Karen Woodall – Psychotherapist, Writer, Researcher, Trainer

17 responses to “Self Alienation: The Underlying Trauma for Children Who Align and Reject”

1. Bob Rijs

   April 1, 2023 at 10:59 pm

   It’s all about the (unconscious) implicit knowledge and memory system.

   Since there are 365 days in a year:

   10 years = 3650
   20 years = 7300
   40 years = 10950

   Every day is a life lesson when surviving there is no room to develop freely to get to know and understand yourself and others.

   In an unsafe living environment, the implicit knowledge and memory system learns & develops survival mechanisms.

   In a safe living environment, the implicit knowledge and memory system learns & develops to mentalize.

   Dyscivilization and dysmentalization
   The Derailment of the Civilizing Process from a Psychoanalytic Perspective by Wouter Gomperts

   Mentalizing ability and attachment quality:

   One of the peculiarities of man is the innate disposition to think about the human mind. Not only do all kinds of inner states occur in people, they are in principle also aware of them and can think about them. People are able to “think of themselves as thinkers” (James 1890, p. 296). However, people are not born with that psychic doubling.

   The initial impetus for the development of an internal representation of inner states of self and others is localized in the affective resonance of the infant and its primary caregiver during the first months of life. At eight months, the baby seems to be able to sense and adapt to the parent’s mood. Understanding of other people’s intentions becomes visible in the cooperative play of a toddler of over a year old. A three- or four-year-old child can exclude a third person from a secret, and a six-year-old child is able to think about what another thinks about what a third person thinks, and is therefore also able to think about what a other thinks about what he thinks. This creates an awareness that different viewpoints are possible in all kinds of situations, that is, an awareness of subjectivity arises. Around the age of 12, the child is aware of the existence and function of unconscious processes, such as the tendency to disguise what is intolerable to oneself (Chandler et al. 1978). An internal psychic reality has emerged that is not a copy of the external reality or the reality of others.

   The ability to perceive and understand oneself and others in terms of inner states is an important common area of ​​focus of cognitive psychology and psychoanalysis. Premack and Woodruff (1978) state that the child has developed a theory of mind around the second year and wonder to what extent the human mind differs from the chimpanzee mentality in that possibility. In cognitive psychology, the emergence of a theory of mind is understood from a genetically determined developmental program whose implementation is directed by the interaction between biological maturation and cognitive learning processes. In psychoanalysis and, in conjunction with it, psychological attachment theory (Bowlby 1973), the onset of mentalizing is localized in the first four to six years of life. Mentalizing develops in primary attachment relationships, and inter-individual differences in the degree of mentalizing capacity have been associated with differences in attachment quality (Main 1995).

   Mentalizing controls psychological and social functioning more or less automatically and unnoticed. It is not something people do consciously, and so it is different from self-reflection or introspection. Mentalizing is an unconscious process, but not in the sense of being repressed. Such an unconscious, autonomous, reflexive procedure is stored in the implicit knowledge and memory system.

   Implicit relational, emotional and cognitive knowledge:

   Cognitive neuroscience distinguishes between two long-term memory systems that have different locations in the brain: the explicit or declarative system and the implicit or non-declarative system (Tulving and Shacter 1990, Squire 1987, Cohen and Eichenbaum 1993; cf. also Kandel 1999, Ladan 1999, Deben-Mager 1999).

   The explicit memory system is concerned with the storage, in terms of symbols, images and language, of facts and events and also relates to the life story. In principle, the knowledge stored in this part of the memory is consciously accessible. The explicit memory system uses brain structures that have not matured sufficiently until the third or fourth year of life. Hence there are no explicit memories of the first years of life. The knowledge stored in this part of the memory can in principle be retrieved, although that does not mean that the memories are an exact reflection of the events to which they refer. First, memories can fade over time.

   Second, they may have been manipulated and distorted under the pressure of psychological and social interests at play at the time of storage or at the time of retrieval. The term ‘unconscious’ is appropriate here, as Freud used that term to indicate what is repressed in a psychic interplay of forces (‘dynamic unconscious’). Repression is only possible if it concerns information that is stored in the explicit memory system (Fonagy 1999). This involves eliminating and keeping away problematic information with the aim of reducing negative affect and/or maintaining or increasing positive affect. In the context of a genocidal state campaign, this classic defense model can apply to the majority of civilians who do not belong to the group killed off, who do not actively participate in the barbarism themselves, but who do not oppose it either.

