Twin phenomena during a transformation process

Introduction

In this article I will describe, with a focus on twin psychodynamics, the course of an outpatient analytic group over a one-year period in 2016/ 2017, from session 188 until session 238. This slow-open group meets once a week for 100 minutes, with costs settled by public health insurance. During the period described, the group initially had seven members, four women and three men of different ages and with various diagnoses. At session 209 another woman joined the group.

The article was prompted by an uncanny feeling I had when one group member, Norbert, recounted a dream. (All names have been changed.) It was extremely similar to another dream that Klemens had told five months earlier, before Norbert had even joined the group. So, it was impossible for Norbert to consciously know what Klemens had dreamt. I was curious about this strange repetition, and wondered how it could be understood in terms of group-analytic theory.

Although only one group member is a twin by birth, four members have siblings who are less than 18 months older or younger; two members started the group together; and three had individual psychoanalytic therapy with me several years earlier. Thus both real and transferential twin-experiences were part of the dynamic matrix, and twin psychodynamics were potentially a creative factor in the group.

George L. Engel, who was himself an identical twin, writes:

Many consequences ensued for us from this prolonged struggle between unification and individuation, the most important of which were on the one hand diffuseness of ego boundaries, on the other complementarity. The latter constituted a developmental process encouraging in each of us the emergence of ego capacities that would complement each other and enhance the effective operation of the twin unit in relation to outsiders. (Engel, 1975: 33)

Other authors agree that unique transference and countertransference phenomena occur during psychoanalytic treatment of twins, sometimes revealing partially fused self- and object-representations as well as phantasized mutual identification (Athanassiou, 1991; Charisius-Weiss, 2017; Joseph, 1961; Joseph and Tabor, 1961; Lewin, 1994, 2017). In analytic groups with twins as participants, this could mean that the dependence on the mother/group/conductor is distinctive, reflecting the fact that twins do not only have the mother but also each other to relate to—and may even take the other twin as the primary object. By extension, an analytic group may oscillate between the occurrence of diffuse ego-boundaries with undifferentiated self- and object-representations on the one hand, and a strong yearning for complementarity and for ego-boundaries on the other.

These dynamics are reminiscent of psychotic transference in groups as recently described by Vollon, Gimenez and Bonnet (2018) who see psychotic patients in a group ‘oscillating in their exchanges between a tendency towards withdrawal and exclusion, and a tendency towards fusional abandonment even undifferentiation’ (Vollon et al., 2018: 11).

It is useful to recall Foulkes’ idea of the ‘transpersonal’ (Foulkes, 2007: 212). He thought that boundaries between individuals in analytic groups get partially repealed so that ‘we must not think of individuals acting upon one another, but of processes instead which interact within . . . the common matrix’ (Foulkes, 1960 [1984]; Foulkes, 2007: 199). As Dieter Nitzgen points out: ‘Therefore, he [Foulkes] maintained that “even to call this interpersonal is not enough” (Foulkes and Anthony, 1965 [1984]: 26) and eventually referred to such processes as “transpersonal” (Foulkes, 1960 [1984]: 169)’ (Nitzgen, 2014: 214). Peter Potthoff adds:

Foulkes sums up the radical-intersubjective stance, writing about, ‘transpersonal processes, that is mental processes, which, like X-rays in the bodily sphere, go right through the individuals composing such a network’ (Foulkes, 1971: 224). Further, ‘The mind that is usually called intrapsychic is a property of the group, and the processes that take place are due to the dynamic interactions in this communicational matrix (Foulkes, 1971: 224)’ (Potthoff, 2014: 274)

This, of course, is also true for the conductor, who is part of the transpersonal network with fluctuating boundaries.

The transpersonal concept tries to delineate the unconscious level of an analytic group on which mirroring, resonance and exchange unfold (Friedman, 2014; Thygesen, 2008). Analysing transference, countertransference and projective mechanisms in a group on the ‘dancing floor’ (Friedman, 2015: 46) of transpersonal processes can approximate to the primary themes and explore the affects which are resonated on.

It is to be inferred, therefore, that the uncanny countertransference feeling I had when Norbert told his twin dream can be understood as a transpersonal phenomenon in the group which arises from ‘infantile complexes which have been repressed [and] are once more revived by some impression’ (Freud, 1919: 248).

