A stunningly intransigent aspect of the caretaker and cared for twin dynamic is the fixed roles reflected in the dyadic interaction. The caretaker’s sense of self-worth rests upon her success at lifting up her twin.

An identical twin in her midforties contacted me because she was worn out, depleted, and depressed after years of caring for her twin, who was diagnosed with bipolar disorder more than twenty years ago. She shared that her sister had been sickly since childhood and that her family made it her responsibility to look after her sister.

This woman consulted many therapists before getting in touch with me. She explained that each of them advised her to discontinue her caretaking role. Of course, this advice made practical sense; however, without understanding more about twin psychology, this suggestion had little impact other than to add to the patient’s frustration and anger. A psychotherapist who understands the twin dynamic has to gently lay the groundwork for discovering the historical and developmental underpinnings of the client’s emotional past.

This patient and I have worked together for several months. Her progress is extraordinary. She is confronting and working through the paralysis, shame, and resentment built up over years of feeling obligated to care for her sister. She intuits that her sister would not treat her as unselfishly if the tables were turned and my patient were ill. She acknowledges how much she allowed her personal growth and goals to be neglected in favor of her sister’s psychological needs.

We have examined how my patient unknowingly sabotaged several educational and professional opportunities by feeling that she had to remain on call should her twin require immediate care. She never felt entitled to pursue her own dreams because her number one priority had to be lifting up her twin.

Similarly to many twins I have worked with, this woman has to come to terms with her role in this dyadic dance. She realizes that she avoided acting in her own interest over the years by rationalizing that this would interfere with her caretaking duties. On a deeper level, she complied with this pact because it offered protection from confronting her feelings of humiliation, social anxiety, and failure.

My patient is beginning to develop a sense of healthy entitlement. She has given herself permission to pursue an educational goal that heretofore seemed untenable. She has worked through some of the guilt over outshining her sister. She is attempting to reconcile being available to her sister and meeting some of her own needs. She is rediscovering her social skills and learning what it feels like to rely on herself. She has stopped introducing herself as a twin—a lifelong habit.

A few weeks ago, she shared an amazing experience. She participated in an outdoor team-building activity as part of her graduate program. She volunteered to be physically lifted up by her classmates in a trust-building exercise. As they cheered her on, she told me that she had never felt such a sensation of support and importance. I told her that it is her turn to be celebrated and recognized. I am confident that she will accomplish just that.

Image courtesy of Montecruz Foto (CC BY-SA 2.0)