   The implicit memory system is located in evolutionarily older brain structures than the explicit memory system. These brain structures also exist, for example, in the reptilian brain, and are already well-developed in humans at birth (Pally 1997). Implicit memory stores information related to automatically performed skills and procedures, such as walking, cycling, swimming, and driving, but also, and this is important here, basic ways of seeing the world and how one perceives it. regarding self and others. Following Stern et al. (1998), one can speak of ‘implicit relational knowledge’ and, by analogy, of implicit cognitive knowledge and implicit emotional knowledge. With regard to the knowledge stored in the implicit memory, the term ‘unconscious’ applies, but not to indicate what has been averted. It is about non-conscious knowing, which automatically directs actions, just as grammar rules organize the use of the native language (“procedural unconscious”).

   The events and experiences that lead to the emergence of basic implicit relational, emotional, and cognitive knowledge occur largely too early to be remembered explicitly (the first three years of life). Knowledge stored in implicit memory cannot be remembered as an autobiographical life story. What does happen is that it is given concrete action (Clyman 1991). Knowledge stored in implicit memory is probably indelible (LeDoux 1996) and thus forms a continuous factor in the organization of psychological, social and moral functioning. Awareness of the behavioral consequences of tacit knowledge can occur when attention is systematically directed to it, for example in psychoanalysis (Stern 1994, Fonagy 1999).

   Psychological attachment theory and psychoanalytic object-relationship theory emphasize that the interaction between primary caregiver(s) and the infant/toddler forms implicit working models (inner schemas, internal representations) of the self, the other, the interaction between self and other, and thus of a relationship (Bowlby 1973, Sroufe et al. 1999). This implicit relational, affective and cognitive knowing (which autobiographical memory does not explain) lays the foundation for dealing with oneself and others in later situations, including one’s own children.

   A specification of that tacit knowledge is indicated by the concept of ‘attachment quality’. Secure attachment experiences generate an implicit capacity for well-being and basic trust in self, others and relationships, insecure attachment experiences an implicit basic attitude of fear and distrust.

   Empirical research has identified differences in attachment quality in small children through systematic behavioral observation, and in adults based on coherence in the semi-structured Attachment Biographical Interview (Adult Attachment Interview; George et al. 1985). Between parents and their children, an important degree of agreement is found in a categorical classification of attachment quality. This also appears to be the case if the attachment quality of the parent(s) was established before the child was born (for an overview, see Main 1993). In adults, the degree of mentalizing capacity can also be operationalized on the basis of the Attachment Biographical Interview. The parent’s mentalizing capacity appears to be an important predictor of the child’s attachment security. This is also the case if the parent’s mentalizing capacity is determined before the child is born (for a review see Fonagy 1993). In addition, traumatized parents who possess mentalizing abilities are significantly more likely to have securely attached children than traumatized parents who do not possess mentalizing abilities (Fonagy et al. 1994).

   The mentalizing capacity of the parent(s) determines the development of attachment security and mentalizing capacity in the child. It appears to be a critical factor in psychological protection against transgenerational traumatization.

   In connection with the above research results, the assumption is plausible that secure attachment and mentalizing capacity develop in an intersubjective process during a critical developmental period. During that period, at least one primary caregiver should be sufficiently able to experience and approach the child as a psychic unit, that is, to see and understand the child in terms of its inner states (impulses, needs, feelings, motives, conflicts, etc.) and to convey this in the (body) language that the child understands. When the parent responds “good enough” (Winnicott 1967) to the child’s physical, motivational, and emotional states of mind in a mentalizing way, the child gradually comes to experience that his states of mind exist in the thoughts and feelings of the caregiver. Of particular interest would be the infant/toddler’s experiences with the caregiver’s reactions following pain, fear, and distress. As the child internalizes that the parent notices, recognizes, understands, and regulates his inner states, an awareness of his own motivational and emotional states and those of others gradually emerges. Thus mentalizing capacity arises in the child.

