Books by Barbara Klein
Raising Gifted Kids: Everything You Need to Know to Help Your
Exceptional Child Thrive
Not All Twins Are Alike: Psychological Profiles of Twinship
Forgotten Memories: A Journey Out of the Darkness of Sexual Abuse
Early Adolescence and the Search for Self: A Developmental Perspective
(with Douglas Schave)
Issues in School Reform: A View From the Bottom-Up
(with John D. McNeil)
Curriculum Design: A Handbook for Educators (with Kathleen Wulf)
Identity and Intimacy in Twins (with Janet Ciriello)
Twins in Therapy
New York London
Taylor & Francis Group
711 Third Avenue
New York, NY 10017
Taylor & Francis Group
27 Church Road
Hove, East Sussex BN3 2FA
© 2012 by Taylor & Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business
Printed in the United States of America on acid-free paper
Version Date: 20111216
International Standard Book Number: 978-0-415-89340-4 (Hardback)
For permission to photocopy or use material electronically from this work, please access www.
copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc.
(CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization
that provides licenses and registration for a variety of users. For organizations that have been
granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Klein, Barbara, 1945-
Alone in the mirror : twins in therapy / by Barbara Klein. -- 1st ed.
Includes bibliographical references and index.
ISBN 978-0-415-89340-4 (hardback : alk. paper)
1. Twin--Psychology. 2. Sibling attachment. 3. Therapist and patient. 4.
Attachment behavior. I. Title.
Visit the Taylor & Francis Web site at
and the Routledge Web site at
For Elizabeth, Jonathan, Kim, Paul, and Richard
and my friends all over the country who
shared their twin experiences with me
. . . Though nothing can bring back the hour
Of splendor in the grass, of glory in the flower;
We will grieve not, rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be . . .
— William Wordsworth
I NTRODUCTION: THE GIRL WITH TWO HEADS xv
C HAPTER 1 THE REAL FACTS ABOUT TWINS 1
C HAPTER 2 UNIQUE DEVELOPMENTAL PROCESSES IN
TWINS: IMPLICATIONS FOR PSYCHOTHERAPY
AND PARENTING 19
C HAPTER 3 ALWAYS CLOSE BUT NEVER ONE: ANXIETY
AND DEPRESSIVE DISORDERS IN TWINS 45
C HAPTER 4 UNDERSTANDING CONFLICTING ATTACHMENTS
IN TWINS: THE RESOLUTION OF MAJOR
D EPRESSIVE DISORDERS 69
C HAPTER 5 “REAL” DIFFERENCES BETWEEN TWINS AND
I DENTITY DEVELOPMENT 91
C HAPTER 6 LOOKING AT AND REACTING TO THE TWIN
C HAPTER 7 WHAT IS LOST WHEN A TWIN DIES? 125
C HAPTER 8 ONCE A TWIN, ALWAYS A TWIN: IMPLICATIONS
FOR PSYCHOTHERAPY 151
C HAPTER 9 ALONE IN THE MIRROR 171
B IBLIOGRAPHY 173
I NDEX 181
BETWEEN TWINS AND
Twins who have been treated as individuals by their parents are able
to develop a harmonious and realistic life-sustaining bond because
their sense of singular identity is clearly established in infancy. Twins
whose identity has been split into opposites of each other by parental
projections suffer from deep emotional pain growing up. The experience
of imposed differences is quite different from the effect of actual
physical, emotional, or mental differences between the pair. When
twins are artificially labeled and measured against each other, conflict,
ambivalence, and resentment are a strong part of twin attachment.
Sustained harmonious interactions for split identity twins are hard
to achieve as they grow into adulthood and separate and individuate
from each other. Interdependent identity twins have confused ego
boundaries, which makes the therapeutic understanding of separation
and individuation very difficult to understand, let alone unravel.
When “real” differences between twins are present at birth or
develop in childhood and adolescence, the twin attachment becomes
unbalanced. One twin has specific limitations and the other must
adapt and adjust to being different, and supposedly, more fortunate.
While the relationship is easier to break down and understand on an
observable level, the undercurrent between the pair has a strong but
somewhat mysterious and unique effect on their emotional development.
It is very difficult for the stronger twin, who more often than
not has to keep her guilt to herself. As well, there is pressure on the
less fortunate twin to maintain a positive sense of self in the twinship
and the family. Parents have their challenges set out for them when
raising twins who have very different strengths.
ALONE IN THE MIRROR: TWINS IN THERAPY
Ultimately being able to understand the roots of individuality
is extremely important to the mental health and the positive selfesteem
of twins. “Real” differences contribute to the development
of individuality and a better sense of self for each child. Depending
on the reason that twins are different predicts the strength of their
adult attachment. The ensuing conflicts and misunderstandings that
arise because of differences will need to resolved, both separately and
together. Psychotherapy is extremely crucial and effective.
It makes sense that blatant and observable differences between twins
cause spoken and unspoken family stress. Although novels and movies
portray the struggles twins have separating from each other when
one twin is mentally ill and the other twin is not, very little is written
from a psychological perspective about how differences between twins
affect the twin pair and family life (Lamb, 1998; Shawn, 2011). Segal
(1999) suggests that identical twins are closer to each other than fraternal
twins because of the degree of similarity in genetic structure.
