Chapter 2 60 or psychological defense. Assessment of such mechanisms in individual diagnostics would represent a major step forward in providing personalized treatment. As the third era of alexithymia research has only just begun, appropriate diagnostic tools to assess these mechanisms remain to be developed. 5.2. Some treatment guidelines Alexithymia is still regarded by many as a personal trait that is hardly amenable to treatment. Therapists have often described alexithymic patients as ‘therapy resistant’, due to their ‘unwillingness’ to reflect on emotionally relevant situations. The quality of the therapeutic relationship often suffers from the alexithymic patient’s inability to express positive emotions within therapy. As a result, therapists may experience the therapeutic relationship with these patients as more negative than with non-alexithymic patients. Therapists also tend to overlook therapeutic progress, especially in the early stages [114]. With contemporary knowledge, it should be clear that nominal progress in traditional forms of psychotherapy it is not a result of the patient’s resistance. More likely, progress is impeded by a lack of a common language that the therapist and patient might use to talk about emotions. Without realizing the immensity of the differences between them, the ‘expert’ on emotional awareness (i.e., the therapist) starts a conversation with an absolute ‘novice’ (i.e., the patient). Metaphorically speaking, it is as if two very different wine tasters meet up in a tasting room: one is an oenophile, the other a person who is about to drink his very first glass of wine ever. As an expert in the field of wines, the oenophile will be able to discern many specifications, elements and dimensions of the wine that he is tasting and, in turn, describe these subtleties. Needless to say, he will not only be describing what he tastes, he will also be experiencing it. As an expert, he will soon be talking about structure, different fruits, wood ripening, depth, finish, tannins, etc. A novice, however, will probably not derive much more out of his experience than noting the taste of alcohol, that the wine is sour or sweet to the tongue, and whether or not he likes it [45]. To begin a mutual conversation about the topic at hand, the expert needs to tune in to the level of experience of the novice. In therapy, the therapist can do this by fine-tuning his interventions to the patient’s level of emotional perception [44, 114]. In alexithymia, particularly in the case of ‘agnosia’, this requires the therapist to first focus on the physical reactions of the individual and the changes thereof [8, 32, 46, 59, 100, 114-122]. Being able to observe and identify the physical aspects of emotions are prerequisites for the eventual perception of the patient’s feelings and thus comprise the essential elements of therapy for alexithymic individuals. As stated by Taylor et al. [123]: “The therapeutic approach for alexithymia patients attempts to elevate emotions from the level of perceptually bound experience (a world of
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