   The child will therefore experience that his own inner states can match or differ from those of others. In addition, he develops the ability to receive his inner states himself, and thus not to be overwhelmed by them or to have to react to them immediately. Basic security and the first principles of self-awareness, self-control and social awareness, therefore, arise in this model from a necessary minimum of sensitivity in the primary interaction.

   https://www.tijdschriftvoorpsychoanalyse.nl/inhoud/tijdschrift_artikel/PA-2000-4-1/Dyscivilisatie-en-dysmentalisatie

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2. Bob Rijs

   April 1, 2023 at 11:06 pm

   Dyscivilization and dysmentalization
   The Derailment of the Civilizing Process from a Psychoanalytic Perspective by Wouter Gomperts

   Insecure attachment, dysmentalization and dyscivilized behavior:

   Secure attachment representations and mentalizing capacity arise in the interaction with the primary caregiver(s) during the period when the child is still largely dependent on the implicit memory system. Early negative developmental factors, without adequate mentalizing by the primary caregiver to some extent, can stagnate the development of secure attachment representations and mentalizing capacity (Fonagy and Moran 1991). Such a developmental defect stems from the period too early for conscious memory and predisposes to severe personality pathology.

   Such development may result from natural disasters or social disasters during early childhood against which the primary caregiver does not provide protection and/or abandonment due to or prolonged separation from the primary caregiver, for example due to physical or psychiatric illness or death. Traumatization may also be transgenerational, for example because the primary carer has been traumatized by natural, social or domestic violence to such an extent that he, as a result, poses a threat to the physical and psychological integrity of the child. Insecure attachment and a dysmentalizing developmental defect may also be caused by chronic infant/toddler frustration due to an extreme lack of coordination in the relationship with the primary caregiver.

   Such a lack may stem from constitutional factors such as major temperamental differences or prenatal or perinatal influences. Babies differ in temperament such as in sensitivity to stimuli (Kagan 1989). An environment that offers insufficient safety can have an extra negative effect on a difficult child who is prone to overstimulation and aggression (Sroufe et al. 1990).

   In the absence of external physical and psychological protection against extreme cruelty, chaos, or deprivation, and the development of self-defense processes, the only way for the very young child to avoid traumatic overwhelm is to inhibit the development of the process of intolerable affect. emergence and recognition. When the child is a little older and intolerable inner states (observations, feelings, thoughts) are more concrete, forming an internal representation of those inner states will also lead to intolerable inner states. So is the child’s internal representation of the inner states of those who cause (or do not protect against) the trauma. By turning away from the other person and not thinking about the other person’s inner states, and thus not acquiring an internal idea of ​​the other person, the intolerable confrontation with, for example, the other person’s hatred, cruelty, sadism is also reduced. avoided. The experience and anticipation of unbearable psychic pain thus inhibits the development of the implicit capacity to internally represent inner states of oneself and others and to see and understand people’s actions in terms of inner states. The development of mentalizing capacity becomes blocked, for the intolerable affect that mentalizing produces has made it its own enemy. Thus, while in an extremely traumatic childhood the destruction of mentalizing potential is an adaptive response, psychological development turns on itself, like a psychological autoimmune response. This has far-reaching consequences for the continuity and coherence of self-esteem, social and moral awareness, and affect and impulse regulation.

   The infant/toddler/preschooler responds with drastic self-protection and survival measures to the overpowering and unbearable fear that an extremely unpredictable, hostile, cruel, neglectful outside world can bring about. Extremely neglected and abused children avoid inner states in themselves and others because those states are intensely threatening. In the development of the self and the relationship to the other, three lines can often be distinguished that are functional in the short term, but pathological in the long term (at least according to the norms of a civilized society). In the absence of mentalizing, a disjointed self emerges, which is maintained, if possible, by a total disengagement from others, extreme mock adaptation to, and/or intense hatred of others. The self structure and expression can become isomorphic with non-relational mock adaptation and aggression. Current resentment is then often the trigger of unbridled violence. The combination of young, strong and social discontent can be life-threatening. The kind of destructiveness at issue here can be distinguished from sadism, for pleasure in the victim’s suffering presupposes the capacity for inner representation of his emotional state. Fonagy et al. (1993) speak of ‘mindless aggression’ in this context and see this as the psychological basis of ‘senseless violence’. Senseless violence occurs on different scales in time and place. In civilized societies, relatively isolated incidents evoke social panic. In dyscivilized societies, mass senseless violence is incorporated into a genocidal state campaign carried out in relative social silence.

