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Lynda Howell: Twinhood: Sense of self and identity

Working with twins, particularly identical ones, challenges therapists to look beyond the individual and consider the influences of the client’s twinhood. In Transactional Analysis, theoretical emphasis often focuses on the influence of parents. Whilst this is an important factor, I submit that in order to facilitate growth and change in identical twin clients, therapists need to take account of the influence that their co-twins have on the development in utero of each other’s script protocols, senses of self, and identities.

When exploring twin symbiosis in this article, I suggest that the nature of the twin pair’s transferential reactions to each other develops from their pre-natal implicit memory, and that a somatic twin bond that develops in utero forms the foundation of three common later developments: post-birth mirroring, twin yearning and characteristic twin-related script developments.  

Triadic bonding between mother and twins is also diagrammed and partly explained through a somatic twin bond and partly by identifying a “twin mirroring” symbiosis. The aetiology of the subsequent narcissism illustrated here will help explain the deep and often inseparable attachment dilemmas that can arise for each twin.

In relation to the psychological factors that influence and maintain twin symbiosis, a Type 4 Impasse is proposed that emanates from conflicts between pre-natal implicit memory and each twin’s drive for growth and individuation.  

When further developing my theories of twin symbiosis, I discuss the ensuing exhibitionist and closet narcissistic character styles. I suggest that they may arise when a twin mirroring symbiosis is present. Understanding the interlocking nature of these twinning types of narcissism can aid recognition in therapy of the enmeshed attachments between twins and highlight their individual dilemmas regarding separation and personal identity.  

Twin attachment in-utero

In recent years new research has given us a deeper understanding into the functions of the brain. It is recognised that perception is activated by neural circuit responses to sensation (Allen, 2000, p.261) and, “a number of disciplines are now converging on the centrality of the basic principal that the growth of the brain is dependent upon and influenced by the socio-emotional environment” (Schore, 1994, p.78).

Gilderbrand notes that the amygdala-based system of implicit memory generates our primary emotions and is thought to be close to maturity at birth (in Sills & Hargaden, 2003, p.6).  Developed earlier than explicit memory and not replaced by knowledge, implicit memory “involves how we feel and is a major element in relationships” (Allen, 2000, p.262).  

As emotional, behavioural, perceptual and possibly bodily somatosensory forms of memory are held here (Tronick et al., 1998 p.290-9), in my opinion it must then follow that in twins and higher multiples their implicit memory carries an imprint, commenced in utero, of a uniquely shared sensory impression of the two that possesses no recognition of separateness, which only starts developing post-birth between two to nine months of age (Sills & Hargaden, 2003, p.17).  Explicit memory, on the other hand, develops even later, is conscious, has a sense of self and time, and contains recognition that we are recalling something (Allen, 2000, p.262).  

As implicit memory is anchored in the forming bodies of the fetuses, I propose that the sense of ‘something missing’ felt by individuals whose twin pairs, unknown to them, died in utero, or were separated following birth, arises from the sensory impression of oneness imprinted in utero.  

It is this implicit memory that I submit underpins the foundation of each twin’s script. There is some further support for this dimension of scripting in Pointelli’s (1999) research which shows that twin fetuses respond to the light strokes and deep pressure of the other twin. Also, with the use of ultrasound, the beginnings of behavioural diversity in utero can be seen (Sandbank, 1999, p.14).  In her earlier studies of twins before and after birth, Pointelli also observed the appearance of individual temperament and couple patterns of behaviour, noting that these seemed to continue into the twins’ post natal lives (1989, p.417).

Furthermore, a fetus develops implicit memories associated with low frequency sound such as music, internal body noises and mother’s voice, the last aiding attachment after birth (Hepper, 2006). Also, in later life, the conscious and verbal script decisions we remember having made, overlay and are rooted in our implicit memories, which remain non-conscious (Allen, 2000, p.261-2).

The impact of the primal blending imprinted in a twin’s implicit memory is very significant when therapists are working with twins as it has a powerful scripting influence on their senses of self, identities, levels of individuation, and interpersonal relationships past and present. It seems clear to me also that twin fetuses are born with a fundamental oneness and post-birth attachment to each other that have arisen from their implicit memories.

