An identical twin patient in her sixties shared an epiphany with me. In our session, when we were talking about repetitive feelings that trigger a great deal of anger and shame, she explained that she was sick and tired of becoming reactive and filled with “disgusting” thoughts. She related that she desires to be a calm, soft-spoken person rather than someone who unleashes a torrent of nasty and irreverent words if someone leaves a coffee cup on the counter. While she intellectually realizes that her behavior is related to her upbringing with a sadistic mother, she becomes frustrated that she cannot get a better handle on her feelings.

Similar issues arise in relation to her twin sister. Growing up, my patient felt as if she were the bad twin and her sister the good twin. Certainly, this dynamic seems plausible because my patient appeared to be the family scapegoat; hence, she functioned as the repository of unspeakable humiliation and denigration. We have talked at length about these abuses over our years of working together. For the past few years my patient and her twin have been able to work on their relationship; consequently, both have reframed their expectations and acknowledged ambivalence.

My patient becomes extremely angry with me if I compliment her twin. For example, she told me that her twin was struggling with something and talking to her therapist about it. I responded, “How fortuitous it is that both of you have the opportunity to understand what may be contributing to a problem or rupture.” My patient became enraged because my acknowledging her sister made my patient feel as if I were saying that her sister is better than she is. My patient intrinsically feels that my complimenting her twin makes her second rate or second best. She hears what I say via the good/bad dynamic and automatically reacts as if I am implying that she is a loser.

The notion of differences without competition or comparison is not yet well-established. My patient cannot help but compare everything she has and does with her sister. As a result, she cannot make any distinction between differences and separateness. When my patient worries that her twin will disapprove of what she has, she feels as if she is going to “crumble into a million pieces.” She recognizes that her vulnerability is related to her inability to regulate and handle competitive feelings that arise for both of them. At the end of the session she mentioned that she has to learn to dismiss, laugh, or engage in “friendly” competition so that she stays integrated in her body and mind. I acknowledged that this would take time and practice and encouraged her to keep trying.

Photo by Matt Brown, CC BY-SA 2.0