In other words, genetic differences are important enough to create a
strong sense of identity. My research suggests the opposite. It is the
nature of the twin attachment that binds twins to each other (Klein,
2003; Schave, 1982; Schave & Ciriello, 1983). This controversy over
the relative importance of genetics as compared to environmental
impact is long standing in the history of twin research (Hopwood &
Donnellan, 2011). I believe it is an unanswerable issue because of the
complexity of what actually contributes to mental health and identity.
Further, these arguments take away from understanding more deeply
the effects of real differences on twins and their families.
Obvious differences can be seen in boy–girl twins who are different
because of their gender and the ensuing social and cultural pressures
that will shape who they eventually become as they grow up.
Let’s look at a healthy “normal twin situation” in order to understand
how the deep attachment that twins share is molded by their
observable differences. Paul is 5 years old. He is the older twin by 5
minutes. Paul is quiet, shy, and highly sensitive to others and to his
environment. He can play for hours with his GI Joe toys. His twin
sister, Nancy, is outgoing, self-possessed, and very active. She plays
nonstop with her Barbie dolls. Nancy develops faster than Paul. She is
better at making new friends. Paul likes to stay home. Nancy likes to
“REAL” DIFFERENCES BETWEEN TWINS 93
go out. They rely on each other. Nancy speaks up for Paul. Paul keeps
Nancy company as she dislikes being alone. Often, Paul and Nancy
want their mother or father’s attention at the same time, which causes
them to fight with each other over who goes first. It is hard for them
to share their parents.
Unlike same-sex twins, identical twins, and fraternal twins, who
can become very competitive for attention and achievement, boy–girl
twins do not always measure themselves against each other. They know
in their heads and hearts that every event is not a competition. They
know better not to be competitive because of parental interactions and
observable physical differences that they are different. Ultimately they
want different kinds of attention and have different interests. Boy–girl
twins establish different roles in their twinship because of gender differences.
Still, each is very aware of the other and that they do have
to share their parents’ attention. Closeness and sharing shape their
identity development as well. Confusion about how they are different
from each other is not as intense as in split identity twins or interdependent
Attachment issues between twins shape their uniqueness.
Irrefutable differences between twins vary widely from gender differences
in boy–girl twins to differences where only one twin suffers
from major physical illness or mental disorders including schizophrenia,
bipolar disorders, and autism. Different sexual orientation also
affects the twin attachment because these differences are significant
enough to markedly shape identity development. Twins separated at
birth, whether identical or fraternal, have different caregivers and different
exposure to the environment, culture, and social experiences.
Twins separated at birth may have a close relationship that lacks the
usual twin turbulence. The following life stories represent how twin
attachment is affected by differences between twins.
Genieve and Lorene
BATTERED TWIN SYNDROME
Genieve (Gena) and Lorene (Lori) were the youngest members
of a large Catholic family. Their father was an identical twin who
still lived across the street from his twin brother and his family.
ALONE IN THE MIRROR: TWINS IN THERAPY
Being the seventh- and eighth-born identical twin children to a
poor family in rural Minnesota made life significantly difficult for
both Gena and Lori to receive the nurturing and financial support
they so desperately needed. At birth, Gena weighed twice
as much as Lori. Gena was able to come home from the hospital.
Lori stayed behind in the intensive care unit. Lori developed serious
problems in her lungs, which led to extended hospitalization
that continued on and off until the age of 6.
Gena’s earliest memory is of how much she missed Lori when
she came home from the hospital for brief visits. Their deep
attachment led Gena to scream and cry and keep everyone away
from Lori during the hours that she was home. Gena also remembers
that she was brought to the hospital as an infant, toddler, and
young child to comfort her sister when she was getting treatments
for her lungs. Gena was frightened by her “experimental” involvement
with Lori’s health care. Unfortunately, because of parental
financial limitations, this approach was used by the medical
facility and her parents. Using Gena, the strong caretaker twin,
to comfort and calm Lori, the fragile sickly twin, was a technique
set up by parents and doctors that deeply embedded distinctions
between these children. Consequently, it was very difficult
for Gena to emotionally put herself first even as an adult. Lori
was unrelenting in blaming her sister and causing trouble for her.
Gena became Lori’s scapegoat.
When Lori finally lived at home full-time, she was in first
grade. Lori was fragile and used to being taken care of continually.
Lori had difficulty in school completing her assignments.
Gena was sadistically criticized for having it too easy and then
used to promote Lori’s self-esteem and educational accomplishments.
Gena was diminished and treated as if she were invisible,
while Lori came to expect and perhaps enjoy tormenting her sister.
Gena remembers Lori intentionally breaking plates while her
mother’s back was turned and then blaming Gena for making the
mess. Was Lori acting out her anger at her twin for being more
fortunate with good health? Or was Lori trained to create stressful
situations for her sister? Why couldn’t Gena rebel?
In essence, Gena was used to bolster her sister’s health and wellbeing
at the expense of her own psychological development. Gena
ran away from home at age 15 and started her own life. She and
Lori were both relieved to be away from each other and the unrealistic
destructive aspects of their childhood relationship. Gena
“REAL” DIFFERENCES BETWEEN TWINS 95
got married, and then divorced and remarried. She successfully
ran her own business. Lori never married and had a great deal
of difficulty finding or keeping a job. Lori’s health was not compromised
because of her childhood illness. Unfortunately, Lori
continued to seek out and to abuse her sister as an adult. Gena,
because of her conscious and unconscious guilt, had a very difficult
time protecting herself adequately from Lori. Psychotherapists
helped Gena see clearly that she was not an acceptable target for
her sister’s unhappiness.