In early childhood, babies make no distinction between their bodies and the outside world; sensations predominate and constitute the core of the self (Tustin, 1972, p.3). Their sense of being has little or no recognition of objects as separate and mother is experienced as a “sensation-object” which is called “normal primary autism” (Tustin, 1972, p.6). It is my conjecture that each twin becomes a ‘sensation-object’ for the other in utero, and that this process predates what occurs with their mother. In this respect, I concur with Leonard (1961) that twins have the extra developmental task of separating from each other as well as from their mother (in Davidson, 1992, p.360).  

Tustin’s (1984) research into autistic children suggested that smell, sound, sight and taste were “shapes” that appeared to be “felt” rather than seen, tasted, heard or smelled (p.279). I hypothesise for twins that the awareness of sensations heightened by the proximity to another in utero is a blended aspect of these “shapes,” and is held in implicit memory at a somatic cellular level.

To illustrate the above dynamics and the unique twin blending that takes place, I have expanded Hargaden’s & Sills’ (2002, Ch.2) model of the development of Self (see Figure A). The model highlights the somatic twin bond which is significant in itself and is at the foundation of my proposed Type 4 Individuation Impasse (see Figure B), discussed later. In these figures, while Berne (1969) meant zero-subscript ego-states to signify ‘at birth’ (p.111), I have used them as Mellor (1980) did to mean starting at conception. ‘F’ represents the fetus of each twin in utero.

This model illustrates the influences that both fetuses have on each other’s C1 core self. I concur with Hargaden’s and Sills’ view that C0 and P0, which overlap, are not distinct ego states at this developmental stage and that the “type of amniotic sac” between the two contains the yet undeveloped A0 which will eventually become the infant’s sense of cohesive okay self (Hargaden & Sills, 2002, p.18).

From this it can be understood that the blending in utero between the pair can be the foundation of a deeply somatic confusion that could lead to a core self that includes a somatically blended sense of affect, coherence and history. In Ken Mellor’s article “Intimate Autonomy: A Worthwhile Goal for Twins” in this issue, he meaningfully terms this twin’s sense of oneness as the ‘we-entity’.

Given the fundamental nature of this pre-natal sensate ‘oneness’ of twins, the trauma arising from their separation at birth can be better understood. Each twin already forms a part of the other twin’s sense of self, which becomes evident when the newborn becomes distressed in the absence of the other, perhaps a similar distress to a baby’s experience of the absence of mother as the “self-object” after birth (Tustin, 1972, p.6-9). This early absence of the “sensuous object” abruptly ends the previous comfort experienced in the womb, and can be likened to the amputating of part of one’s self (Tustin, 1984, p.97). Evidence of the somatic twin bond is there for all to see, too. For example, there are many stories of firstborn twins being apparently unable to breathe unassisted until the second-born twin arrives. Ken Mellor’s brother, David and my sister Christine both arrived first in this way.

This uterine oneness is largely unconscious in many twins so that its importance may only dawn on them in later life, often when they are separated and no one else is there to fill the void that the other twin’s absence creates. Separation from each other frequently heralds extreme anguish and inexplicable loss, or childhood temper tantrums, by one, other or both of the twins – responses that can thwart normal personality development (Jarrett & McGarty, 1980, p.196).  

Symbiosis in early infancy

When developing healthily, babies start to evolve a sense of identity through the “not me” experiences that arise naturally in relation to their mothers. It is the dawning awareness of mother as “not self” that prompts this. My conjecture is that the powerful in utero blending of twins continues after birth leading to each twin being the self-object for the other, pre-dating that with mother. These highly confused blendings between the pair can hamper the post-natal bonding process between mother and child, particularly when parenting does not enhance separateness between each baby.  