   Dysmentalization as a psychological developmental defect may go some way to explaining why the genocidal perpetrator can just hang his torture suit on the coat rack after a busy day at work, as if nothing had happened, and why, when times and circumstances change, he can wear that same suit again in no time. the boy takes. Thinking about one’s own and other people’s inner states need not be resisted. It is not there, it has not developed. The concept of dysmentalization makes the effortless borderline between the decivilized and civilized domains of behavior less incomprehensible. Without an internal representation of inner states, the feeling, doing and thinking of oneself and other people is given meaning only in a limited sense. It is seen and understood almost exclusively in terms of the physical, material, non-psychological sense of reality that is rudimentary from birth, and already present in a complex form by the six-month-old (Stern 1985). In the absence of the capacity to appreciate the subjectivity of feelings and beliefs, a sense or belief of threat refers only to objective danger that is immediately acted upon. In the absence of an inner representation of inner states, there is no capacity for identification with the other and thus no sympathy and concern for the other.

   Relationships with others are dictated by immediate gratification and/or external demands and command. A relationship with another as he really is is beyond the psychological possibilities. Without an inner representation of affects and impulses, self-control is determined by external control or convention, and without an internal theory of pain, an inner brake on cruelty is lacking. If self and others cannot be thought of in terms of inner states, shame and guilt are not an issue. In the absence of the capacity to imagine inner states, the perpetrator’s inner representation of the victim’s inner world lacks thoughts and feelings, and hence the latter’s awareness of suffering. Without some coherent and stable internal representation of inner states, inner conflicts do not exist and contradictions in feelings, thoughts and actions are not given meaning. This applies, for example, to dealing with children, but also to dealing with dogs: early in the morning and late at night, the beloved dog is an instrument of self-love, and during the day and at work, the agitated dog is an instrument of hatred for others. . Depending on the context in which one finds oneself, there are extreme differences in behavior. Life is divided into mutually isolated sectors that are divided according to black and white contrasts. Such a ‘compartmentalization of the mind’ (Kernberg 1966) is referred to in psychoanalysis by the concept of ‘cleavage’. However, as far as an imperfect integration process is concerned, that is an unfortunate term, because there was no unity in the inner representations that was too unbearable to persist and therefore split up. After all, that unity did not exist (Hummeleni997).

   Without the possibility of psychological unity, different spheres of existence can be effortlessly separated from each other. Without an inner struggle, the decivilized and civilized domains of behavior can effortlessly coexist for the torturer. Under the conditions of a dyscivilized society, a dysmentalizing mind is eminently functional to fulfill the role of genocidal executor.

   The claim here, of course, is not that everyone who lacks mentalizing capacity will develop into genocidal performers. The assumption is more limited: dysmentalization is a predisposing factor that can lead to such a development under the conditions of a dyscivilized society. This is not to say that every mass murderer has a dysmentalizing mind. Surely there will be those who do have mentalizing abilities. A dysmentalizing mind, however, has an advantage when it comes to selection for a place in the genocidal workplace. The hypothesis that the genocidal performer approaches zero on the continuum from more to less mentalizing capacity can in principle be tested in (imprisoned) genocidal killers.

   There are war criminals whose diaries or autobiographical notes have survived. Within the framework of the Nuremberg Tribunal, a number of top Nazis were interviewed by prison psychiatrists (including the later psychoanalyst Leonard Rosengarten) and psychologically tested. Such material may lend itself to establishing experimentally something about the psychological functioning of such people (for a critical review see Borofsky and Brand 1980). In a casuistic interlude I explore this possibility within the theoretical premises of this article.

   https://www.tijdschriftvoorpsychoanalyse.nl/inhoud/tijdschrift_artikel/PA-2000-4-1/Dyscivilisatie-en-dysmentalisatie

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3. Sharon

   April 1, 2023 at 11:27 pm

   As always Karen, your wisdom illuminates the many unrecognized and misunderstood truths of the alienated child, and how easily it is as the targeted parent to unintentionally do or say the wrong thing. I’m writing a few of your pearls on cards and posting them in my home to remind myself to nurture and support my daughter’s true self. Thank you.

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4. CJ

   April 2, 2023 at 7:59 am

   Karen, a plea for help. My wonderful intelligent children two weeks ago made emotional abuse disclosures to social services against me (this was after a disagreement via text between my partner and their father- the children stayed with him for the weekend and then made full detailed statements using adult words), they will not see or speak to me. Their father abused and kept for captive for almost 10 years, we could see he was beginning to become a god for them after their every-other weekend visits, he could do nothing wrong, the children would get highly emotional if any slight suggestion was made that something he did could have been done differently- like discussing our relationship with them.
   None of what the children have said is true, I’m a registered medical professional, I work with children and lead safeguarding myself! Now their father has complete control over them, they do not want to see their sibling, grandparents, anyone of the life they have know for the last 11/13 years!