EXPERIENCES IN PSYCHOTHERAPY
Both women were advised by psychotherapists to stay away from
each other. Gena had more psychotherapy than Lori. Gena’s
therapists believed that she should move far away from her sister.
Gena also had a deep alliance with her older sister Irene, who
re-enforced Gena’s right to be free of Lori and her abusive behavior.
When Irene died at the age of 35, Gena once again faced
her confusion and guilt about her relationship with her twin.
Unfortunately, there was family pressure for these women to get
along, which created the re-enactment of Lori using Gena to help
her to feel better about herself. Gena was seriously battered by her
sister’s neediness and enactments of sadistic abuse throughout her
lifetime. Their attachment was self-destructive and strong enough
to wreak havoc on both of their lives.
An adult pattern of interacting developed from the input of
psychotherapy. Gena would try to cut her twin sister out of her
life completely. There would be several months, even years, of distance,
which helped both of these women develop their separate
strengths. And then Lori would complain to her large family that
Gena was ignoring her. Gena would be made to feel guilty that
she was not being a devoted sister and would connect in some way
with Lori, who once again would abuse her sister.
Perhaps more time and more therapy will help these women to
value each other.
Eleanor and Ira: Irrefutable Differences
Ira and Eleanor were born into an artistic family. Both parents
were well known in Hollywood. Dad, Marty, was an actor. Mom,
Helene, was a producer and director. Delighted to be blessed with
twins and fortunate to have household help, Ira and Eleanor were
ALONE IN THE MIRROR: TWINS IN THERAPY
well-loved and well-cared-for babies. From their first moments of
life, they were very different children. Ira was quiet and kept to
himself except when he was playing with Eleanor, who was the
“show-off ” twin. Ira and Eleanor played together for hours on
end as infants and toddlers. Although they had their own separate
bedrooms and special toys, they were usually content together.
It became obvious that Ira was developing more slowly than his
sister, who started talking at 9 months and walking at a year. Ira
walked at 15 months. And he was communicating with his sister
only nonverbally at the age of 2½. Developmental pediatricians
and speech therapists were consulted about Ira’s developmental
arrests. After hours of testing, observations, and family interviews,
a diagnosis of autistic spectrum disorder was decided upon
by the treating doctors. Behavioral interventions, play therapy,
and a special school were selected for Ira. Eleanor was very upset
that she could not attend the same preschool as Ira. She had a very
difficult transition into preschool because she was separated from
A great deal of individual attention, special education, and
play therapy was given to both children. Ira attended schools for
autistic children through the sixth grade. Unfortunately, Ira was
unable to develop the ability to take care of himself. Eventually
as an adolescent he was placed in a fine home for autistic children.
Eleanor was old enough to understand her brother’s problems
getting through his day. With great psychological-mindedness,
Eleanor was told about her parents’ decision to place Ira out
of the home. On some deep level, Eleanor was relieved to be
free of her brother’s behavioral difficulties. On the other hand,
she was also quite disappointed and confused by his departure.
Eleanor worked individually with a therapist to explore her feelings
of loss, abandonment, and anger. Eleanor missed Ira and
was always eager to visit him. They were very able to connect on
a nonverbal level.
An unfortunate turn of financial events when Ira and Eleanor
were 15 left this well-to-do family bankrupt. A new, scaleddown
lifestyle was adopted by the family. Ira was placed in a lessexclusive
residential treatment, and Eleanor was placed in public
schools. Arguments between Marty and Helene escalated as their
lifestyle declined. Eventually Marty and Helene divorced when
Eleanor went off to college.
“REAL” DIFFERENCES BETWEEN TWINS 97
FAMILY AND INDIVIDUAL PSYCHOTHERAPY
In childhood, family therapy was an important aspect of Ira’s
treatment. Care was given to help Eleanor deal with her twin
brother’s behavior problems that were related to his social skills
deficiency. As well, family therapy helped Eleanor to understand
that she would not develop her brother’s illness. Both parents were
very tuned into giving each twin what they needed as individuals.
Still, Eleanor suffered from feelings of guilt that she was the
healthy twin. Eleanor had difficulties with her anger at home and
at school when her brother was placed in a residential home for
autistic children. Eleanor worked with a child therapist at this
time. At first she visited her brother once a month. As her life
got more active with others, Eleanor visited her brother less frequently.
Ira and Eleanor grew apart, and they developed their
own lives. Their connection to each other remained strong and
important to their sense of who they are. They visit with each
other as often as possible. The use of family and individual therapy
was critical to the growth and balance in this family because family
members were able to express their range of feelings toward
one another. Shame and fear about family difficulties related to
differences between the twins were greatly reduced by the sharing
of thoughts and feelings.
Nick and Charles: Who Is Who
It is still a mystery whether or not Nick and Charles (Chuck) were
identical or fraternal twins. These men in their 40s still looked
similar. Nick in midlife was heavier than Chuck because Nick
had been on medication for bipolar disorder. Or perhaps they
were just fraternal twins and Nick was built bigger than his twin
brother. As can be common with twins, no one really knew for
sure. Acting in their characteristic everything-is-the-same manner,
Janet and Andre—their parents—did not want to explore the
zygote issue. Janet and Andre preferred to assume that they were
Born into a wealthy Italian family who lived in an upscale
community outside of New York City, Nick and Chuck had
everything money could buy. They grew up with their older sister,
Melissa, who was jealous of her twin brothers and came to resent
the attention they attracted. Melissa was defiant and difficult. She
was mean to her brothers and parents. Janet and Andre were very
ALONE IN THE MIRROR: TWINS IN THERAPY
bright older parents who truly lacked any kind of psychological
mindedness about raising twins. While both were highly educated,
Andre was an orthopedic surgeon and Janet a graduate of
a prestigious Ivy League college, they functioned as an old-fashioned
enmeshed Italian family. Closeness alongside intrusiveness
was a tantamount family value.
