be with the mother, as in singletons, but with the other twin. However, 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.

This self-contained narcissistic system is characterised by a sense of inseparability, individual incompleteness and a fear of being unable to survive alone. Each baby regards the other as a part of itself, not a separate object or person, and uses the other to hold the split off, projected parts of the self that are unwanted or too painful to be experienced, while at the same time being the receptacle for the projections of the other twin.

An extreme example of this is the Gibbons twins, The Silent Twins (Wallace 1986) who since their teens spoke only to each other in a private language, were elective mutes as regards the outside world, and seemed incapable of forming separate identities. Their passionate, enigmatic love-hate relationship has inspired books, television plays and, recently, a French rock-opera called Jumelles (the silent twins), directed by Michel Rostain, which takes as its theme the quote `I can’t live without you, yet near you I’m in danger of death’.

For twins to develop separate identities – i.e. to develop emotionally into reasonably mature people – requires extra work on the part of the parents, particularly the mother. As the twins identify so strongly with each other, they may regard the mother as interfering in their relationship and as unnecessary to them. The capacity to perceive the mother as a container will depend on each twin’s acceptance of her interference in their relationship (Athanassiou 1986). In order to establish a developmentally useful relationship, the mother needs to help the baby overcome this conflict, and the rage and rejection each baby experiences because of the presence of the other, to try and give each one a unique experience of a relationship with a containing mother.

In a report of an observation of twin infants, Susan Davison (1992) explores the importance for each baby of the establishment of a good internal relation to the breast and to the mother, in the development of the twins. She describes the mother’s struggle to hold both babies in mind, her awareness of and ability to tolerate feelings of exclusion – both her own exclusion by the twins, and each baby’s exclusion by the other in relation to her – as well as the feelings associated with being excluded – rejection, envy, jealousy and rage. Based on her observation, Davison suggests that it is only in abnormal circumstances that the twinship supplants the primary relationship with the mother. Athanassiou (1986) suggests that:

“…the birth of twins severely tests the parent’s capacity to maintain bonds between different objects and not reduce everything to ‘something the same’ as the little couple in front of them are doing temporarily.”

While there are no doubt many twins who have developed successfully, I suspect there is always a shadow of the other for each individual twin. Those we see in psychotherapy are likely to have been less successful in their development and who have adopted strategies for emotional survival based on the twinship relationship rather than the dyadic relationship with the mother.

Obviously this will be reflected in the transference. I have found these patients lack a relatedness to the therapist as a separate person. The predominant processes seem to involve omnipotent control of the therapist as a part of the self – a projection into the therapist of, and a constant preoccupation with, the twinship, with little awareness of the processing function of the therapist. Bion (1950) describes the patient’s perception of the therapist in this situation as `a twin to be fashioned into a shape he desires’. The therapist is not regarded as a thinking mother with whom to engage because the patient relates to the internal or projected twin throughout the sessions.

Clinical Examples

I will give a few very brief clinical vignettes to illustrate some of the strategies for emotional survival I have encountered in some patients who are a twin, and the difficulties in working with them. I will then describe in greater depth my work with one patient looking more closely at the dynamics of the work and the implications for the transferential relationship.

Mr A has a non-identical twin brother. Mr A was the stronger, larger, more robust of the twins and deeply resented having to look after his smaller weaker twin whom he experienced as parasitic. He felt cheated of his mother’s attention by this pathetic weak twin and by having to `mother’ his twin. He felt he could not separate from his twin and attempts to do this physically, to be rid of him, e.g. by leaving him stuck in a ditch when he was a child, only led to mother’s wrath. He spent many months in therapy complaining repeatedly about all of this, but always at an angle to me and the therapy. I was a bin for his anger and, as long as I remained quiet and made a few helpful noises, things seemed fine. He missed sessions from time to time but denied any significance and paid for them without comment.

He had a series of relationships with weak dependent women which echoed his twinship, leaving him feeling powerful but aggrieved at not getting more. He said he had been placed in the incubator with his weaker twin at birth, to help him. He projects into his twin and twinship relationships the weak needy part of himself, so he can remain strong, full of value and resources. He keeps firm control to try and maintain the split – this was reflected in the transference. There was a pervading and frustrating sense of unrelatedness to me, defeating me as a potent creative therapist, maintaining me as the weak twin. Interpretations of this were regarded as confirmation that I was indeed the weak twin.