I will now describe how the twin psychodynamics which this uncanny impression alerted me to, and in particular twins’ early projective mechanisms, appeared in the group.

Group members

Jana, age 53, started in session 57. She had individual psychoanalytic therapy with me from 2006 until 2010. From the age of eight weeks she lived in a nursery for most of each week. Later on she suffered physical abuse at the hands of her mother. At 14 she found out suddenly that the man she believed to be her father was in fact her stepfather (he had adopted her when she was two). She is traumatized transgenerationally: her father was abducted and displaced as a child; her maternal grandfather was a Nazi perpetrator.

Klemens, age 43, started in session 66 and ended in session 237. He had individual psychoanalytic psychotherapy with me from 2005 until 2009. He is a fraternal twin. His father disappeared when he was 22 and he is diagnosed with paranoid schizophrenia. He did not attend two sessions (with notification). In session 208 he presented his suicidal thoughts in the group.

Kristin, age 37 years, started in session 66 and ended in session 232. She has a sister who is 13 months older. She shows a high level of control and rationalization as a result of separation trauma after having been her mother’s self-object.

Katharina, age 27, started in session 119. She has a brother who is 14 months younger. Her father left his first family when her mother was pregnant with her. She suffers from severe self-esteem problems.

Ralf, age 49, started in session 142. His father committed suicide ten days after Ralf’s first daughter was born. Since 2008 he has been separated from his children’s mother, who developed Munchausen by proxy syndrome in regard to their ten-year-old son.

Eva, age 27, started in session 169. She has a sister who is 16 months older, with whom she has a highly ambivalent relationship. Her father died of cerebral cancer when she was four and she has no memory of him. She experienced severe parentification by her mother. She missed several sessions without notification and often turned up late by up to half an hour.

Norbert, age 47, started in session 188. He had individual psychoanalytic therapy with me from 2008 until 2012. His adopted brother is ten months younger. His mother developed paranoid schizophrenia when he was five and he had had no contact with her between the ages of seven and 17. He has four schizophrenic half-siblings.

Tamara, age 47, started in session 209. Her mother suffered from postpartum depression and subsequently turned Tamara into a self-object. She has extreme feelings of seclusion.

Working with dreams

My approach to working with dreams in groups is influenced by intersubjective theory as outlined by Robi Friedman:

The transpersonal perspective suggests that an individual’s dreaming function may be ‘used’ (Winnicott, 1969) by . . . groups to process their emotional difficulties. Dreaming is an elaborating and containing process (Bion, 1992; Ogden, 1996; Friedman, 2002; Friedman 2012) function. (Friedman, 2015: 49)

I told the group that when one group member recounts a dream the others may take the dream as their own—as if you yourself had dreamt it—having first let it sink into the mind and resonate. Or, as Friedman puts it, ‘re-dreaming the dream “through the Other”’ (Friedman, 2015: 50). The group was therefore acquainted with this ‘transformative’ (Friedman, 2015: 50) approach towards dreamtelling. When working transformatively, also beyond verbal responses, ‘the group’s spontaneous individual affective responses—the personal resonance reflecting (unconscious) identifications with latent contents’ (Friedman, 2015: 50) are focussed on.

Another aspect in working with dreams and dreamtelling is the ‘formative approach’ which I choose when self-fragmentation is impending and which implies for example to retell a dream, or in Friedman’s words: ‘Working formatively by listening, accompanying the dreamer and the group through fears threatening affective moments as if grabbing an infant’s hand through a dark ally . . .’ (Friedman, 2015: 55).

The course of the group

The section of the group I am reporting here began in session 188 when Norbert joined the group. His first session was mostly about siblings. When I mentioned this, nobody commented on it at all. My countertransference feeling was that the group grew bigger, heavier to hold, like a baby too huge to embrace. And in retrospect it is clear that this feeling foreshadowed the process I am trying to define here.

In session 195 Klemens tells the following dream:

I am near a large river, on a small beach with my two brothers. There is a car driving on the water, it looks funny. A female colleague is sitting in it. She smiles and waves at me. Then there are lots of refugees drifting in the water. They catch hold of me. Soon there are more and more of them and I cannot bear it. All at once the water splits in two and everyone can walk on dry land. I thought it is like Moses—I was surprised, it was funny.

