Social Workers as Advocates for Enlightened Twin Counseling



By Joan A. Friedman, PhD

For my social work field education in graduate school, I worked at community mental health centers that served Latino populations. These experiences helped me appreciate how social workers, more than any other helping professionals, are educated to be sensitive to cultural and societal differences. Since the birth rate of twins essentially doubled over the last 30 to 40 years, social workers will benefit from familiarizing themselves with the psychological issues common to this subgroup of the population. Contrary to public opinion, not all twins are best friends, lifelong soul mates, or telepathic communicators. Rather than viewing twins through antiquated stereotypes, social workers need to be advocates for a more enlightened approach.

When I began my research on the psychology of twinship over 30 years ago, most of the literature was written in a style inaccessible to the nonacademic reader, and many psychotherapists focused on extreme abnormalities among twins. Understanding the role that twinship can play in causing serious emotional dysfunction is certainly important; however, the extreme case studies in my research did not mirror the issues that I struggled with in my own twinship and that I knew other twins grappled with as well.

The lack of published analyses of common twinship issues motivated me to write The Same but Different, a book for adult twins. I wanted to offer adult twins the opportunity to learn about the expectable—rather than the extreme— developmental issues that often arise as a consequence of being a twin, and I wanted to explain the positive and negative impacts that a twinship can have on one’s emotional health, relationships, and sense of self. As my therapy practice grew and an increasing number of twins contacted me for help with their twinship problems, I realized that many of my clients had experienced difficulties with previous therapists who were unfamiliar with twin psychology. In fact, a number of clients related how past therapists misunderstood their twinship issues and inaccurately characterized what it meant to be a twin.

In light of the many roles that social workers occupy, they are very likely to interact with clients who are twins. For example, if a medical social worker counsels a child patient who is a twin, recognizing that the twin will need to see his sibling is vital. The social worker may surmise that the twins have never been separated. Thus, providing them the opportunity to see one another is essential to each child’s well-being and minimizes the trauma of the separation and the hospitalization.

Similar circumstances may arise when twins are separated in school. Parents often bring their twins to kindergarten without realizing that their local school district mandates that twins be placed in different classrooms. Lack of adequate preparation for this transition traumatizes many twins. Practitioners who understand twins’ developmental histories can help manage the behavioral problems that might erupt because of the disruption to the twin bond.

Another commonplace scenario occurs when a social worker counsels a new mother of twins. Most people are surprised to learn how isolated and overwhelmed mothers of twins feel when coping with two babies at one time. Moreover, if the infants were premature and came home with complicated medical issues to manage, their mother may have a higher risk of postpartum depression.

Finally, if a social work clinician treats an adult twin whose sibling has passed away, she must realize that this sibling loss is like no other. Individuals who lose their twin often feel as if a part of themselves has died. The grief and mourning processes for a twin are distinct from those for a different-age sibling.

These scenarios represent social work roles with a specific population. Giving voice to issues common to twins is a valuable treatment goal.

Dr. Joan Friedman is an identical twin, a mother of twins, and a longtime therapist to twins. Learn more about Dr. Friedman at