In Frances Tustin’s (1972) work, she describes the need for an infant to have parental support in “bearing the ecstasy of ‘oneness’ and the tantrum of ‘twoness’ if the necessary primal differentiations are to take place” (p.94). I suggest that intense primal and mutual C0 post-birth yearning between twins emanate from the somatic twin bond and is a powerful force between them. Any challenge to this can result in distressed confusion between twin and twin in the earliest stages of life, confusion with flow-on effects in the bonding process between the mother and each child.

The degree to which the individuation of twins develops throughout their lives partly depends on their separate bonds with their mother. These in turn may be significantly influenced by their mother’s ability to maintain a separation of each infant in her own mind, to manage any feelings of guilt she may experience about not being able to give exactly the same to each twin, and to deal emotionally with any rejection by one, other, or both of the twins in the bonding process. At the same time, environmental influences and cultural attitudes towards twins may also play an important part in the separation/individuation process. In Ken Mellor’s corresponding article “Intimate Autonomy”, he sensitively highlights the different requirements needed for parenting twins, as opposed to singletons, in order for healthy individuation to take place between the pair.  

Added to these influences, the triadic relationship between the mother and twins can become psychologically more complicated because of their rivalry for their mother’s ‘breast’, attention, cuddles etc. Sometimes one or both twins will also reject their mother’s contact because she is seemingly unavailable when needed (Sandbank, 1999, p.167). The resultant divided attention may provide what one needs while causing a lack of consistent mirroring with the other. This second twin may, nonetheless, develop a needed symbiosis through a deeper relationship with another carer (e.g., father, grandmother or an older sibling). In such circumstances, each twin has the opportunity to develop a separate identity and sense of self.  

Alternatively, when the mother bonds with only one of the pair or one twin opts out of the relationship in order to avoid rivalry, the excluded twin may form what Athanassiou (1986) refers to as “a parasitic relationship with the co-twin in order to have a proxy relationship with the mother” (Sandbank, 1999, p.168). Figure B shows this “parasitic” relationship as a “twin mirroring” symbiosis. I developed this model by extending the Cathexis Institute model of symbiosis (Schiff, J., Schiff, A., Mellor, K., 1975, pp.6-9).

In this Figure, I have shown a “twin mirroringsymbiosis with mother who is available to her Child ego state. Being open in this way gives her significantly more capacity to nurture her babies than if she were not available to her Child. (In that event her Child would be shown outside the envelope in the figure.) It is important to note also that, unless there is ample support for mother from the father and/or others, her ability to bond individually with one or both babies will be diminished. This is important because when there is sufficient sustenance for mother from her support team and from her to twin 1, a healthy bond will develop for this twin to evolve a separate sense of self and identity.

To explain; when Twin 2’s projection, introjection and identification with mother become blurred, Twin 1 may become an additional “mirror” and the primary object for Twin 2. Of course, the co-twin is unable to contain and reframe the other’s emotions, and as a result, “Where the twin is the primary object, the projective and introjective identifications between the two set up powerful interpenetrating forces creating a confusion of identities that is not adequately resolved by such processing because neither twin has yet developed the capacity to do so...”  (Lewin, 1994, p.501).

In a “twin mirroring” symbiosis, Twin 2 projects unwanted feelings onto Twin 1, who learns to hold them, instead of the mother, experiencing them as his or her own. In this transformational transference that emanates from primitive affect in C1/P0 (Hargaden & Sills, 2002, p.49 & 60-1) the pair maintain an enmeshed identity with Twin 1. often developing profound empathic abilities.

Furthermore, a desire for emotional sustenance from Twin 1 by Twin 2 can become a lifelong dependency as well as creating difficulties to do with identity and sense of self (Sandbank, 1999, Ch. 10). To quote Sandbank, “This can result in the twin remaining a dangerous as well as a ‘safe’ object, one that is life threatening as well as life-giving, and the infant feeling of omnipotence may continue inappropriately because the ‘object’ has become a part of his/her own identity. The mother may remain outside because she is seen to have failed to supply what has been obtained from the twin.”  (ibid. p.168).  

Ken Mellor’s article about twin autonomy effectively reveals how healthy parenting skills can prevent this “twin mirroring” symbiosis.

