Do you struggle to understand or describe how you feel? 

Is it hard to understand what’s happening in your body?

Can people around you find it difficult to know your mood or needs?

 

My experience in therapy is that people tend to have very different warning systems that we are not feeling great, but society often shows a single way of doing things.

 

In films people describe ‘butterflies in their stomach’ if they are feeling anxious, being ‘warm and tingly’ if excited or having a ‘lump in their throat’ if sad or grieving, but what do these actually mean?

 

Often talking therapy is recommended when someone needs support with their mental health, but what if you can’t connect with your emotions or find it hard to describe your feelings to others?

 

For some people talking about feelings and emotions is exactly what’s needed and for others that description feels alien and like a secret language that ‘other’ people seem to have the code for. It can leave clients thinking they are getting something wrong in counselling.

Or worse, that there is something wrong with them.

 

Interestingly what might actually be happening are challenges with Interoception or people having Alexithymia.

 

What do these words mean?

These are both experiences that can be common in people who are neurodivergent, for example people with ADHD or ASC.

 

Interoception

Can be thought of as the ability to feel sensations from within your body.

Common signals include: hunger, thirst, fullness, body temperature, pain, muscle tension, and a full bladder. 

For example someone with good interoception will receive a signal from their bladder that they need to urinate and have time to find a toilet.

Others may not have such a connected system between their body and mind and miss these signals, or receive them later.

In mental health this internal system is helpful as it provides signals into our emotional health; for example, a rapid heart rate (detected through interoception) might be interpreted as fear or excitement. 

 

Alexithymia

Alexithymia is often called "emotional blindness" it can be thought of as significant difficulties in identifying, processing, and describing emotions. It is not a mental illness, instead it’s a way of being often co-occurring with autism, PTSD, or depression.

 

How can therapy work if someone struggles with interoception or thinks they may have alexithymia?

 

Firstly and most importantly in counselling is the therapist getting to know the person sat in front of them, and what they hope to gain from sessions. 

Part of getting to know someone maybe their history but also internally how their brain and body work and communicate.

The relationship between therapist and client is key, can they find a language to understand what it is like to be human for the client. Then the work may focus on how the counsellor can help the person in distress to describe their experiences without making assumptions.

 

It might be that using thoughts is better than emotions.

Could working with bodily sensations or physical behaviours be the key?

Sometimes there might not be the right words for someone to describe something, they just know it doesn’t feel right and they don’t like it.

That is fine.

 

Humans are all different, some of us have very large and varied felt emotional connections throughout their body and mind, and a wide vocabulary to describe their experiences.

Some people have really complex cognitive processes and their ways of thinking are the main way they perceive their differences of mood.

 

For others, it’s neither felt in their body or understood in the mind, instead they might impulsively behave in ways that help or are unusual for them. Providing insight through actions.

 

For example different people feeling overwhelmed might describe: a heavy ball on their chest, that their thoughts are racing, or they might not be able to talk and instead rock themselves.

 

The experience might be named ‘overwhelm’ for them all, but their communication needs to explore, understand and consider future situations may look and sound quite different in the therapy room.

 

Below are some examples of embodied emotions written by Ira Kraemer an autistic person, who describes having 4 ways to describe their feelings: content, unpleasant, annoyed, or frustrated. With annoyed and frustrated just being two different strengths of the same feeling.

 

• Anger/frustration – it’s like there’s an energy I have to get out of my vocal chords. I often want to growl. My throat gets tight from suppressing it, and I tense my jaw muscle a lot (often without realizing it until later). I often tighten/wring my hands to try to get the energy out, and my chest can sometimes feel hot, as well as my head.
• Sadness – It feels like my head is weighed down, or I’m kind of sinking down when I breathe. I’m not sure if it’s necessarily heavy breathing. I feel like a rag doll. I just let my arms kind of sit there and don’t really tighten many muscles (which is noticeable because I usually do that in baseline life).
• Restlessness – The obvious one is feeling like I need to move. I also seem to feel energetic, like wanting to do some manual task or something. Similar to being angry in terms of getting energy out of my system, but not with a tight chest or anything, and not wanting to scream. More like needing to be productive or something. I feel kind of itchy, like, none of my positions I’m sitting in are comfortable or pleasant. Nothing feels “right” but I’m not upset by anything and am not intentionally tensing anything. This also may be overlapping with motion/pain/comfort section, so maybe I haven’t worked out restlessness yet.
• Anxiety – Usually I can hear my heartbeat. Honestly this is the hardest one to describe because I’ve felt it for so long. I’m more noticing what it feels like without it. If it’s social, I’ll have something to say in my head, or repeat a thought over and over to try to get it right. I’ll often put my hands on my neck/shoulder or face. Sometimes I’ll dig my fingernails into my skin to get a distraction to reduce it if it’s really bad and also overlaps with anger or frustration. I might have sweaty palms and try to put pressure on my hands – put them under my knee or sit on them. It’s like I need to put my hands somewhere that they will sink in and be safe, where they are not just roaming around everywhere. Maybe it helps me feel grounded. I’ll feel my throat tighten up and notice saliva in my mouth a lot more. The inside of my head becomes louder (my own mouth movements/talking/breathing/heartbeat becomes louder). I tense my jaw and neck. I get tingling/butterflies when I exhale, slightly lower than where I would get the feeling of nausea.
• Nausea – Weird feeling of moving pressure right under the center of my ribs, or at the sternum. Feels like it’s near my lungs (but it’s probably my stomach). Doesn’t really cause pain. It kind of pulsates when I breathe which I really dislike.
• Hunger – I only notice hunger when it gets to the point of pain. It feels more like pain near the gut, so lower than nausea, but I can feel kind of an empty space above where the pain is, like there’s a deflated organ right there (which, there might be, cause I probably haven’t eaten that much..)

(Shared from: https://autisticscienceperson.com/2018/06/11/alexithymia-and-interoception)

 

If you have found this blog interesting or are considering therapy please get in contact:

clairecramptoncounselling@gmail.com.