   He has changed their GP, will not take them to the dentist, or engage with any offered therapies.

   Child services will not listen, they have said they will not investigate him as he is acting protectively. I believe they think this is all new but I have shown evidence from solicitors I have been worried about this for years. We have started an emergency court order but I can not escape the pain and fear for what they are being told. Everything is hidden being their feelings and wishes, without any consideration they are being mg manipulated.

   I have offered therapy for them, to have someone else to talk to, as I believe they see their social worker and school as on their fathers ‘side’. The enormous pressure of having told these things to the school and child services can’t be easy either.

   What else can I do? I am feeling very low, I have reached out to various agencies but no one can help.

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   1. karenwoodall

      April 2, 2023 at 4:34 pm

      I am so sorry to hear this, if you would like to email me at karen@karenwoodall.blog, I will try to help you. Kind Regards Karen

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5. Bob Rijs

   April 8, 2023 at 12:23 pm

   OMG, I read

   Duet for life: Is alexithymia a keynote in couples’ empathy, emotional connection, relationship dissatisfaction, and therapy outcomes?

   Pamela D. McNeill
   Edith Cowan University

   This can make every High-Conflict Divorce a Criminal Investigation.

   Extreme Emotional Inner Conflicts (in combination with Projective Identification)

   Cognitive Distortions
   Hostile Attribution Base
   Immature Defense Mechanism
   Primitive Defense Mechanism
   Psychotic Defense Mechanism

   Alexithymia Definition
   The defining characteristics of alexithymia were formulated by Nemiah et al. (1976), which provided a basis from which investigation could take place. Alexithymia is currently viewed as a multifaceted construct, and is defined as “(i) difficulty identifying feelings and distinguishing between feelings and physical sensations of emotional arousal; (ii) difficulty describing feelings to other people; (iii) constricted imaginal processes, as evidenced by a paucity of fantasies; and (iv) a stimulus-bound, externally oriented cognitive style” (Bagby & Taylor, 1997a, p. 29).

   It is important to note that alexithymia is not considered a free-standing diagnostic condition that should be listed in any psychiatric diagnostic manual of mental disorders (Swiller, 1988). Rather, the term and definition provide a way of communicating a set of “thinking, feeling, and relating processes which can exist in people with a wide variety of psychiatric diagnoses” (Swiller, 1988, p. 48), medical illnesses, psychological conditions, and in the non-clinical general population (Taylor et al., 1997b; Taylor & Bagby, 2000, 2013).

   Aetiology of Alexithymia
   There is both theoretical and clinical value in knowing the aetiology of alexithymia, and as Krystal (1988) stated, “the question of what to do about alexithymia depends on what we think it is and in regard to this question there is quite a bit of diversity” (p. 256). To date, no single cause of alexithymia has been established, which is congruent with the multifaceted and dimensional nature of the construct. In this, it would seem that the aetiology is multifactorial and involves interactions between genetic and environmental influences (Taylor & Bagby, 2013).

   Early distinctions were made between primary alexithymia, which is proposed to include genetic and dispositional factors, and secondary alexithymia, involving developmental experiences, and/or transitory, chronic, or traumatic events (Nemiah, 1977; Nemiah et al., 1976; Sifneos, 1983). Krystal (1988) suggested that alexithymia represents an arrest in emotional development due to childhood experiences, or regression during adolescence or adulthood resulting from psychic trauma. The early views of the influence of traumatic events are consistent with findings of large effect sizes associating conditions such as Posttraumatic Stress Disorder (PTSD) with alexithymia (Frewen, Dozois, Neufeld, & Lanius, 2008). Other researchers have proposed that socialisation processes have a role in the origins of alexithymia (Lindholm, Lehtinen, Hyyppa, & Puuka, 1990).

   Studies with twins have strengthened the views suggesting genetic and environmental components underlying alexithymia. Comparisons between monozygotic (identical) and dizygotic (fraternal) twins have shown a strong genetic effect of alexithymia (Heiberg & Heiberg, 1977). In a large sample of Danish twin pairs, 30 to 33 percent of the variance in TAS-20 scores was attributable to genetic factors, with environmental factors accounting for the balance (Jorgensen, Zachariae, Skytthe, & Kyvik, 2007). Similarly, in a study with Italian twins, after controlling for depression, 33 percent was accounted for by genetic factors and the balance accounted for by developmental indices (Picardi et al., 2011).

