An adult identical twin in her fifties, “Missy,” came to see me to help her resolve her contemptuous and irksome feelings toward her twin sister. Missy was ashamed of these thoughts. She had recently spent a few vacation days with her twin and was distressed that she felt so annoyed by her and could not wait for her to leave. Although they lived on different sides of the country, they had always kept in close contact with each other. At the time, they were having more frequent interactions because they were dealing with the care of their elderly mother.

Missy had never been in therapy before and made it clear from the start that she had no intention of having more than a short-term experience. She was a professional woman who had opted not to marry and felt comfortable with her choices and lifestyle. She repeatedly mentioned that she felt very loved by both of her parents. Her father had passed away several years ago. She was adamant that her childhood had been just fine. She scoffed at the idea that her present difficulties might be related to childhood experiences.

Rather than uncover past difficulties, Missy wanted me to help her get rid of her guilty intolerance toward her mother and sister. She felt despicable about expressing anger or resentment toward her mother and twin. She believed that her impatience and small-mindedness were her fault, having nothing to do with her twin’s and mother’s selfish and inconsiderate reactions. Missy wanted to be less sensitive to or reactive about the ways in which she felt dismissed and devalued by both of them.

In time we explored how she had little capacity to appreciate and manage her ambivalent feelings. In fact, her dissociated anger and hurt had tainted many other intimate relationships. Gradually she understood that being able to acknowledge negative feelings and thoughts did not make her a hateful, ungrateful person. To the contrary, Missy recognized that being able to articulate and own hostile feelings empowered her to embrace a new perspective about the personality traits of her twin and mother.

She realized how different she was from her twin, probably for the first time. Missy had not realized how their sensibilities diverged. So instead of railing against her twin’s insensitive parenting style, obsessional thinking, and chronic complaints, Missy let go of these gripes and relaxed, without self-recrimination or a belief that she was obliged to do something about these issues.

In our concluding sessions, Missy talked freely about her very close friend who had recently died. Their relationship had been authentic, reciprocal, and intimate. She could be herself in many ways, including expressing her disappointments and sadness. When Missy was able to appreciate how different she felt with her girlfriend, she felt less triggered and entangled with her twin and mother. Over time she communicated her true feelings with ease and self-acceptance.

True to her word, she ended therapy when she felt her goal had been accomplished. I was absolutely on board with her plan. A patient’s agenda in therapy should be heeded and respected first and foremost. We therapists are there to serve our client’s needs, not our own.