Echoes From The Therapy Room: Alexithymia

Echoes From The Therapy Room (1) : Alexithymia

This week, I found myself returning to a familiar but often misunderstood experience: the sense of feeling something without being able to name it. In clinical terms, this is called alexithymia—not an absence of emotion, but a difficulty identifying, interpreting, and expressing internal emotional states.

What’s striking about alexithymia is how quietly it shows up. It doesn’t usually announce itself as distress. Instead, it often appears as confusion, flatness, or a sense of being “fine” while something underneath remains unresolved. People may describe events clearly but struggle to describe how those events landed inside them. The emotional signal is present, but the pathway to awareness feels interrupted.

In the therapy room, this can look like long pauses. Shrugs. Statements like “I don’t know” or “I just don’t feel much.” Not as resistance, but as honesty. This was the case for a client this week. A long pause after being able to note something was being felt but having a complete inability to reach the word for the feeling. For many, emotional language was never modeled, encouraged, or made safe. The nervous system learned to prioritize functioning over feeling. With that, sometimes taking away the naming of feelings which in itself can be a very regulating practice.

It’s important to say this plainly: alexithymia is not a failure of insight or effort. It’s often an adaptation—one that once helped someone stay oriented, protected, or connected in their environment. The difficulty comes later, when relationships, decisions, or a sense of self begin to ask for more emotional access than feels available. This difficulty can show up as anger in the room, and distance between what the client knows to be true, and what they can authentically convey.

Therapeutic work around alexithymia tends to be slow and relational. Less about digging, more about noticing. We track sensations. We stay with uncertainty. We practice naming around feelings before naming the feelings themselves. Over time, this builds tolerance for internal experience rather than forcing immediate clarity or brushing feelings off with “I don’t knows'“ and trying to move on.

What stayed with me this week is how much patience this process requires—from both sides of the room. Learning to feel isn’t about pushing harder; it’s about creating conditions where awareness can emerge safely, at its own pace.

Sometimes the most meaningful work begins not with answers, but with permission to linger in the the silence of not-knowing.

in my work I am never diagnosing, merely being curious about my perception of what might be happening in the room - this week that curiosity lead me to thoughts on an alexithymic experience.