آلکسیتیمیا؛ یک چالش هنردرمانی: داستان ریتا

Since Sifneos in 1973 introduced the term, “alexithymia” to describe the apparent incapacity of some of his patients to discern and verbally express their emotions, without finding a physical cause for it, this phenomenon has become the object of various studies and publications. In the pursuit of effective treatment methods, art therapy has been indicated as being among the possibly effective forms of treatment. But in the literature on art therapy alexithymia up to now has scarcely received the attention the authors believe it deserves. This paper focuses on the concept of alexithymia, especially in psychotrauma, and the usefulness of art therapy. A concise review of literature on the concept of alexithymia is included and an illustration of the use of art therapy by a detailed description of treatment of a case of alexithymia in a patient, Rita, with severe self-pathology, who had grown up in a traumatizing environment. The patient was able to recognize and name emotional reactions after the treatment with art therapy, and thus, art therapy seems to be a promising form of treatment for traumatized patients suffering from alexithymia, even in cases of severe self-pathology.

In treating patients who survived concentration camps as children, we were struck by the fact that many of them were unable to verbally express their often-violent emotions. Verbal therapies are for many traumatized people insufficient, for the simple reason that they do not avail of the necessary words and concepts. It is our impression that for many patients with a history of violence, neglect, or humiliation in their early youth, the availability of words for their private emotions is remarkably limited. Can art therapy2 offer an alternative for verbal therapy in those cases? The story of Rita is an illustration hereof. Rita suffered from a disorder of the self with alexithymia as a predominant symptom, which means she could neither name nor express her emotions verbally. However, in art therapy emotions of patients like Rita who suffer from alexithymia are visible in their artwork, if sometimes only in disguise. In the patients’ drawings, the outside world has color and form; the inner world often remains empty and undifferentiated. The purpose of this article is to demonstrate a non-verbal approach (art therapy) of the treatment of alexithymia in an early-traumatized person.

This portrait of Rita's case illustrates that the inability to recognize and name emotional reactions (feelings) was a serious handicap, all the more so because the inclusive deficiency of this handicap means that an important guideline is missing when it comes to defining opinions, acting, and reacting for one's own good. With the account of the therapy process we feel we have shown that art therapy can contribute to the elimination of this handicap. Major points are, for instance, that by the way of the produced images, refinement of the diagnosis and further exploration of practical problems can be procured. Moreover, these images can be stored and, in the course of time, used as a reference point to fall back on, in order to illustrate and steer the patient's progress. The creative process and the produced images lead up to discovery and growth of the self, aided by subtly stimulating interactions with the therapist. As in many cases of alexithymia, this case also shows that treatment should start with individual therapy, because with group therapy there is the risk of having the patient involving himself or herself solely in other people's problems. As a result the patient will not get in touch with personal experience and/or exploration. It seems to be of vital importance in the therapy to allow the patient to be free (to learn) to play and fantasize and, in doing so, to learn to find the words for the gained experiences. Paradoxically, an essentially non-verbal approach seems to be helpful to provide the patient suffering from alexithymia with the words and concepts that are needed to be better equipped to face life.