Janet and Andre did not consider the importance of raising
twins as individuals. Nick and Chuck shared everything—bedroom,
toys, and clothes—as infants, toddlers, children, and teenagers.
Astonishingly, Nick was the only family member who was
concerned about having his own space. At age 3 he asked his parents
for a separate bedroom from his brother Chuck. This bedroom
separation was implemented efficiently because there was an
extra bedroom in the home. The boys often slept in each other’s
rooms when they felt the need to do so.
Nick and Chuck shared an interdependent twin bond. Janet
and Andre did not distinguish between their children because
they wanted their family to always stay closely interconnected.
Unfortunately, these twin boys were encouraged to live intertwined
lives. They went to the same schools. They shared all of the
same friends until they went to college. Even as teenagers these
bright young men could not describe how they were emotionally
different. Finally separated from each other at college, Nick had
a psychotic breakdown. He was diagnosed with bipolar disorder.
In reaction, Chuck suffered from an atypical form of survivor’s
guilt because he felt that he was healthier than his brother. Chuck
suffered from depression and a personality disorder. He returned
home after his first year of college. This guilt-laden reaction of the
healthy twin to the illness of the other twin is very common and
is described in fiction and nonfiction (Lamb, 1998; Shawn, 2011).
These young men received the best psychiatric care that money
could buy, which helped both of them finish college. Through
individual psychodynamic psychotherapy, each of them learned
individually that they were different from the other. Knowledge
and understanding of how each was unique had profound positive
effects for both as they experienced that they were entitled to be
individuals. Nick married, and he and his wife adopted a child
because he did not want to transmit his mental illness to his children.
Chuck never married, as he had insurmountable problems
making an ongoing attachment to a woman. Because the family
enmeshment and twin dynamic were always enforced, they were
“REAL” DIFFERENCES BETWEEN TWINS 99
exceptionally hard to disentangle. Every family birthday, holiday,
and vacation was always shared. The consequences of family above
all meant that new relationships for Chuck and Nick were not
supported or encouraged even in adulthood.
Janet and Andre continued to financially help all three of their
children well into their 40s to live middle-class lives. All three,
Nick, Chuck, and Melissa, were in on-and-off psychotherapy and
on psychotropic medication as adults. This ensconced family was
trapped into a “no exit” lifestyle. Their intrusive behavior toward
one another led to their general and persuasive social awkwardness
in other interpersonal relationships. Only gradually did intellectual
awareness develop that individuality was acceptable and appropriate.
A real sense of separation from the family is still developing.
EXPERIENCES IN PSYCHOTHERAPY
Psychotherapy was essential and critical to help each twin understand
that their differences led them to pursue different lifestyles
and that individuality was normal and important. Because they
shared an interdependent identity twin attachment, there was a
great deal of confusion well into adulthood surrounding the development
of individual identity, which affected their ability to form
new relationships. For example, Chuck had difficulty accepting
that he was not the parent of Nick’s son, Arnold. In turn, Nick
was very aware that his brother was unable to respect his relationship
with Arnold. Nick continually had to make it clear that his
son was not to be shared.
Endless arguments over “inappropriate behavior and expectations”
were always taking place. One therapist would say that his
twin patient’s behavior was appropriate and the other twin’s therapist
would disagree. While these exchanges may seem humorous,
they were exhausting for the therapists and twins.
Nick: Ongoing Short-Term—Long-Term Therapy
Nick was diagnosed with bipolar disorder at the age of 18 when
he had a psychotic breakdown at college. After a 2-week hospitalization,
Nick saw a psychiatrist and psychologist on a regular
basis for medication, insight, and emotional support. Nick
changed therapists on an as-needed basis, even though all mental
health professionals agreed that he needed to separate from his
brother and the entire family. Nick gradually accepted over the
years of psychotherapy that he was different from his brother
ALONE IN THE MIRROR: TWINS IN THERAPY
because they did not share the same mental illness. Arguments
between Nick and Chuck were more heated and commonplace.
Psychotherapy was helpful and critical in that Nick finished
school, married, and adopted one child with his devoted wife.
Nick worked to support his family. As well as his family’s lifestyle
was financially supported by his parents and his wife’s parents.
In spite of years of therapeutic intervention, Nick could not
manage to get along with Chuck. Passive–aggressive interaction
between the twins could not be disentangled.
While some mental health professionals or twins may conclude
that psychotherapy was of limited success because these men
could not get along, from my perspective, the enormous gains in
individual development indicate that therapy was successful.
Chuck saw a child psychiatrist before going off to college because
he was extremely awkward socially and very reluctant to achieve
at his intellectual potential. Chuck was not doing his homework
because he believed that he was not as smart as his brother. The
first psychiatrist suggested to Chuck that his underachievement
was a way of keeping close to his brother and rationalizing his
fear of success. This therapeutic intervention helped Chuck attain
a better sense of himself and developed his intellectual self-confidence.