   However, as Fonagy, Gergely, Jurist, and Target (2002) suggested, developmental influences are not created by the environment per se. Rather, their creation occurs through an interaction between these factors and the way in which children experience and interpret the events that occur.

   The role of developmental influences in the aetiology of alexithymia has been supported based on associations with emotional deficiencies in parents, and in the family environment. From the age of two and a half to three years, children begin to learn what to do with the emotions they experience, and the learning process establishes the foundation for the emotional and cognitive representations of their reality (Lewis, 1989). Alexithymic tendencies in parents will seriously limit their capacity to provide children with the adaptive emotional learning that is necessary for development and growth (Firestone & Catlett, 1989), and this will influence how children learn to regulate emotion and its expression (Lewis, 1989; Taylor & Bagby, 2000).

   Lumley, Mader, Gramzow, and Papineau (1996) found that the alexithymia scores of mothers correlated significantly and positively with their offspring’s TAS-20 total score and each of the three factors, with no differences found between mother/son or mother/daughter combinations. Within the family environment, Lumley et al. (1996) also found that in males, a perception of emotionally dysfunctional parental over- or under-involvement correlated positively with the TAS-20 total score, difficulty identifying feelings and difficulty describing feelings. For females, a lack of family rules/guidelines for behaviour correlated positively with the TAS-20 total score and externally-oriented thinking.

   Furthermore, Mallinckrodt et al. (1998) found that parent-child role-reversal in terms of exposure to inappropriate parent-child coalitions correlated positively with the TAS factor difficulty identifying feelings. Somewhat similarly to Lumley et al. (1996) and their findings for males, Kooiman, Spinhoven, Trijsburg, and Rooijmans (1998) found maternal care to be inversely associated with difficulty identifying feelings and that paternal overprotection was positively associated with the TAS-20 total score.

   Another area within the family of origin to show associations with alexithymia is that of emotional expression and communication difficulties. Findings have indicated that the development of high alexithymia is associated with an emotionally inexpressive family atmosphere (Yelsma, Hovestadt, Anderson, & Nilsson, 2000), family members’ lack of expression to each other of opinions and feelings (Kench & Irwin, 2000), a decreased level of positive communication, and feeling emotionally unsafe (Berenbaum & James, 1994).

   In addition, a study of adults’ own expressiveness within their current families found positive expressiveness to be inversely related to difficulty describing feelings and externally oriented thinking, and negative expressiveness to be positively correlated with difficulty identifying feelings (Yelsma, Hovestadt, Nilsson, & Paul, 1998). These associations are important given findings that, compared to individuals with low alexithymia, those with high alexithymia have significantly higher scores on negative affects, and lower scores on positive affects (Parker & Taylor, 1997b), thus leading to a possible propensity for less positive expressiveness and greater negative expressiveness.

   Linehan (1993) considered the role of what she terms ‘invalidating environments’ relating to lack of emotional expressiveness. Within such environments, painful experiences of the child are trivialised, punished through physical, sexual, or psychological means such as criticism, attributed to negative characteristics within the child, or reinforced erratically. The child learns that whilst moderate expression of emotion will fail to be validated, extreme emotional expression often brings a response. Through this kind of learning, “the family shapes an emotional expression style that vacillates between extreme inhibition and extreme disinhibition” (Linehan, 1993, p. 3).

   Moreover, the child can fail to learn how to tolerate distress, and accurately label, modulate, or trust his or her emotional responses as being valid interpretations of experiences. When children cannot trust their own interpretations of events, they can become dependent on others to provide cues about how to feel and act. With emotional expression as a form of communication being effectively cut off, there can be a disruption in the ability to adaptively cognitively organise, redirect, or control behaviour in response to strong feelings.

   Continual inhibition of emotional expression may lead to a sense of numbness and feelings of emptiness, and the seeking of relief through maladaptive behaviour strategies (Linehan, 1993). Indeed, young adults who report deficiencies in family of origin emotional expressiveness appear to have difficulties with experiencing and expressing emotions (Yelsma et al., 2000).

   The socialisation process is also considered to play a role in the development of alexithymia, which is related to consistent evidence that males have higher alexithymia than females (e.g., Taylor et al., 1997b). Evidence has suggested that boys and girls are socialised differently in terms of their emotional expressiveness (Brody, 1997) through different culturally determined gender roles, display rules (Malatesta & Culver, 1993), and persistent socialised stereotypes that may act as self-fulfilling prophesies (Brody, 1997).

