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A sixty-three year-old woman formed a transference that appeared to be affected by her identical twinship, and which seemed to play a part in repetitive negative patterns, including intense and frequent treatment-destructive behaviors. The patient sought tirelessly to be joined with the analyst in a relationship that resembled the one she reported sharing with her twin, but also yearned to be separate from her twin. This conflict was realized in the transference as she oscillated between attempting to create and to destroy a twinship relationship with the analyst.