Fundamental Considerations in the Psychotherapy of an Identical Twin

Identical twins encounter unique psychological and maturational difficulties alien to the experiences of single children. A brief review of the literature on these points is presented, emphasising both the tormenting and gratifying aspects of a twin who has in the outside world another identical self that the world notices and confuses with him. Such aspects need to be taken into consideration when engaging an identical twin in analytical psychotherapy. ‘Fallout’ from psychotherapy can have repercussions on those close to the patient but in the case of identical twins the effects on the twin not in therapy can be disastrous. In particular, when psychotherapy-by-proxy ensues it appears possible for the co-twin to establish strong links to the analyst through his narcissistic relationship with his twin, which appear transferential in nature. A clinical vignette is presented which elaborates on the issues of twin transference and the fallout effects on the twin not in therapy. A question is put forward: whether it is realistic to analyse identical twins individually and not together when their narcissistic dependency and defensive hostility are paramount to internal processes. The author takes the view that a psychoanalytical orientation to the psychotherapy of an identical twin is the most recommended but cautions against individual psychoanalytical psychotherapy where the real drive is the assassination of the internal and external twin-object as a means to individuation from the twinship. The nature of this object - whether selfobject or transformational object - is tentatively discussed.