The development of an enmeshed twin relationship

Intense twin relationships, in which each of the twins need each other to feel complete, develop more often when there are no other brothers and sisters. For identical twins particularly, developing identity and an individuated sense of self presents a problem if, as children, they spend a considerable amount of time together and are treated symbiotically – like two parts of a whole.

In babyhood, identical twins recognise each other in a mirror before recognising themselves. They are several months behind fraternal twins in recognising their own mirror images (Bernabei & Levi 1976, p.381-3), showing a delay in establishing their self-identity. If an enmeshed connection manifests between the pair, it will inevitably impede their development further, as they each identify with and place some of their sense of self and identity in the other: “They become like two pieces of a jigsaw puzzle, each needing the other to become complete.” (Sandbank, 1999, p.177).  

Post birth, the somatic twin blending commenced in utero will continue to develop if the twins’ preoccupations with each other lead to a reduction in their demands for their mother. This may in fact give her respite from the hectic routine and attention required in looking after two babies and be welcomed as such. However, further development of this enmeshed relationship then ensues in which both twins view the other as part of themselves; with the introjective transferences between the pair incorporating mirroring, twinning and idealising (Hargaden & Sills, 2002, p.51-6).

These transferences emanate from euphoric and blissful C0 longings that are a normal, unconscious developmental process we all use psychologically to achieve health and autonomy. They can also, however, become a defence to diminish separation anxiety in twins and so preserve the safe, secure feelings of the symbiotic “oneness,” inhibit stabilising identifications and accentuate pathological fixations of the grandiose self (Ackerman, 1975, p 405).  

Bearing in mind the “twin mirroring” symbiosis, when Twin 1 develops a sense of self through the mother’s bonding, a message from Twin 2 that reinforced the unhealthy enmeshed symbiosis might be: “You can have the sustenance you require from me only if you deny the development of yourself.” (Johnson, 1994, p.136).

Due to Twin 2’s requirement for merger with Twin 1 in order to feel secure, attempts at separation by Twin 1 are either punished or blocked by Twin 2. These defensive behaviours by Twin 2 prevent connection to their real self that would be experienced as vulnerable, rage-full, empty and desolate.  This shared sense of false self is maintained comfortably unless one or both twins develop a healthy symbiosis with mother or another in which a separate sense of self can develop. Of significance, when a degree of separateness by Twin 1 is achieved, empathy and tenderness are learnt through the developing bond with mother, enabling Twin 1 to give and receive love and empathy in future relationships (Ackerman, 1975, p.391).  

In the confusion between self and other, differentiation between the internal and external world may also be only partial with a belief developing that the other is the same as self.  In these cases, arrested development of the self follows; the twins’ relating then becomes dependant on projective and introjective identification and splitting, which may be used as a defence to avoid experiencing separateness and envy. Whilst for some twins this transferential relationship leads to mutual closeness, others may experience bitter rivalry as one of the twins fights to stay in the unhealthy symbiosis (Sandbank, 1999, p.180-1), whereas the other struggles to get away in order to maintain and develop what little sense of self and identity he or she may possess. “The yearning for the other twin can be intense as can the hatred, and some literally wish for the other twin to die as the only apparent means of ridding themselves of the hated parasite.” (Lewin, 1994, p.500).

In all of this, I share the view held by Freud & Dann (1951), Leonard (1961), Dibble & Cohen (1981) and Athanassiou (1986) that a twin symbiosis appears to be equivalent to an infant/mother symbiotic relationship, and may compete with and, at times, weaken or replace entirely the mother-child symbiosis (in Davidson, 1992, p.369).  

When an enmeshed twin symbiosis is present, severe separation anxiety will be experienced if one or other twin leaves the relationship through death, marriage or personal decision, and relationship problems are likely to develop between them as the individual twin seeks the other part of him or herself in another person. This highlights the importance in Ken Mellor’s article of raising twins to be both autonomous and available to their inherent oneness.

Somatic impasse in twins

Awareness of the somatic twin bond leads naturally to considering the high probability of a deeper level impasse than both Goulding & Goulding (1976, p.41-8) and Mellor (1980, p.213-21) proposed. I suggest that a Type 4 Impasse exists that is experienced as somatic discomfort.