At the point when he began to relate to me transferentially as the unrewarding mother, complaining that he was never in a rewarding relationship, even with me, he ended the therapy. He was enraged by my transference interpretation which he understood to be confirmation that I was actually like his mother and left the session, never to return, despite my letters and a phone call, and never paid his bill. It was as if I had interfered with and diverted his attention from his primary preoccupation, his twin, and was threatening this relationship and his stability by becoming a separate object for him. This would have resulted in him having to own the split off parts of himself which aroused the powerful feelings which he found intolerable. So he resorted to his familiar strategy, leaving me (in the ditch) as the needy, dependent twin.

Strategy: splitting and projecting into twin, psychotherapist and others the weak, unwanted parts of himself, maintaining his belief that he is the resourceful one, and avoiding any resolution of this.

Miss T has an identical twin sister. She described them as `interlocked twins’ at birth and believes that she was half strangled by her sister and was `given up for dead’, before being seen to move and rescued by a nurse i.e. not her mother. She was the smaller baby, her twin being the preferred one who preoccupied mother. Mother was unable to cope with her babies and became chronically ill – and so was unavailable to help them separate and develop. She had little support from father who travelled abroad frequently and remained aloof and distant when home. Miss T regarded herself as permanently impoverished and hates her twin sister in whose shadow she always falls.

She was in her early thirties when she started treatment, unmarried, but had lived with a man for ten years and they had three young children. Throughout this relationship she had conducted a series of affairs. That is, until she started psychotherapy, when the affairs ceased. She spent five and a half years in a therapy that never really touched her deepest phantasies about herself in relation to her objects. She travelled from outside London, several times a week, was almost always on time, and seldom missed a session. On arrival, she would go through a process of undressing – taking off her coat, scarf, cardigan and shoes before she lay on the couch in a manner of finding comfort, intimacy and relaxation. At the start of the therapy she even managed to get her psychotherapist to dim the lights, complaining of headaches. She would bring him gifts and contrived to make physical contact with him whenever she could e.g. hand-shakes or brushing past him. She brought a lot of material to therapy and spoke with feeling – even passion – whether in response to transference interpretations or to outside issues. But it always had a hollow ring to it.

It was fairly obvious that, in her phantasies, her psychotherapist was the new affair. She could replace her unrewarding partner/mother with a phantasied lover (eroticised therapist) idealised twin, who in her imagination provided her with a loving, exciting and exclusive relationship. Using this perverse strategy she would never have to encounter her real internal objects in the transference. So she avoided disturbing the eroticised twinship she projected into her psychotherapist and thus did not have to face her true dilemma.

Strategy: This patient constructs an idealised phantasy twin with whom she remains interlocked and which she projects into her psychotherapist/lovers, so trying to obliterate the hated external and internal twin, and empty mother – a perverse solution aimed at avoiding knowledge of the state of her internal world.

Thus, these patients were pre-occupied with their twin throughout therapy, to the exclusion of the mother who could help them process and develop emotionally.

I will now talk in more detail about a patient I have seen once weekly for more than three years.

Ms D was referred to me by a speech therapist. She had lost her voice some eight years previously apparently as a result of a viral infection. Following numerous operations on her larynx, a new voice had been created and she had spent some years in speech therapy learning to use it. She was referred because it suddenly transpired during her speech therapy that she had been raped at the age of eight years, had just begun to remember the event, and the speech therapist felt Ms D’s distress would be more appropriately dealt with in psychotherapy.

It was suggested that while there was physical damage as a result of the viral infection and some of the operative procedures, the loss of voice was also related to emerging memories of the rape and being sworn to silence by her abuser. Her mother was away in hospital for nine months at the time of the rape, and Ms D became mute – this and her evident distress were dismissed by those around her as her upset at her mother’s absence.

Ms D is in her 30s, single, and has an identical twin sister. Ms D was the second born, `unexpected’ and `caused problems’. She says she and her twin are so alike that people still have difficulty telling them apart. She described them as `almost like Siamese twins’ – they shared a placenta and lay head to foot in utero. Frequently her sister will say something Ms D is thinking and she speaks for Ms D to the family. Ms D experiences her sister as very clinging, always wanting to look alike, dress alike.

The parents, described as `formidable’, were experienced as unavailable to their children. Both are heavily committed to the Church, frequently to the exclusion of their children and family life; for instance, at Christmas the parents have always spent much of the day visiting parishioners while the children wait for their return mid-afternoon for Christmas dinner. Ms D feels enraged at her mother’s unavailability, especially as she felt mother was constantly preoccupied with her twin.

