In this paper the writer explores the work with a couple whom she came to think of psychically like Siamese twins, stuck together in order to survive and lacking separate psychic entities with intact coverings. Such a covering is something that we take for granted and which implies that each of us is a separate individual. However, this paper draws attention to the way that some individuals, who have not developed a robust enough sense of identity, might seek a desperate solution, by partnering with someone who shares their dilemma. Being ‘stuck’ together can help stave off intolerable anxieties but tends to raise claustrophobic anxieties. The paper investigates how the underlying anxieties are primitive and serious, and the terrors which are being defended against are often in the area of suicide or breakdown so that, although couple therapy can help to loosen this deadly structure, a more containing intensive individual treatment is likely to be necessary to support the process of individuation.