The group refers to Klemens’ suicide attempt in 2004 during the first manifestation of his paranoid schizophrenia. He jumped and fell 20 metres but when he was in the water he decided to save himself. They mention the difficulty of getting close to him due to his precision, aloofness and intellectual capability, which they think prevents him from being intimate and needy in the group.

In session 197 Kristin tells a dream:

I am in a nice kitchen . . . on a chopping board lies my dog’s head, severed, but not cut off. It becomes clear that I ate the dog. This is clear but not bad.

Jana is very sad about Klemens, fearful that he might kill himself. The group talks about boundaries between them and the fear of being eaten up in intimacy—as in the phrase ‘I love you so much I could eat you’. Eva says she has been sick all day, then goes to the bathroom without closing the door in order to vomit. Afterwards she refuses any psychosomatic interpretations—she says her sister also had food poisoning that day.

The dream about Kristin’s dog, her self-object, which is killed and reincorporated as an unconscious attempt to expel intrusive objects/mothers is acted out in Eva’s somehow bulimic undoing of aggressive impulses towards the maternal self-object. When Klemens wants to talk again about his dream from the earlier session, nobody resonates.

Shortly before session 199, Klemens leaves an answerphone message to say he is going to drop out of the group. When I call him back, he accepts my offer of an individual session, at which he is able to speak about feeling ignored by the group. When we meet, he wants to talk more about his dream but feels outdone by the dramatic dog dream of his transferential twin Kristin (they started the group together). His envy becomes apparent because previously he had often dreamt about his dog, who recently started to talk to him in the dreams. He says that when the group’s attention was drawn away from him it caused him to feel inferior and impaired, much as his father used to make him feel by belittling him—an experience his twin brother was spared! To make matters worse, his mother did not protect him enough; she spent most of her time with the twin brother, who had needed a lot of care due to illness. After his parents’ divorce, finally, his father had disappeared, leaving behind an angry letter. Thus he becomes aware of his previously unconscious identification with his father, who had not been able to talk about his feelings of humiliation but could only enact them.

Klemens rejoins the group for session 200 and brings the issue of this problematic identification with his father. In a session of great intimacy, the others reflect their difficulties in getting close to him because he rejects the group by his self-exclusion. The hate he feels for his mother because of her rejection of him was not spoken of, but I kept it in mind.

Session 204 is filled with dreams. Jana starts:

I am in a hospital in bed. A nurse is coming and covers me caringly. I feel safe and secure. Then, as it is a hospital, another nurse arrives and beds me in. She reaches under the cover and tries to take out my diaphragm, but I do not want her to.

Jana was sent to a nursery at the age of eight weeks. She lived in this Wochenkrippe in the German Democratic Republic from Monday till Saturday morning throughout her early childhood. As an adult she became an alcoholic, although at the time of the dream she had been abstinent for 17 years. She spent four years in individual psychoanalytic psychotherapy with me, ending in 2009. Her anger is located in a recurring spasm of the diaphragm, which stops her crying or shouting.

The group’s unconscious material of good and bad mother, and the splitting between these two object-representations, become apparent in Jana’s dream. We in the group are now right in the middle of her unconscious hate of her mother and her suppressed cry for love.

Norbert is one hour late. He apologizes, he just got the time wrong. Ralf asks him if the previous session was too much for him, since Norbert revealed a lot about his family history, involving Nazi persecutors, abandonment, losses, physical and sexual abuse, and psychoses. Norbert shrugs, says he does not know but would like to recount two dreams:

First: I am in a flat building with no glass in the windows. There is nothing in the room but a bed frame. I am shot from outside. I try to conceal myself but there is no hiding place.

Second: My five-year-old son is falling into the water. I cannot rescue him, feel so helpless.

Questions are raised by the group: ‘Did we attack you? . . . But we wanted to listen to you even though we had to interrupt once in a while . . . We have a bad habit of treating the member who talks first as the patient for the session—we have had this trouble before.’ The atmosphere is warm and protective, as though a child could be calmed down just by the presence of the mother.