There is a brother, four years older, who threw terrifying temper tantrums, especially in his early teens – the twins were banished to their rooms during these episodes. Any expression of feelings was unacceptable within the family. The parents enforced a very rigid moral code where duty and correctness were paramount, and anything regarded as ` selfish’ was not permitted – so one did not ask for something to be passed at the dinner table but waited to be offered.

The twin girls were treated as two halves of one, always dressed alike, never allowed to be distinguished from each other, except by the colour of their glasses. When my patient won a scholarship abroad and her sister did not, she was not allowed to go. They are still treated as one – birthday cards are to both, not individual, usually sent to the parental home. Presents to each are identical. And any visit to the parental home by Ms D immediately provokes a phone-call to summon the twin.

The sister was the favoured twin and Ms D believes her twin holds all the good memories of childhood while hers are bad. Her mother refers to her by her sister’s name most of the time and, when challenged, says ‘Oh you know who I mean’. As a child, Ms D was referred to as her sister’s `shadow’; as an adolescent she was called her sister’s ` reflection’.

Ms D had feeding difficulties (projectile vomiting) from early infancy and during her childhood she became allergic to various substances – sugar, dairy products, red dyes – while her twin was unaffected. But her parents denied her allergies and as a result she was frequently ill. When I suggested to her this was one way of trying to distinguish herself from her twin, she was thoughtful but non-committal.

Thirteen years ago, her twin had a very serious road accident as a result of which she suffered severe whiplash leading to brain damage and other injuries. She has suffered since then from severe depressions, fits and considerable infirmity. She has several times attempted suicide, using Ms D to rescue her each time while swearing her to secrecy. Prior to the accident, she had a very successful career and was much envied by my patient who worked in a similar field.

It was two years later that my patient contracted the viral infection that changed her life – her voice was permanently damaged, she suffered some auditory loss, a neurological loss to the right side affecting her right arm and leg, and a blood disorder.

It is clear that Ms D has a very strong investment in her somatic disorders and takes any opportunity to talk in great depth and detail of the mechanics and technicalities of her problems. She is much happier considering the physiological or physical aspects than the emotional ones – indeed she is very resistant to admitting any emotional content to her problems, and feels attacked and disbelieved, even dismissed when this is suggested. I believe her investment in her somatic illnesses is a strategy to try and differentiate herself from her twin and to negotiate the world outside – a strategy for emotional survival.

This seems to have been made even more necessary by her sister’s recent diagnosis as schizophrenic. It seems that this dates back to her late teens, is not the result of her accident (as was thought previously), and that some disturbance was evident in her childhood. Ms D says her sister, as a child, frequently referred to a ghostly man she believed to be present, and the family ignored it as a silliness. One might speculate about the sister’s use of this fantasied object in the twinship. It seems possible that Ms D’s investment in somatic symptoms might also defend her from psychosis.

It did not take long in therapy for Ms D to acknowledge her loathing for her twin and her wish to be rid of her by any means whatsoever. She considers her twin a burden – another of her disabilities. She wishes her twin were dead and believes her twin’s death would free her from this crippling burden. But the twin she wishes dead is, in her phantasy, the preferred baby who had access to mother and therefore to all mother had to offer. Ms D wants to take (omnipotent) possession of the good breast and believes she is blocked by her twin from access to it. But she was also deprived of the possibility of finding mother as a container, the mother who could help her process her anxieties and experiences, and separate from her twin.

In wishing dead the twin whom she believes had found mother, she is therefore wishing to stifle the possibility of a creative relationship with mother and therefore of being able to separate from her twin. She often seems triumphant and excited in sessions when telling me of some difficult or even disastrous situation she has had to endure. It is as if she triumphs in destruction. Her early and continuing difficulties with regard to food indicate a disturbance of the introjective processes which serve the life instinct.

Rosenfeld (1971) describes the process whereby the life and death instincts are initially kept in a state of defusion by projective identification. However, simultaneously with these projective processes, introjective processes occur, initially life-giving ones, e.g. taking in food. `This process is essential in initiating the fusion of the life and death instincts’ (p. 244), so mitigating the destructive effects of the death instinct.

The extent of Ms D’s murderous feelings towards her twin and her triumph at the idea of killing her off became quite apparent shortly after Christmas. Ms D arrived at her session glowing with triumph, saying her sister had been readmitted to hospital and that she thought she was very close to death. I asked what had happened and Ms D said she thought her sister was dying from her physical infirmities – she would be rid of her at last.