Chuck was very bright and an able student. He completed
college and graduate school easily.
Chuck experienced all kinds of emotional issues and inner turmoil
when he learned that he was different from his brother because
of his brother’s mental illness. Actually accepting that he would
follow a different lifestyle path from his brother’s was excruciatingly
difficult. He felt guilty that he was not suffering with mood swings
and psychosis like Nick. Resenting that Nick got more attention
and financial support from his parents because of his bipolar illness
was deeply troubling as well. Chuck wanted to be the center of
parental attention, but it was an impossible task given his passive–
aggressive personality and the enmeshed family structure.
Chuck was truly confused by the changes in parental involvement.
He felt that Nick was the favored child, which made him
feel lost and abandoned. Ambivalence toward his entire family
led Chuck to look for another psychotherapist. For 5 years Chuck
worked once a week with a psychodynamic psychotherapist to
develop career goals to work on romantic relationships and to
“REAL” DIFFERENCES BETWEEN TWINS 101
develop a more stable relationship with Nick and his parents.
Chuck decided to go to graduate school in business after pursuing
a career in graphic design. His relationships with Nick, his parents,
and sister remained very strained. Chuck was always critical
and never satisfied with “real” interactions with people he came in
contact with at work, school, and home.
Chuck, in anger and frustration, terminated long-term psychotherapy.
He believed that his therapist had taken over the
direction of his life journey and had given him faulty advice. His
therapist, Dr. A, was frustrated with Chuck and supported his
plan to terminate. On a deep and partially unconscious level,
Chuck could not understand what it meant to be different from
his twin and from his therapist. Although Chuck felt this psychotherapeutic
experience was a failure, clearly progress was made in
developing his sense of separateness from his entire family.
After 5 years of working and dating—living his own life, which
was very different from his married brother—Chuck felt hopeless
and depressed. He wanted a wife and a child, but he could not
hold on to a relationship with a woman for more than 3 months.
His business career was not as fulfilling as he had imagined it
would be. In fact, business obligations were nothing but frustration.
He continued to feel nothing but obligation toward his still
enmeshed and intrusive family. Chuck sought out the counsel of
yet another different, supposedly smarter, better-trained therapist,
Dr. Gerard. For more than 2 years Chuck worked with this
psychotherapist to overcome his passive–aggressive and avoidant
behavior. Although Dr. Gerard and Chuck tried, it was very
difficult for them to establish a stable therapeutic alliance. For
example, Chuck would come into a session feeling emotionally
connected to Dr. Gerard and without an explanation become
angry and agitated. Chuck often felt totally misunderstood or
ready to terminate the therapy. Idealization and devaluation
punctuated their work together. Interpreting issues of the longedfor
merger with Dr. Gerard was impossible for Chuck to listen to,
let alone accept. Chuck could not hold on to a positive trust with
the new therapist, whom he eventually dismissed as incompetent.
Dr. Gerard was frustrated with his work with Chuck. But Chuck
was indifferent to Dr. Gerard’s concerns and sought out the help
of yet another mental health professional who was covered by his
insurance (Clarkin, Fongay, & Gabbard, 2010).
ALONE IN THE MIRROR: TWINS IN THERAPY
Psychotherapy helped both of these interdependent identity twins
create their own separate lives. Therapeutic alliances and transference
attachments were difficult to stabilize, which made the work
of therapy very slow and tedious. Nick and Chuck were always on
the lookout for the best doctor, but not so willing to see their own
shortcomings (Clarkin et al., 2010). In spite of all the criticism
about therapeutic failures, both men did learn to be themselves.
Eventually each learned to accept the other as different.
Whether or not these men found harmony and happiness
with each other or in their lives with one another is impossible
Gay Emotional Issues in Twins
Julie and Jennifer: “Sensible Twins”
Twin research has traditionally been used to understand the
importance of genetics as compared to the environment on individual
development. So it is very interesting to researchers who try
to understand the determinants of identity when identical twins
choose different sexual orientations. Is there a gay gene (Bailey
& Pillard, 1991)? Does this mean that sexuality is determined by
the experience of parenting and the type of nurturing each twin
receives (King & McDonald, 1992)? The following life story indicates
the variety and complexity of factors that come into play for
twins when one is homosexual and the other heterosexual.
Julie (Jules) and Jennifer (Jen), identical twin girls born and
raised in Sacramento by a large Anglo Mexican family, were
exposed in childhood to serious abuse and neglect. As early as
they can remember, Julie and Jen knew that they were an afterthought—unplanned
and unwanted. Both parents were emotionally
unavailable. Ramon, their father, was stoic and withdrawn
from his wife and all five of his children. A first-generation college
graduate from a poor family, he was very concerned with
making himself known and respected as a business success.
Unfortunately, Ramon left the real parenting to his wife, Sandra,
who had no intuitive sense or knowledge about how to parent.
Sandra, who came from a small town in Kansas, had difficulty
dealing with raising five children on her own. She was often in
a state of hysteria and panic about everything from ordinary to
serious. Her emotional instability frightened her children. Anger
“REAL” DIFFERENCES BETWEEN TWINS 103
and anxiety were ongoing. Sandra’s upset seemed endless. Jules
remembers at least once a day her mother screaming, “Goddamn
good-for-nothing kids” repeatedly.