Following Robi Friedman, two questions can be asked about this material: ‘1) what is the dreamer’s request for containment in (from?) the group; and 2) what is the influence the dreamer is seeking from (on) the audience?’ (Friedman, 2015: 52). I think Norbert requested containment of his fears of being abandoned, persecuted and unsheltered. His early helplessness as a child is shown in the second dream because it recalls how, when his mother developed paranoid schizophrenia during his childhood (he was five), she left the children unattended all day long for many months. As a consequence he had suddenly been taken to his father’s and did not see his mother again for ten years. The response he seeks from the group is to shelter him, while the influence he seeks to exert on the group is to let the others be part of the fragmentation he experiences when he becomes highly depressed and feels psychically paralysed.

At this point I retold Klemens’ dream from session 180, which Norbert had not yet heard:

I am in a room without a roof; there is nothing inside except a rotating machine gun in the middle. It revolves automatically, shooting without any rhythm. I try to escape, I run around. I am not shot but I know it will happen soon. Then I wake up.

I intervened because the group needed support in the face of these massive fears of dissolution caused by murderous aggression. As the picture that the group/conductor attacks the members was too obvious to need to be stated, I contained the negative transference of the death-bringing mother. I also connected Klemens and Norbert all the more as twins, bearing in mind the similarity of their infant histories:

Klemens’ mother did not realize until delivery she was carrying fraternal twins. Their birth was premature and the twins spent weeks in an incubator.

Norbert’s parents adopted a new-born when Norbert was ten months old. Norbert soon became severely ill with diarrhoea and had to be hospitalized for weeks.

Klemens and Norbert are transferential twins as well because both of them (and also Jana) had simultaneously been in my analytic womb during individual psychoanalytic therapy.

The twin dreams show that one main theme of the matrix is being exposed to murderous parental aggression without protection. Given that the personal histories of all the group members include severe losses and/or attachment problems during early childhood, we can assume with Morris Nitsun:

The dynamics of the group can be seen in the light of a strong latent repressed anti-group in the ‘foundation matrix’ . . . Evidence supporting this hypothesis is the social alienation and underlying rage at the family unit that was present in several participants, suggesting a shared internalized anti-group constellation. (Nitsun, 1996: 89)

The group had denied these feelings and developed a ‘false self’ of a progressive, cool, intellectual get-together, with no need for any parents. This meant that feelings of dependence on the mother were repressed, whilst in the matrix there was splitting between the hated and the idealized mother.

This phenomenon was also the group’s resistance against cohesion, located in Eva who often acted out with non-attendance or reacted somatically and in so doing refused reflection. For example, she spoke tediously about her five rescue puppies without acknowledging the other group members’ idea that she unconsciously might identify herself with her pets. Her acting-out can be understood as a malign mirroring of the group as an unempathetic mother who does not take care of her as a lost and orphaned child—in contrast to her being the self-sacrificing ‘mother’ of five puppies. Thus, she unconsciously through projective identification showed her unbearable experience of abandonment: after her father’s death she had been left utterly at her mother’s mercy. It took some time to understand this linkage (even more so because the group gave Eva a lot of leeway to discuss her puppies). As long as this resistance continued the group could not become a transitional space (Winnicott, 1969) where transformation is possible. How could the group overcome these defensive mechanisms?

In session 208 Klemens talks about his mother who was quite ill at the time. She wants medically assisted suicide but he has refused to help. He tells the group that he plans to kill himself as soon as his mother dies, thinking that the group would be shocked at first but would later accept his decision.

Katharina leaves the room for about 15 minutes, explaining that she cannot stand it. Ralf, whose father had killed himself 13 years earlier, calls this incident ‘the absolute limit for the group. You, Klemens, are asocial. You do not realize what you do to us, you are unpredictable. It hurts everybody at the core when someone commits suicide, and it never heals.’ Others call it ‘the total failure of the group’. Kristin rants at Klemens, Norbert is stunned. Only Jana keeps calm as if she has always known about Klemens’ plan. Ralf is insistent: ‘to make it clear, you will not kill yourself!’ Klemens talks about his father’s bad intentions when disappearing; Eva points out to him that if he killed himself he would be doing to the group what his father did to him. I explore Klemens’ suicidal tendencies in the group and make an anti-suicide pact with him. He confirms that his plan is not a serious intention.