I was terribly aware that Ms D’s voice, while telling me this, was stronger and clearly audible as compared with the soft, husky voice she usually produces. I commented on this and her apparent triumph over her sister’s imminent death. Ms D responded by telling me her voice varied with her state of tension and she was feeling much relieved. She went on to talk about an invitation she had received from her former choir master to the annual choir reunion – an event she usually shuns with great bitterness since losing her voice. She had accepted the invitation and said she even intended to sing in the choir, to the best of her ability.

There was a further complication in that the school-friend daughter of the man who raped her would be at the reunion, and Ms D spoke openly, for the first time, about the rape and her feelings about it. While she believed her sister was nearly dead, she was no longer consumed by her hatred of her and she found her voice. But when her sister recovered and survived, Ms D crashed back into her consuming hatred and unhappiness – and her loss of voice. She cancelled the invitation to the choir reunion. Unable to rid herself of her twin by wishing her dead, she went back to her preoccupation with the twinship and her inability to separate from her.

During the three years or more that I have worked with Ms D, I have, as we all do, interpreted her missing me during breaks, in gaps between sessions, her fears for her survival and so on. She has always concurred with this and spontaneously spoken of her difficulty in coping with the long gaps between sessions, and especially during the summer break.

Throughout her therapy, Ms D has usually started each session saying she is `going to launch straight in’ as she tries to pick up the thread of her previous session. But she then loses herself in bureaucratese and formal-meeting-type speech. She maintains her distance while at the same time saying she wants to be close. Inevitably I end up breaking into this to try to make contact with her. It has recently become apparent to me that she was not actually speaking to me during sessions. Rather she seemed to be communing with her twin whom she projects into me. In this way I became useful to her – she could take control of me (her twin) so I would not upset the equilibrium. Her need to hold onto the thread of the sessions was not to hold onto me, her therapist, but to deny the gap/my absence – the gap between her and me, the gap between sessions, i.e. our separateness. By so doing, she denied her need for me as a separate object and her loss of me during gaps.

As long as she had her twin, she did not feel she needed me as a processing mother. When I interpreted this, she agreed that I was the cold ungiving mother and she was bound up with her self/twin, not me. She did not hold me in mind nor did she believe I held her in my mind during absences. She did not even believe I provide her with a special space for her. As with babies in the womb, her twin is ever present and it is with her that she relates.

It was in the session following this interpretation that she said she felt as if something was different. It was the first time she had admitted her own lack of any warm feelings for her mother; previously she had always seen her mother as the cold unresponsive one. She began to realise that over the past few months she does feel she has a relationship with me and that I am very important to her. She felt the thread she held onto from week to week was to compensate for not finding me. Unless I actively intervened, I was not present for her. She did not seek me out. In fact she thought I looked like her mother and commented that I must hate her for that.

Ms D was able to tell me about previous therapists she had been referred to when she first lost her voice. They were both men, and she felt she had been totally unheard and abused by them. She had also felt very rejected when the speech therapist was unable to cope with her distress and referred her to me. She thought she had brought this hangover from them to me, and was only now beginning to dispel it.

Following this, Ms D visited her mother ‘to try and see who she really is’, and found that she herself was cold and stiff in response to mother’s affection. She became very distressed in the session and the following ones. She felt that she had turned away from her twin to seek mother/me, had not found mother/me, and had become aware of a terrible aloneness. She panicked. She felt she could not exist except through her sister, in either her own or her mother’s eyes. She compared herself with a charcoal and chalk portrait that can be rubbed out. She felt she was a non-entity and only knew who she was through her sister. The only difference between them was her voice and that represented such a loss to her, it enraged her. She wanted me to define her.

Thus she had shifted her identification from her sister, seeking a mother she could not find, leaving her feeling alone and separate – and no-one. In her next session she suffered a profound sense of loss of self. I did not hear her on the entryphone and she had to repeat her name. She panicked – she felt she had ceased to exist for me and during the session demanded repeatedly to know if I understood `what had really happened’ to her. What she wanted was that I repeat to her my understanding of the process of her losing her voice and all the reconstructive surgery and other procedures she had since undergone. I believe what she really needed was to know whether I was really there for her now that she had shifted her focus away from her sister? Would I, like her mother, know her only as her sister’s shadow and not see her as a person in her own right? In what way was I there for her – as her twin/reflection, or as a container?

