There are people who feel but struggle to recognise their emotions and put them into words. They may experience bodily sensations such as tension, fatigue or tightness without being able to connect them easily with emotional states. In psychology, this condition is called alexithymia.
The term was introduced in the 1970s by the Greek psychiatrist Peter Sifneos and means the lack of words for feelings (from the privative a-, lexis = word, and thymos = emotion). From an existential perspective, emotion is not simply a psychological function; it is a way of existing and of interpreting the world. When we are not in good contact with it, it is as though we can function but without a deep sense of meaning or inner guidance. As though we were living more through roles and less through our own experience.
Before every thought, before every decision, there is already a “colouring” of experience, an emotional stance towards existence. An infant, before acquiring thought, exists as body, sensations and feelings. Emotion is not something we “add” to experience. It is a fundamental component of experience. Within this frame, alexithymia is not simply a difficulty with expression, but a form of disconnection from inner experience. It involves difficulty in recognising and verbalising feelings, limited imagination or symbolic thinking, and a tendency towards externally oriented thinking, with an emphasis on events rather than on lived experience.
An adolescent came to therapy recently with anxiety and difficulty in social relationships, particularly with connection and a sense of belonging. After a few sessions, she began to report an intense pain in her chest, which she experienced for most of the day. Once organic causes had first been ruled out by a doctor, we focused on the psychological dimension of the pain. She found it very difficult to connect any feeling with that pain. It was important that the connections came from her and that I did not bring her ready-made interpretations of my own about what she was feeling. After two sessions, as she was describing how the pain had appeared again, she mentioned that during the first hour at school she had been very busy with a test and so the pain had not come. In the following hour, with nothing else to occupy her, it appeared.
Although she herself did not dwell on this detail, I invited her to notice the difference. To stay a little longer with that point and with what it might mean for her. Although possible connections were arising in my mind — the experience of loneliness, for instance — it was important that no interpretation be imposed before she had found her own way of relating to her experience.
The therapeutic process takes time. Our role is not to speed it up or to guide it prematurely, but to create the conditions in which what is essential for the client can emerge.
The ability to recognise and express our feelings is not innate; it is cultivated within relationship. According to John Bowlby’s theory, a child learns to recognise and understand what they feel through the person caring for them. Through the gaze of an adult who can attune emotionally to them, through the mirroring and naming of their feelings, their emotional language gradually takes shape.
When this process is inadequate, contradictory or traumatic, the child will grow up with limited access to their inner experience. Seen this way, alexithymia is not a deficit of character but a way of adapting and surviving in an environment where emotion could not be recognised and tolerated.
In Gestalt psychotherapy, emotion is considered a basic element of a person’s contact with their environment. Mental health is connected with a person’s ability to come into authentic contact with their needs and their experience in the here and now. From this perspective, alexithymia can be seen as a rupture between the body that experiences and the mind that cannot recognise and symbolise that experience through words. So in the example above, the adolescent’s physical pain could be related to processes of somatisation reinforced by her difficulty in recognising her feelings.
One of the most characteristic features of alexithymia is that emotion is often expressed through the body. Physical symptoms such as muscular tension, headaches, gastrointestinal problems or chronic fatigue can be non-verbal forms of emotional expression. As Bessel van der Kolk’s work has shown, the body “keeps” experiences that have not yet been symbolised.
Within a safe therapeutic frame, a person can gradually develop an emotional vocabulary, connect with their body, learn to recognise inner states and bear experience without disconnecting from it.
The therapeutic relationship plays a decisive role in this. It functions as a new “mirror” that gives meaning to what was previously formless.
Alexithymia is not an absence of depth. It is an absence of access to it.
Beneath the apparent absence of feeling there is often a rich but unprocessed inner life. A life that has not yet found a way to be spoken.
Psychotherapy contributes to precisely this process: the gradual translation of the unspoken into something that can be experienced, said and shared within a therapeutic relationship able to recognise and hold what the past could not.