As the destructive forces originating in the matrix were now very obvious in the group, the opposite of the transitional process was present. The group as an object could not yet be used, but nevertheless there was a strong demand for development. As Nitsun writes, picking up Klein’s (1975) and Winnicott’s (1948) concept of reparation:

. . . reparative wishes and actions emerge from the constellation of anxiety and guilt in the depressive position. In the case of the group, its survival in the face of disintegratory forces enhances personal responsibility for the group . . . Symbolically, the group-mother is restored as a source of nourishment and containment and there is a diminution of envious and destructive attacks, with a corresponding increase in the capacity for concern. (Nitsun, 1996: 209)

In session 214, after the Christmas break, Jana recounts a dream:

I am with my boyfriend, an old friend and my mother in a jazz club. During the performance we walk under the earth, along a river that is supposed to be Styx. I am wearing a white skirt, suddenly I am menstruating, thinking, whoops, at the age of 52? I ask my mother, she does not know anything, and my boyfriend is texting a message. We call for paramedics and they help somehow. I go to the toilet, it rattles, I lose a lot of blood, and all of a sudden there is a baby. I think, a baby at 52? Because I did not notice anything beforehand, it must be dead. But the baby is alive and coughs.

There are no associations, no resonance in the group. Jana talks about her nursery experiences again. The group is concerned with prospects for the New Year—who might finish the therapy and who will continue. Jana decides to apply for more sessions through her insurance. Ralf asks Klemens if he will continue, saying he is concerned about Klemens’ thoughts of suicide and thinks the idea is not worked through thoroughly enough. Others also want Klemens to stay because of his situation of unemployment, his mother’s illness and in particular because he has now begun to open up in the group. Eva announces she is going on a five-week trip to India.

The following night I have a countertransference dream:

There is a serial killer with a particular obsession: he only kills after he has intensively built up an intimate relationship. Next he kills those he is related to.

The death-bringing relationship and the serial killer as an utmost symbol of the anti-group were now again symbolized but there was also a connection between Jana’s dream and mine—hers restoring the group-mother (as Nitsun says), mine remaining in the paranoid-schizoid position where murderous aggression is the fundamental quality of relation.

In the sessions which follow, the group grows closer: early losses are painfully remembered; Tamara speaks about feeling cut-off and her depressive mother; Jana resonates and responds tearfully; Klemens speaks about the nearly catastrophic circumstances of his birth.

Then Norbert’s issues around the adoption of his brother come up. Klemens finds it absurd to adopt a second baby so soon after the birth of the first, while Jana idealizes the mother who breastfeeds a second child. Suddenly Klemens attacks Norbert, devalues him and Ralf, who supports Norbert as well.

The next day, Klemens leaves an answerphone message saying he has decided to end the therapy. I am very annoyed, thinking his departure will destroy the constructive work of the group. Since a worsening of his psychosis seems imminent, I call him back to offer an individual session. At the next group session, in his absence, the others discuss Klemens’ behaviour as an expression of his inability at that time to endure intimacy. They ask me to clarify the problem in an individual session with him and then carry on working fruitfully on their problems.

At his individual session Klemens tells me he had to protect himself against psychotic symptoms—feeling persecuted, assaulted and also abandoned by the group, feeling unconnected and even annihilated. Even so, he asks to rejoin the group so he can try to talk about these severe emotional disturbances.

Klemens’ psychotic reaction was caused by Norbert talking about his adopted brother at his mother’s breast. The powerful impact of this scene can be understood in terms of twins’ early psychodynamic challenges, as described by Athanassiou:

In view of the twins’ confusion . . . the one at the breast sees his alter ego filled with rage at being separated not only from the breast but also from his twin; he therefore perceives this without really knowing whether it is himself as well . . . The normal projective identification and incorporation of the mother’s breast is mixed with this parasitic element [i.e., the other twin]. (Athanassiou, 1986: 331)

Klemens’ and Norbert’s twin dreams can in this context be interpreted as expressions not only of the existential fear of being left alone, but also of the projected murderous rage against the other as a parasite at the breast—which in this instance meant all the other participants in the group.

However, Klemens’ experience of me as a mother in an intense relationship with him during the individual session won out over his projective identification, i.e. over ‘the unconscious violence of defence processes’ (Beland, 2004), against his feelings of being parasitized by the others which had also grabbed hold of me in my countertransference anger. My countertransference dream can be understood as an extreme unconscious attempt at differentiating between the diffused group members within myself and therefore within the group members themselves—maybe a sign that the group was nearing the limits of its capacity for mutual elaboration.