In some way these twins were protected from their mother’s
rage by their older sister and two older brothers. And Jules and
Jen turned to each other and their twin attachment for a sense of
safety and security from the family violence and chaos. There is no
particular information or memories to suggest why these identical
twin girls were differentiated into leader and follower unit in such
a clear-cut, drastic manner. However, differences between Jules
and Jen were clearly respected by the entire family. Both Jules and
Jen were aware by age 6 that there was a clear split between who
was responsible and who was not responsible in how they were
treated. Jules remembers complaining to her mother and father
about living in her sister’s shadow. Jen remembers that she always
had to perform and never make a mistake to keep her mother
from screaming at her.
Because of the chaotic family structure, these twins were
unfairly measured against each other. Jen was the high achiever
in athletics and the caregiver, and Jules was the “less than” twin
who lived in the gray area behind her sister, whom she looked up
to and wanted to be like. Jen was burdened by her mother’s expectations
that she should never make a mistake. In reality, both
of the twins had strengths and vulnerabilities that were related
to their underattended-to childhood identity. Fortunately, both
young children seemed to understand that they were more than
halves of a whole because of the attention they received at school,
in sports, and from their brothers and sister. These twins were
able to use their deep attachment to each other for comfort and
support, which allowed them to achieve and thrive in the world
outside of their family home. However, their clearly defined roles
in their twinship followed them as they matured and created different
and serious emotional obstacles.
Active and sociable, Jules and Jen were well-behaved children
who out of fear of their mother’s rage did what they were told.
They played together and comforted each other when their father
was absent and their mother was out of control. They shared the
same bedroom until they were 11 years old. Sharing friends, doing
homework together, and playing sports made up their activities
outside of their chaotic home life. Unfortunately, they were
introduced into the neighborhood drug culture by their brothers
ALONE IN THE MIRROR: TWINS IN THERAPY
and sister in middle school when their parents divorced. While
managing to keep up their grades and participating in sports,
involvement in drugs was central to their adolescence. Parental
involvement was very minimal to absent, as their parents were
preoccupied with their respective issues. The attachment of twinship
allowed these teenagers to successfully work together to free
themselves from drug addiction in the first 2 years of college.
Closeness between this pair began to be disrupted when Jen
fell in love and had an affair with Jules’s best girlfriend, Monica,
at college. Jen’s choice for a romantic encounter made Jules feel
deeply betrayed and created a break in their enmeshed relationship.
Jules was not concerned with her sister’s lesbian choice. Jules
knew that her sister was a tomboy who never would play dolls
with her. Jules studied acting to distinguish herself from Jen. She
was not surprised or in any way upset, threatened, or ashamed
that Jen was a lesbian. Rather, Jules felt that Jen had taken over
a friendship that they shared without her permission and behind
her back. Jen suffered with obsessive intense guilt for disappointing
her sister for many years.
Jen’s affair with Monica escalated the necessary separation
process for Jen and Jules to become their own persons, which
required them to slowly give up their identity as a unit. Jules no
longer wanted to be the helpless little sister. Jen was disinterested
in being in charge and being the big sister. As separation and
anger grew between these women, both of them suffered with
serious self-doubts, and painful misunderstandings surfaced in
their relationship. Their unique depressive episodes were most
likely related to the sense that they were not able to rely on each
other. As well, both did not understand the rules of non-twin
relationships. They had opposite problems with relationships.
Jules was confused about how to react to expectations from others.
Jen was too eager to give to others. Both women sought out
psychotherapy from a series of professionals for support and
insight as they confronted career challenges, identity struggles,
and relationship issues. In their late 40s, Jules and Jen worked very
hard to get over their anger at each other so they could enjoy the
safety of their twinship.
Their life story demonstrates that “happy endings” are possible
even if twins share a split identity and different sexual orientations.
Out of a chaotic and destructive childhood, these very outwardly
different women managed to seek out help for themselves in many
“REAL” DIFFERENCES BETWEEN TWINS 105
different types of psychotherapy to feel whole as they separated
from each other. They were able to accept that they had made different
sexual identity choices. In adulthood, after processing and
digesting their anger at each other and their parents, they were
able to rekindle the support of their twinship. This is truly a hopeful
tale about the power of attachment and of psychotherapy.
EXPERIENCES IN PSYCHOTHERAPY
Because of the extent of abuse and violence in their childhood,
both women needed the support of psychotherapy for many years.
The positive attachment that they had with each other helped
them to continue to seek out help from mental health professionals.
Their separate quests in psychotherapy, although oftentimes
unconscious, were in some ways attempts to re-create their twinship
with other people who were attentive to their deep feelings
of pain. Seeking out support and attachment helped them to live
the best life they could make for themselves.
Jules developed a serious eating disorder and sought out the help
of psychotherapy in her late 20s. She needed to understand her
deep feelings of emptiness and loss and her reactive need to continually
“feed” herself. Self-doubt and poor self-esteem were very
troubling for Jules. For more than 10 years she worked with her
psychotherapist Dr. Elaine putting together the strengths and
limitations in her sense of herself and taking in the support and
insight of her engaged and caring therapist. She was able to work
through her childhood anger and make peace with her parents
and older sister and brothers. She completed her college education
and attained a very prestigious job in Newport Beach, California.
At the termination of this lengthy and highly successful intervention,
Jules was aware that there were a lot of unresolved feelings
about her relationship with her twin sister, Jen.
In her mid-40s, Jules sought out the support of another psychotherapist,
Dr. George, in Orange County, California. She
felt that she was consumed and unsure of a romantic relationship.