She was enraged with me for not answering her question i.e. whether I knew what had really happened to her. I suggested she was seeking her twin in me but she denied this. Her mother did not know, she said, and mother said ridiculous things which infuriated her. Towards the end of the session she explained that, during speech therapy, she had used a TV monitor to help her to learn to speak again – it reflected to her the mechanics of what was happening so she could correct her voice production. So she wanted me to be the reflecting monitor, the mirroring twin. How else could she know I understood her? She had no conception of a containing, processing mother.

At the end of this session, she said she had realised that last week was eleven years to the week since her voice problems began.

Her anxiety continued in the next session. She felt she had lost control of her voice, and was unable to produce the sound she wanted. She looked wildly, distractedly around the room, saying she felt wrong, in the wrong place. She had visited her brother at the weekend, desperately seeking her identity, as she had done with her mother and me. I suggested she was seeking in me a reflecting monitor. If I did not mirror her in this way, she did not know who I was for her. She responded saying she was trying to give up seeing herself through her sister, but was left very panicky – who is she? Who will she be? If she cannot be her sister or her sister’s reflection, she is nobody – nobody she knows. The weekend with her brother was repeatedly interrupted by mealtimes, which she linked with mother never having time for her. I suggested my ending sessions felt like that to her too. She agreed angrily, I was like mother, like all the rest. I had no time for her.

Ms D’s finding me in the transference as the unavailable, ungiving mother and my interpretation of this calmed her. Over the next week she felt less distressed, though still frightened by not knowing who she was or quite how to go about finding this out other than by seeking her mirror image in others. Not knowing led to fear and a sense of being nothing. She had begun the session saying she was `not sure how to find an opening’ – an indication that she was more able to tolerate not knowing and had not felt she had to cling to the thread of her twin to avoid this. She was seeking me/mother.

Her voice was still very weak, expressing her feeling that she was no-one – a nobody has no voice. She told me that she was taking her sister away for ten days during the summer break and was dreading this. It was an annual arrangement but this year felt especially difficult for her as she has withdrawn her focus from her sister and was afraid she would not be able to maintain this when she was actually physically with her continuously. She understood that she had begun to separate her inner and outer objects and was afraid the holiday would lead back to confusion.

Ms D told me that in speech therapy, she had sought a model when rebuilding her voice and the therapist had suggested she tape her sister’s voice as that most similar to her own and use this. She had been appalled by the idea and resisted it as it had always been one of the only features that distinguished them from each other. She knew she had to find or create her own voice from within herself, as she was now doing with her identity.

Alongside her fear about this, there was a sense of curiosity and excitement and we discussed how this differed from her excitement at the prospect of her sister’s death – that was excitement about destruction and killing off, whereas she was now excited about discovering herself, creating something from within herself. Ms D was even able to introduce a little humour into the session when talking about how she was `opening up’, linking this with her father reverting to his broad dialect when with his family, letting out something of himself. She is seeking a common language with me.

In her last session before the summer break, Ms D and I happened to wear similar skirts. She was initially shocked as if I had become her twin, but felt greatly relieved when she realised we could be similar, but were not the same i.e. we could share something but were not twins. She brought a dream – a rare occurrence – in which I had moved and she was seeking me all over the house, in the attic room. It was a public house called `The Mermaid’ and she was confused.

The dream linked with the break and Ms D’s seeking me in the transference. Will I be here for her? Who will I be? Am I like the mermaids that lure sailors into the sea and leave them to drown? She spoke again of her fears about spending time alone with her sister and the pressures on her to return to the twinship. But she recognised her feelings of closeness to me, her developing sense of self and her greater openness about herself.

She told me for the first time that she and her sister spoke a private language comprising more than 50% of their communications, and they have special names for each other. Over the past few months she has more or less stopped using this language with her sister, speaks more directly with her, and has concurrently started speaking in more direct, less distancing terms, with me.

This was a lively, creative session in which we could be in good contact and work together, allowing Ms D to leave with hope. She recognised the importance of the work we had done over the past few months, her need to separate from her sister, and to find a mother to help her do so and to enable her to develop a secure sense of self.


Ms D’s engagement in an enmeshed relationship with her sister, based on excessive mutual projective and introjective identification with an immature object, has been extremely damaging to her and, I believe, to her sister. It seems that not only was mother not able to intervene in and ameliorate the debilitating effects of the twinship in her new babies, to enable them to develop separate identities, but she could not allow them to be separate in any way whatsoever. They were treated as two halves of one whole and so the twinship was actively encouraged. As they were not able to help each other develop emotionally, and mother was unavailable to separate them and act as a container, they have remained locked in the damaging twinship.