In this respect I concur with Erskine (1997, pp.147-148). However, I diverge from his conjecture that “The conflict occurs between the introjected emotions of the parents and the fetus’/baby’s affective response to the situation.”  (ibid. p.147). I consider that the disturbance involved is primarily between the twins and is somatic rather than emotional, as the fetus is still to become available to the emotional realm. Furthermore, I suggest that the effects of the parent’s emotions are secondary as they only begin to be significant in early post-birth stages of Type 3 Feeling Impasses formation.  

Preferring to view impasses in Mellor’s (1980) developmental terms (Figure C), I also suggest that a Type 4 Somatic Twin Impasse occurs between the sensate imprint of “oneness” in C0 (held in the twins’ implicit memory) and their internal drive to individuate that starts during the later stages in utero as their differences, which are held in P0, start to impact each other in subtle ways.  

These impasses begin during fetal life and continue developing up to nine months post birth. Arising out of the pre-birth somatic twin bond, they can result in an underdeveloped sense of separateness.

Figure D shows how I have extended Mellor’s impasse diagram to include a Type 4 Somatic Twin Impasse in C0, an impasse involved in the twins yearning for a sense of complete “oneness” in the face of their internal drive to individuate.

In Figure D, note that the dotted lines around the ego stages are to indicate that these are located in implicit memory with little or no form or structure.

In this type of impasse, the conflict is between “no sense of separateness” (an imprint of ongoing “oneness”) and a human “drive for growth and individuation.” The experience of this is unique to each twin. In therapy, unpacking and releasing the primal roots of later developments that arise out of such impasses requires a depth of process that is often not easy to realize.

Co-joined “Don’t Exist” injunctions

In therapy, the presence of Type 4 Impasses highlights the importance of considering the possible later development of a “Don’t Be, (Don’t Exist)” injunction (Goulding and Goulding, 1976, p.9-10). Both twins may have these relative to each other in ways that have developed from any existent Type 4 Somatic Twin Impasses, an active “twin mirroring” symbiosis and parental/others’ messages that oppose separation/individuation.  

During my work with twin clients it was apparent that a number presented with a “Don’t ExistInjunction in which one twin believed he/she could not exist without the other, whilst the other believed that he/she would exist only at the expense of the other.

For example: Twin 1 presented with a “You Won’t Exist Without Me” position, which was created out of omnipotent fears of annihilating the co-twin through separating/individuating. This is consistent with Winnicott (1971, pp.144-145): “In the unconscious fantasy, growing up is inherently an aggressive act….. If the child is to become an adult, then this move is achieved over the body of the dead adult/twin (unconsciously).” [my italics]

When a “twin mirroringsymbiosis is present in which Twin 2 uses Twin 1 to seek his/her sense of self, and identifies with and idealises the other twin instead of the mother, I found that Twin 2 presented with an “I Don’t Exist Without You” injunction.

Generated through identity confusion in a self-contained narcissistic system, each twin experiences a sense of individual incompleteness, inseparability, and fears of being unable to survive alone.  

Narcissistic character styles in identical twins

A lack of bonding between mother and Twin 2 in the “twin mirroringsymbiosis (see Figure B), generates a situation in which an infant does not experience the mirroring required to manage the emergent difference between “self’ and “not-self” that occurs when experiencing mother’s separateness and when starting to develop a sense of self. A degree of schizoid unreality is then created in object and reality relatedness that can pave the way for a highly narcissistic character adaptation.  

When there is also parental/other idealisation, as is often the case with identical twins, and humiliation when they attempt to project their true selves, the impetus towards narcissistic resolution can become overwhelming. According to Masterton (2000, pp.11-12), if this continues through what Mahler (1968) refers to as the rapprochement sub-phase from fifteen to twenty-two months of age, the narcissistic character traits can deepen. In order for individuation to take place during this phase, the children must gradually and painfully work through their delusions of grandiosity. The extent to which they do this will depend on the strength of their enmeshed twin relationship and the ability of their parents to support each child individually through this life phase of separation and individuation.

