Alone in the Mirror: Twins in Therapy - Routledge

Alone in the Mirror: Twins in Therapy - Routledge




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

Barbara Klein

New York London


Taylor & Francis Group

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New York, NY 10017


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© 2012 by Taylor & Francis Group, LLC

Routledge is an imprint of Taylor & Francis Group, an Informa business

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Library of Congress Cataloging-in-Publication Data

Klein, Barbara, 1945-

Alone in the mirror : twins in therapy / by Barbara Klein. -- 1st ed.

p. cm.

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.

BF723.T9.K54 2012

155.44’4--dc23 2011042831

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 NDEX 181





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.




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


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

identity twins.

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


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.



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


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.


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



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

her brother.

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.



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

identical twins.

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



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


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.


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



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


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).




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

to predict.

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


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



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


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.


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.


Long-Term Therapy

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



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


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.



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.


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



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.

Concluding Thoughts

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.


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.

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