Jules wanted to understand and work through her fear of
being in a committed relationship, which always made her feel
inadequate. Jules also dealt with issues forming relationships that
related to being a twin. In this existential therapy, which extended
ALONE IN THE MIRROR: TWINS IN THERAPY
for 5 years, she worked on making specific goals for herself, lowering
her expectations for her life, and learning to live in the present.
Jules began to try to spend more time with her twin sister,
believing that their relationship was missing from her life. When
Jules terminated her therapy with Dr. George, she felt more at
peace with her life.
Conjoint Therapy With Jen
Jules and Jen agreed to see a psychotherapist, Dr. Jeanette, who
worked with twins on specific twin problems. This is an ongoing
process (once every few months) that is helping both Jules and
Jen feel more whole and more connected to each other. Jules has
learned how deeply important she is to her twin sister. Jules has
gained confidence in helping her sister and turning to her for help
and understanding. Past arguments and unhappiness are put into
the past because each has had a great deal of therapy and insight.
Forgiveness and understanding have helped both women move
forward with their lives. Jules is very enthusiastic about working
out her adult relationship with Jen and vice versa.
Jen spoke with a counselor at college when she had her first
romantic relationship with a woman. This brief intervention
helped Jen to feel “good” about her decision to follow a lesbian
lifestyle because the therapist was understanding and positive.
When Jen moved away from home to go to graduate school, she
was away from Jules for the first time in her life. Jen, always feeling
she must do her best, continued to be a serious overachiever
at graduate school. Eventually she developed suicidal thoughts
because she never felt like she was “doing enough” or “accomplishing
enough.” Even though she was very successful in graduate
school, finished her doctorate, and had positive experiences
with other people, she could not overcome the internal dread of
having to get through each day perfectly. Jen began working in
therapy with a therapist in training, Leeann. Jen continued to
work with Leeann to keep her thoughts of killing herself at bay.
She realized that this young therapist could not connect with her
in the way that her twin sister could. Leeann was able to provide
privacy and a place for Jen to talk about her private self-loathing
and her public self-confidence. This inexperienced therapist did
not make the connection that Jen was depressed because she was
“REAL” DIFFERENCES BETWEEN TWINS 107
missing her sister. This interpretation and understanding could
have helped Jen connect and conquer her depression more quickly.
From this therapy, Jen learned to reach out to others who were not
like her sister, Jules. Jen began to see that her depression was serious
and that she could not will it away.
As a professor at a major southern university, Jen sought out
the help of an older and experienced therapist, Dr. Melinda, to
help her understand a destructive relationship that she was in
with another woman professor. This kind therapist helped Jen to
understand that she had gotten into this volatile relationship to
replicate her familiar childhood of chaos and abuse. Eventually
Jen was able to remove herself from her partner’s jealousy and
rage. Jen met her “real” partner and moved on with her life. Jen
learned from this experience about the terror and fear in her
childhood and how she falsely believed that she could solve or fix
anything through reason and hard work. Dr. Melinda was always
concerned that Jen was pressuring herself mercilessly. Jen could
understand but not internalize this valuable insight.
Jen moved to the Midwest to a prestigious university where she
is a full professor. Completely stressed by the politics of academia
and illness in her family, she entered into a highly negative cognitive
behavioral therapeutic relationship that made her feel misunderstood
and taunted. Jen immediately realized that her new
therapist, Dr. Hyatt, was not her intellectual equal. Unfortunately,
Jen did not trust her sense that the relationship was not workable.
She stayed way too long in this relationship because of her own
false belief that she could fix anything by being reasonable and
listening closely to the other person. Although this treatment was
ineffective and nonsupportive, it did demonstrate to the next therapist
the power and intensity of Jen’s need to please the other person.
Knowing that her last experience in cognitive behavioral therapy
made her feel misunderstood and not valued, Jen searched for
an expert, Dr. Long, who knew about psychological problems of
twinship. Jen wanted to rekindle her attachment with Jules but
always felt frustrated in her attempts. Amazingly, Jen still felt
guilty about the breach between herself and her sister over her
romantic interlude with Monica in college that occurred over 25
years earlier. Jen felt like Jules would never forgive her for having
an affair with her “best friend” and that this was the source
of their disharmony. Jen still needed to learn how not to blame
herself for problems that were larger than herself.
ALONE IN THE MIRROR: TWINS IN THERAPY
Jen felt understood and confident about reattachment to Dr.
Long. Working with a therapist who had knowledge about twinship
gave her insight into her need to re-create her twinship with
others and hope that she might be able to reconnect with her sister
as an adult. Jen worked on her self-loathing that led her into isolation
and depression. Delving into her deep ambivalence toward
her mother helped Jen develop a more realistic picture of herself
and her personal and academic accomplishments. Unrealistic
expectations for herself were examined from a psychodynamic
perspective. Real issues of saying no to students, colleagues, and
her mother were practiced. Jen began to write and finished a book
that she had been unable to complete for 10 years. The strong connection
between Jen and Dr. Long helped Jen take care of herself
instead of putting others first.
Conjoint Therapy With Jules
Jen and Jules attended sessions together to develop a new way of
interacting. Jen had to develop the ability to ask for help. In turn,
Jules had to learn to help her sister get over her guilt and confusion
about needing help. Changing the embedded roles of the relationship
was difficult for both women. The entanglements between
Jules and Jen were based on similar ways of seeing the world. In
other words, both lacked faith in themselves. Because they had
been abused in childhood and adolescence, they did not believe
that they were entitled to attaining happiness. When problems
arose, they both became hopeless. Understanding their similarities
brought these women emotionally closer to one another. Jen
and Jules began to take care of each other as they had done in
childhood. Both women began to grow in new ways that had been
arrested by their estrangement. Jules was able to protect her sister
from her mother’s anger and demanding behavior. Jen was able to
help Jules feel good about herself in new relationships.
