How Occupational Therapists (and Other Professionals) Can Support Clients with Alexithymia

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Your Health Magazine Contributor

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How Occupational Therapists (and Other Professionals) Can Support Clients with Alexithymia

Picture this: a client sits across from you and you ask how they’re feeling. They shrug. They look at the floor. After a long pause, they say “I don’t know” and you can tell they’re not being difficult or guarded. They genuinely cannot answer the question.

If you work in occupational therapy, counseling, speech therapy, psychology, or any helping profession, you have probably met this person. What they’re experiencing may be alexithymia, a term that literally translates to “no words for emotions.” It describes a very real difficulty in identifying and describing one’s own emotional state, and it shows up far more often than most professionals realize. Research suggests roughly one in ten people experience it, and the rates climb higher among people who are neurodivergent, have lived through trauma, or carry a mental health diagnosis.

The tricky part is that alexithymia is often mistaken for disinterest, avoidance, or even defiance. A client who cannot tell you how they feel is not refusing to engage. They are missing a piece of internal information that most of us take for granted. And when we misread it, our supports miss the mark entirely.

So what can professionals actually do? Let’s get practical.

Start by Looking for the Root Cause

Here is the most important shift in thinking: alexithymia is a surface description, not an explanation. It tells you what a person struggles with, but not why.

Over the past several years, research has pointed to interoception as the underlying piece of the puzzle for many people. Interoception is our ability to notice and interpret the internal sensations inside our own bodies. A racing heart, a tight chest, butterflies in the stomach, clenched jaw muscles. These body signals are the raw data that emotions are built from. When I feel anxious, it is often because my chest feels tight and my stomach is doing somersaults. My body gives me the clues first, and my brain translates those clues into an emotional label.

Now imagine what happens when that signaling system is unclear or hard to read. The body might be screaming, but the message never arrives in a form the person can use. Without access to those body clues, emotion words like “anxious” or “excited” become abstract vocabulary with no concrete meaning attached. It is like being handed a map of a city you have never visited. The words are there, but they do not connect to anything.

This is why simply teaching emotion vocabulary, pointing at faces on a feelings chart, or asking a client to “use their words” so often falls flat. We are handing someone a label without giving them the experience the label is supposed to describe.

Support Tip 1: Regulation Comes First

Before any emotional awareness work can happen, the nervous system needs to be in a place where noticing is even possible. When a person is dysregulated, their attention narrows and their motivation to tune into an overwhelmed body drops to nearly zero. Asking a flooded nervous system to quietly observe internal sensations is asking too much.

This means inner stabilization strategies, like breathing, movement, or whatever genuinely calms that particular person, come before anything else. It also means outer stabilization. Take a hard look at the environment. Is the lighting harsh? Is the room noisy? Does the client feel safe with you? A sense of safety is not a nice-to-have in this work. It is the foundation everything else sits on.

If you find yourself repeating emotional awareness exercises week after week with no progress, the missing ingredient is often regulation, not effort.

Support Tip 2: Evoke Sensations on Purpose, and Make It Fun

Once a client is regulated, you can begin building interoceptive awareness through direct, playful experience. The key word here is playful. Nobody wants interoception practice to feel like a test they are failing.

Try evoking clear, noticeable sensations in the body and then drawing gentle attention to them. Hold an ice cube and talk about what the hands feel. Jump up and down a few times and notice what the heart is doing. Do a big stretch and describe where the body feels it. These small, concrete experiences give the body a voice before we ever ask the client to name an emotion.

Daily routines are gold mines for this work too. Washing dishes, taking a shower, petting a dog, walking outside on a cold day. Every one of these activities produces sensations worth noticing. Instead of treating body awareness as a separate exercise, weave it into the ordinary moments of a session or a day. The more natural the context, the more the learning sticks.

For professionals, this is also where our scope shines. Occupational therapy in particular is built around meaningful, real-life activity, which makes it a natural fit for this kind of embodied learning. But counselors, teachers, speech therapists, and physical therapists can all use the same principle. Experience first, language second.

Support Tip 3: Throw Out the “Right Way” to Feel

Here is something that trips up even well-meaning professionals. Many popular emotional education tools, the feelings wheels, the emotion faces, the color-coded charts, quietly teach that each emotion has one universal body signature. Happy looks like this. Angry feels like that.

But that is simply not how bodies work. One person’s anxiety feels like a racing heart. Another person’s anxiety feels like numbness or a fog. Some people feel sadness as heaviness in the chest, others as an empty stomach, others as nothing at all at first. Every person has a unique internal signaling system shaped by their own body, history, and nervous system.

When we hand a client a chart that says anger lives in clenched fists and their anger actually shows up as a hot face and a churning stomach, we have just told them their experience is wrong. That can shut down trust fast.

The better message, repeated often and out loud, is that there is no wrong way to feel. Validate whatever the client notices, even if it does not match the textbook. Their body clues are theirs alone, and our job is to help them map their own territory, not memorize someone else’s map.

Support Tip 4: Normalize the Struggle and Practice Self-Kindness

Many people with alexithymia have spent years being told they are cold, detached, or emotionally unavailable. Some have internalized deep shame about not knowing how they feel. That shame becomes its own barrier to progress, because it is hard to explore your inner world while simultaneously believing something is fundamentally wrong with you.

Professionals can counter this directly. Say it plainly: not knowing how you feel is okay, and it makes sense given how your body communicates. Remind clients that nobody is connected to all of their emotions all of the time. Emotional awareness is not an all-or-nothing achievement. It is a gradual, ongoing process of building connection, and progress often looks like small flickers of noticing rather than dramatic breakthroughs.

Modeling matters here too. When you as the practitioner name your own body sensations out loud during a session, you are teaching without lecturing.

A Few Practical Pointers for Any Setting

Keep sessions predictable and let clients know what to expect, since surprise and unpredictability can push a nervous system into defense mode. Slow down. Emotional awareness work cannot be rushed, and pushing harder usually backfires. Track tiny wins, like a client noticing a sensation for the first time, and name those wins out loud. And involve the people around the client when you can, because caregivers, partners, and teachers who understand what alexithymia really is will stop misreading the struggle as a character flaw.

The Bottom Line

Supporting a client with alexithymia is less about teaching emotion words and more about helping the body’s signals become heard, understood, and trusted. Get the nervous system regulated first. Create real, playful opportunities to notice sensations. Honor each person’s unique way of feeling. And wrap the whole process in patience and compassion, including compassion for how long it takes.

When we shift our focus from the surface label to the underlying experience, we stop asking “why won’t this client talk about their feelings” and start asking “what does this person’s body need in order to be heard.” That single shift changes everything about how our supports land, and it is often the moment real progress begins.