The psychological development of a twin: a case study of the importance of a symptom

In this paper we focus on the evaluation, assessment, diagnostic conclusions, and individual psychotherapy of a four year old twin who presented with the symptom of encopresis. Of great relevance to this boy is the literature concerning his vulnerability as a twin to develop symptomatology as he starts dealing with separation and individuation issues. Especially relevant are the multiple impacts of attitudes, perceptions and family rearing issues on the psychological development of this twin, and also on the development of this specific symptom choice--encopresis. Incorporating literature with case material, the meaning of the symptom of encopresis to this twin is discussed. The hypothesis defended is that the symptom enabled the twin to attract attention from his somewhat favoured brother, and to promote the process of separation and individuation from his parents and from his twin. It promoted his sense of himself as a separate and unique person in his own right. The child developed a sense of himself despite parental interference. With individual psychotherapy and family therapy, the need for the symptom was neglected.