Jules and Jen were not troubled by their different sexual identities.
They believe that sexual choice has never been as issue for them as
children and as adults. It is not an important aspect of their relationship
to one another. Both are concerned with reconnecting to
their supportive and life-sustaining attachment.
“REAL” DIFFERENCES BETWEEN TWINS 109
Twins Separated at Birth
When twins have different parents and family structures, different
personalities develop that reduce the emotional attachment and the
sometimes confusing turbulence that twins brought up in the same
family share. Twins may be separated at birth when adoption occurs
or in times of external crisis such as war, when life circumstances lead
parents to place one child with one family and another child with
another family without an actual adoption process. Twins are treated
differently and exposed to different educational experiences and social
and cultural values. Most recent researchers believe that twins without
actual information about being a twin are aware on some level of
their loss (Hayton, 2007; Schultz, 2003). Awareness of absence or loss
affects twins in different ways. For example, I have spoken with twins
who were separated in the adoption process who have a sense that
they are missing something that they can’t put into words. Some may
feel a kind of profound emptiness that is unexplainable. Later in life
they meet up with their twin and feel more whole. From observations,
interactions, and readings it is my opinion that a sense of emptiness or
loss is not as profound in twins separated at birth as it is in twins who
have lost their co-twin in death.
There are accounts of “extraordinary twins” who are separated at
birth who meet coincidentally later in life and are very similar to
one another in looks, personality, and support for each other (Segal,
2005). These accounts suggest that the intensity of attachment and the
need for the twin are not as compelling as in twins who are brought
up together. Less intense and conflicted reactions to each other are
understandable because environmental differences and upbringing
are so unique and competition between the twin pair is nonexistent.
Struggles with identity development are not as seriously conflicted
because twins separated at birth do not share intertwined lives. They
are not measured against each other. They do not feel deeply and overly
responsible for the other. As well, they do not seem to be ashamed of
being twins when they meet as adults.
Farber (1981), a psychodynamic researcher who studied case histories
of twins reared apart, reports that twins, because they strive
for individuality in such a determined manner, are not actually good
ALONE IN THE MIRROR: TWINS IN THERAPY
subjects for the nature–nurture controversy. Further, Farber suggests
that twinship is a serious complication that parents have to contend
with. My daughter Elizabeth, who was brought up with my sister’s
and my on-again, off-again relationship, read my first book on twins.
As an 11-year-old she decided that my theories on twin development
were faulty and that twins should be separated at birth. Although I
respect my daughter’s opinion based on the countless fights I had with
my twin sister, I still do not believe that separating twins at birth is
the way to raise healthy twins. There is no one answer to how to individualize
Are the hazards of twinships eliminated with the loss of day-today
attachment? The mystery of the twin connection is baffling and
remains baffling. Individual decisions about how to deal with competition
and blurred ego boundaries always need to be seen in the
context of childhood experiences.
Differences between twins have deep and profound roots that shape
identity. The memory of the twin relationship remains in the mind of
the twin sibling even when the co-twin is not present. This mindset
of twin interaction is a strong determinant of who twins become as
they grow and develop into maturity. Because of the diverse issues
from serious mental disorders to sexual identity choices described in
this chapter, it is difficult to make sweeping generalizations. For me,
the most memorable account of the twin attachment when there are
distinct differences between twins is written by Allen Shawn (2007,
2011). In literary detail he explains his private relationship with Mary,
his twin sister. Mary was born with autistic spectrum disorder and
placed in residential treatment in late childhood. Shawn carefully and
brilliantly describes his inner attachment to her, his fears of abandonment,
his fears of developing her problems, and his attempts through
the composition of classical music to identify with her often unpredictable
and unexplainable behavior. Unfortunately, like his father,
Shawn develops agoraphobia, which prevents him from visiting more
than once a year. Maintaining a more lively relationship is difficult;
still, Mary remains in his heart and soul an irrevocable part of himself.
“REAL” DIFFERENCES BETWEEN TWINS 111
When differences between twins are observable, and they are not
imposed by family projections and expectations, the twin attachment
does not get as entangled with identity confusions. Real differences
affect each child’s sense of self and the parent–child interactions with
their children. While differences eliminate some intensity in the
attachment process, or overidentification of ego structures, there is
still guilt over being different and competition for parental attention.
Twins with observable differences suffer from either being the betteroff
twin or the less fortunate twin. Working out these issues is important
to the development of healthy self-esteem.
Unfortunately, it is very difficult for twins to be in psychotherapy
together for practical reasons. Most likely, twins do not live next door
to each other. However, even with only one twin in the room, the
therapist’s awareness of the deep roots of entangled attachment will
help twins work through these issues of perceived imbalance. Just talking
about favoratism lessens the intensity of feelings. Psychological
stress related to different roles needs to be understood and articulated.
Giving life to feelings about being different from your twin in
psychotherapy is necessary, or these strong feelings will be acted out
or internalized into depression. When differences between twins are
acknowledged and accepted, the life-sustaining twin bond will provide
longed-for support during happy events and stressful times.