Unique solutions for unique individuals.
As a therapist who specializes in autism, ADHD, and OCD (and has lived experience) I feel pretty strongly about how we approach treatment for people who experience alexithymia.
Alexithymia refers to difficulty identifying, understanding, and expressing emotions. It's particularly common among autistic people and can also occur in people with ADHD, PTSD, and other mental health conditions. (https://pubmed.ncbi.nlm.nih.gov/30399531/)
What if the Goal Wasn't to Be More "Normal"?
Many traditional approaches to therapy focus on helping people move closer to what is considered typical or normal…(p.s. a lot of new therapy models are are much much more client centered, YAYYY!)
When it comes to emotions, this can look like teaching someone to identify their feelings, name them, communicate them, and express them in ways that other people recognize and understand.
And while these skills can absolutely be helpful, I think we're missing something important when we assume that the goal should always be to move someone closer to the norm.
What if, instead, we focused on helping people move closer to what makes sense for THEM?
When I'm working with someone who experiences alexithymia, I want to understand how their brain naturally works.
What interests them? What excites them? What do they value? How do they process information? How do they recognize that something is wrong, even when they can't identify the emotion behind it?
Maybe identifying emotions through physical sensations makes more sense than using an emotion wheel.
Maybe they need to talk through an experience logically before they can understand how they feel about it.
Maybe writing, movement, music, or connecting emotions to specific experiences works better than sitting across from someone and answering, "How does that make you feel?"
And maybe sometimes, they genuinely don't know how they feel.
That's okay, too.
I want to work WITH someone's brain, not against it.
Can We Have a Little Fun With This?
This is something I wish more providers would consider.
Not every therapeutic intervention needs to feel like an assignment.
Not every emotional experience needs to be processed through a traditional feelings chart.
And not every person needs to develop the same relationship with their emotions.
I want to know what makes someone curious, what they enjoy, what naturally captures their attention.
If someone loves patterns →let's explore patterns in their emotional experiences.
If they connect through music → let's use music.
If they love data → maybe tracking physical sensations, energy levels, or emotional responses over time makes more sense.
If humor helps them approach something uncomfortable →let's make room for humor.
Therapy can be creative. It can be collaborative. And yes, sometimes it can even be fun.
Unique Solutions for Unique Individuals
If you're a provider working with alexithymic clients, I hope you'll approach their experiences with curiosity rather than assumptions about what emotional functioning should look like.
If you love someone who experiences alexithymia, I hope you'll take time to understand how they experience and communicate emotions, even when those experiences look different from your own.
And if you're someone who experiences alexithymia, I hope you find people who are willing to understand you.
I hope you find providers who work with your brain instead of constantly trying to change it.
I hope you develop strategies that feel natural, useful, and meaningful to you.
And I hope you get to have a little fun figuring those things out.
You don't need to become someone else's version of "normal" to have meaningful relationships, understand yourself, or live a fulfilling life.
Adrienne Marcellus-Altman is a therapist specializing in autism, ADHD, and OCD, providing neurodivergent-affirming assessment, education, and clinical support.