Ms D does not yet know how to exist without her sister yet she experiences her as parasitic, draining, life-depleting. She can neither merge with nor separate from her. The self-object confusion in twins as a result of massive projective identification serves to erase differences between them and deny separateness. For Ms D, separation from her twin arouses anxieties at the more paranoid end of the spectrum, leading to fears of catastrophic consequences.

She fears the loss of her sense of self, as identified through her sister, and that separation will result in her feeling like a non-person. In order to separate and find herself she would have to re-introject the hated parts of herself which she has projected into her twin, including her projected fear of separation. She would have to tolerate a re-introjected, very damaged and unacceptable part of herself. This will puncture her omnipotence and her belief in an ideal self – a narcissistic injury which she believes will lead to annihilation of herself and/or her twin sister. In this intertwined narcissistic system, she is afraid that separation will lead to the death of herself or her twin, as if they cannot both survive as individual people. She has been increasingly distressed recently at finding that she is `not coping’, not in control – that she, like her sister, is fragile, needy and damaged.

She was enraged with me for not being her fantasied twin – mirroring her like the TV monitor – because it meant I denied her the possibility to transform me into her, her into me, thus creating a fused, grandiose twin pair that can deny the existence of the damaged self and the need to depend on a containing mother. Sheerin (1991) similarly describes twin brothers (p. 22):

locked together in a `pathological clinch’ of enhanced rivalry, complementarity and hostility/ dependency. Their highly cathected but ambivalently invested relationship was balanced precariously between the processes of splitting and fusion. Clarification of the self necessitated the destruction of internal objects which were fused to external self-objects.

Ms D’s discovery, in her therapy, that I am available as a containing mother and that she has need of me has terrified her. It is an experience new to her and one she cannot control as she could the projected twinship. I have intruded into the twinship and opened up the system. This has upset her equilibrium. She knows she needs urgently to extricate herself from the twinship. She has to seek me, forge links with me and use me. She does not truly believe I can be any more trustworthy than her mother but she has to take the risk or return to her deadly relationship with her twin. But, if she can use her creativity to mitigate her deathly attacks, she can begin to form a personal identity.

This raises the issue of whether this is possible when her twin is not also in therapy, and what effects it will have on her twin. Sheerin (1991) suggests that “‘Fallout” from psychotherapy can have repercussions on those close to the patient but in the case of identical twins the effects on the twin not in therapy can be disastrous’. He `cautions against individual psychoanalytical psychotherapy where the real drive is the assassination of the internal and external twin-object as a means to individuation from the twinship’.

I am hopeful that my patient has diverted her energy from this drive for assassination (the death instinct having been somewhat mitigated by the introjection of some life-giving elements in the therapy, so lessening the defusion of life and death instincts) towards a possibility of resolving her crisis of identity through a creative, containing relation his with a useful and available therapist/mother.



Athanassiou, C. (1986) A study of the vicissitudes of identification in twins. In International Journal of Psycho-Analysis 67, pp. 329-336.

Bion, W.R. (1950) The imaginary twin. In Second Thoughts. Selected Papers on Psycho-Analysis, pp. 3-22. New York: Jason Aronson, 1967.

Bion, W.R. (1962) Learning From Experience. New York: Jason Aronson.

Davison, S. (1992) Mother, other and self – love and rivalry for twins in their first year of life. In International Review of Psycho-Analysis 19, pp. 359-374.

Hinshelwood, R.D. (1989) A Dictionary of Kleinian Thought. London: Free Association Books.

Klein, M. (1946) Notes on some schizoid mechanisms. In International Journal of Psycho-Analysis 27, pp. 99-110.

Piontelli, A. (1989) A study on twins before and after birth. In International Review of Psycho- Analysis 16, p. 413.

Rosenfeld, H. (1971) A clinical approach to the psychoanalytical theory of the life and death

instincts: an investigation into the aggressive aspects of narcissism. In International Journal of Psycho-Analysis 52, pp. 169-178.

Sheerin, D.F. (1991) Fundamental considerations in the psychotherapy of an identical twin. In British Journal of Psychotherapy 8(1), pp. 13-25.

Wallace, M. (1986) The Silent Twins. London: Chatto and Windus.



Vivienne Lewin is a member of the London Centre for Psychotherapy and is in full-time private practice. Address for correspondence: 24 Estelle Road, London NW3 2JY.

British Journal of Psychotherapy, Vol 10(4), 1994, p499-510