When Klemens returns in session 219 he remains in an emotionally distant state. Katharina, the participant who has not been able to stand his suicidal thoughts, criticizes him for acting out his feelings instead of putting them into words, whereas others try to understand why he has not been able to talk. Gradually, over the course of several weeks, Klemens engages with the group again and it becomes possible to understand his enactment of self-exclusion as a way of protecting himself from the group which he perceives as a destructive mother and/or parasitic twin. He even suggests that his self-exclusion was an attempt to shield the group from his own violent impulses, and this view helps the whole group to reintegrate early fears and experiences of fragmentation.

During the same period of several weeks Eva is regularly absent. The group resents her for her non-attendance. She apologizes but continues not to attend consistently. When she does come to the group, she resists talking about her absences, merely telling the group she is planning to move out of the apartment she shares with her sister in order to live on her own.

Referring back to the imagery of the twin dreams, through this process the group tried to create a protective bullet-proof room where attacks happen but do not lead to death because they can be contained. The group intersubjectively connected with Klemens’ psychotic experience, with the result that the early projective and splitting mechanisms, present in most of the group and used to cope with fears of separation and abandonment, could be worked through. In this way the group created its own transitional space, which meant the group could be used as a transitional object that enables transformation. Separation and individuation were no longer equivalent to death but could at last become thinkable and manageable.

It was only at this point that I regained my capability for dynamic administration in the group concerning Eva’s non-attendance. After she missed another three sessions in succession, I wrote to tell her that if she did not attend the next session I would have to end the group therapy for her. She neither answered nor came again to the group. It now became possible for the group to express anger at Eva’s attacks on the group. Until then, any show of aggression in response to Eva’s behaviour had been inhibited, and the group’s reticence can be understood as stemming from an unwillingness to risk being identified with a bad maternal object. Therefore, the group now felt sufficiently protected by the boundaries I had set to express anger more freely.

The conclusion of the transformation process being described here occurred when Klemens left the group—and finally me as his long-time psychoanalyst—for a good job in another city. His decision to leave was bewailed in the group, and worry at his being alone and unprotected far away accompanied the farewell. While the group/conductor/mother was so concerned with Klemens’ severe and dramatic issues and had nourished him so well, his transferential twin Eva had not been understood. Her enactments were an attempt to evoke empathy and she implicitly tried to contribute to the group’s main issues with her experience as an orphan. However, she was unconsciously separated and (self-)excluded from the group/mother in the confusion of the twin dynamics. For Eva, who lived in a highly ambivalent relationship with her (almost twin) sister, the impact of the twin dynamics in the group sadly may have led to a displacement onto the group of a process of separation from her real family.

Conclusion

In this group, twin phenomena functioned as catalysts in a transformation process. The twin dynamics helped the group switch between the good and bad mother while still keeping each other as primary objects, in line with the intersubjective approach described by Potthoff: ‘in group analysis we also work with multiple transference but give equal if not more importance to the new experience in the group that is enacted, worked through and internalized’ (Potthoff, 2017: 364). This was enormously helpful in dealing with the psychotic dynamics because the power of splitting and projection mechanisms could to some extent be intercepted by what can be called the twin layer in the matrix. Twins are more than singletons skilled in depending on each other: they can more easily manage fluctuating ego-boundaries and they are experienced in withstanding the other’s aggression. These qualities, which especially Klemens and Norbert brought into the group, had previously not been of benefit to themselves in solving their own psychic problems. But twin dynamics in a group are also inherently confusing and involve the danger of favouring one transferential twin and overlooking the other. Therefore an ‘extra eye’ must be turned on groups in which twin dynamics emerge because so many factors are in play. In the case of the group discussed here, when it came to the trio or triplet of Jana, Klemens and Norbert, who had all been in individual therapy with me, it had previously not turned out to be possible because of the gravity of their histories to analyse the negative mother transference sufficiently.

The transpersonal processes in this group eventually permitted mutual digestion of previously unbearable and therefore repressed real and transferential experiences. The group members were helped to strengthen their own capacities and in so doing to achieve a reduction of fear. The urge to split and project in the presence of a highly ambivalent maternal object diminished.