The degree of psychopathology present in one, other, or both twins is paralleled by the corresponding degree of bonding each one encounters with mother or another.  When both experience each other as the “self-object” their senses of self will be inhibited and lead to pathology in which one twin develops an exhibitionist narcissist character, whilst the other is likely to present with a symbiotic/closet narcissist character.

I have compiled the table below to aid therapist awareness of the enmeshed and interrelating nature of identical twins who present with narcissistic character styles. Identifying traits from the chart will highlight possible script issues and the potential transferential realms that might arise within the therapeutic relationship.

Twins in therapy

As therapists we need to be aware that a twin client’s interpersonal relationship issues will stem from the somatic twin bond and Type 4: Somatic Twin Impasse. These will inevitably emerge in the therapeutic process as the client will have a drive, unavailable to conscious awareness, to invite the therapist into a transferential twinning relationship in order to diminish separation anxiety and/or prevent connection to his or her real self.  Mindful of the importance of introjective transference as a normal developmental process to attain health and autonomy, gradual change can be effected through a relational integrative psychotherapeutic approach (Erskine, 1997, p.20-35) with twin clients seen individually or together.

Also, as any therapeutic work with one twin is bound to affect the co-twin, who may not be in therapy, unacknowledged collusion between the pair outside the therapy room may be present and have a strong impact on therapeutic outcomes.  A psychotherapy-by-proxy can also develop in which the non-client twin “establishes a transference to the therapist through the intermediary host of his or her identical twin.” (Sheerin, 1991, p.24); in a “twin mirroringsymbiosis with the therapist.

When one twin enters therapy, we need to consider the basis of their scripting and the degree to which a lack of a sense of self and identity is influencing their presenting problems.  In order to find a true self, twin clients each need both to re-introject those unbearable parts of self that they project onto their other twin and manage their fear of their own and/or their co-twin’s annihilation (Lewin, 1994, p.509).  For some this may simply be intolerable. Sheerin (1991 p.25) makes the observation that: “The separation of Siamese minds may nonetheless be a difficult and dangerous task.”

Autonomy can come at a price for some twin clients; attachment to the real self may create confusion and rejection if their co-twins need the false self to survive in order to feel complete. To celebrate the uniqueness of twinhood, these clients will also require support in grieving the loss of the harmony experienced in the “twin mirroring” symbiosis. This is not an easy journey.

It is worth noting that, while twins discounting themselves in order to maintain the twin symbiosis may appear dysfunctional to a singleton, it may simply be blissful to a twin. A symbiotic relationship of this type can be an enormously enjoyable, fun, beautiful and life enhancing experience when the discounting of both parties remains in balance with each other. Accordingly, in any therapeutic process, along with dealing with pathology, it is important to encourage the celebration of the parts of the client’s positive and life enhancing twinhood scripts that work well for him or her. Mellor also mentions this as a worthwhile orientation when parenting twins.

Working therapeutically with twin clients creates a challenge for singleton therapists. They will need to consider twinhood and how it may be impacting on their client’s presenting problems. It also challenges therapists to consider autonomy and twinhood and the subtle and sometimes profound differences inherent between singletons and twins.

Naturally drawn to it, my work with twin clients has been a challenging and profoundly growth enhancing experience, as has my understanding of twinhood both from my clients’ and my own perspectives as I am also an identical twin.

I would like to thank Ken Mellor for all his enthusiastic support and for taking the time to write his article “Intimate Autonomy: A Worthwhile Goal for Twins”. I hope that these two pieces of work will stimulate thought and discussion of an area that is little written about in psychotherapy.  

All views expressed in this article and are those of the author, and do not necessarily represent the views of Psychotherapy Excellence Ltd and it's employees.



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Lynda Howell

Lynda Howell MSc (TA Psych) RGN, RCNT has a private practice in South Wales. Her previous training as a nurse and nurse educator led her to working with clients in prison and medium secure psychiatric hospitals. She is a member of the Northern College of Body Psychotherapy.

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