   Although developmental and socialisation influences undoubtedly play a part in alexithymia, studies have found that gender differences in sensitivity to internal or external states are observable in very young children. For example, evidence has indicated that in infants, girls are more sensitive to their own, and others’, internal states than boys, and, compared to girls, boys have more difficulty regulating and controlling internal negative emotions (Zahn-Waxler, Crick, Shirtcliff, & Woods, 2006). This gender difference was supported by Watson, Futo, Fonagy, and Gergely (2011) who tested 12-month old infants and found that compared to boys, girls showed significantly greater sensitivity to internal cues, suggesting that from as early as one year of age, girls are more attuned to internal experiences than are boys. This may indicate that babies are born with a genetically predisposed sensitivity toward focusing on internal and/or external experiences, and that different developmental and socialisation experiences influence the salience of that focus.
   A further suggestion is that alexithymia reflects an underlying problem in cognitive processing and emotion regulation (Bagby & Taylor, 1997a). This is believed to influence the way in which emotion is experienced, communicated, and cognitively appraised and processed, which subsequently affects the organism’s ability to self-regulate (Taylor et al., 1997b). This notion is supported by findings of negative associations between alexithymia and the recognition of verbal and nonverbal emotional stimuli (Grynberg et al., 2012; Lane, Sechrest, Reidel, Shapiro, & Kaszniak, 2000; Lane et al., 1996; Pandey & Mandal, 1997), thereby suggesting deficits in encoding and transforming emotional information (Parker, Taylor, & Bagby, 1993a, b).

   Research utilising a signal-detection paradigm to assess recognition of neutral and negative emotional facial expressions under slow and rapid presentation conditions found that the alexithymia factor difficulty describing feelings was related to a lower ability to recognise negative emotional facial expressions, particularly when detection was under the speeded condition (Parker, Prkachin, & Prkachin, 2005). In contrast to these findings, however, when shown black and white slides of facial expressions depicting anger, sadness, disgust, surprise, happiness, and fear, no differences in emotion recognition were found between individuals with low and high alexithymia (Montebarocci, Surcinelli, Rossi, & Baldaro, 2011). Given the general and relational importance of the ability to recognise facial expressions of emotion, and the conflicting findings, it is clear that this area of research requires further clarification.

   Sifneos (1996) believed that as sophisticated technology became available, the final answer on the aetiology of alexithymia would arise from neuroimaging research. In a review of the early neurobiological literature, Parker and Taylor (1997a) suggested that alexithymia “is associated, at the very least, with a variation in brain organization” (p. 113); however, it is unclear whether “this variation represents a dysfunction of the right hemisphere, an interhemispheric transfer deficit, an inhibition of the right hemisphere by a highly activated left hemisphere, or merely a preferred hemispheric mode” (Parker & Taylor, 1997a, p. 113). Of interest is that a later study did find indications of the presence of interhemispheric transfer deficits involved in alexithymia (Parker, Keightley, Smith, & Taylor, 1999).

   Furthermore, along with the development of sophisticated imaging technology, the neurobiological research into alexithymia has expanded, and it has provided a deeper understanding of the processes that can occur. Utilising three-dimensional positron emission tomography (PET) scanning, Karlsson, Naatanen, and Stenman (2008) examined alexithymia and the way in which the brain processes emotion. These researchers compared a group of highly alexithymic women to a group of women with low alexithymia on their responses to viewing videos depicting neutral, amusing, and sad situations. With the amusing and sad videos, compared to the low alexithymia group, the brains of the highly alexithymic women showed greater activation in the motor and somatosensory areas, and lower activation in the anterior cingulate cortex (an area that plays a part in experiencing emotion in a differentiated and complex manner). This group also showed evidence of “distinct left-sided lateralisation” in the brain (p. 36). Of particular interest is that the highly alexithymic women reported greater anger after watching the amusing films, more disgust after the sad films, and a high rating to threat after the neutral films.

   Essentially, this study found that in women viewing emotion-evoking stimuli, high alexithymia was associated with “a tendency to activate brain areas relating to bodily sensations”, and “impairment in the processing of emotions” (p. 36).

   Through the use of functional Magnetic Resonance Imaging (fMRI), Berthoz, Armony, Blair, and Dolan (2002) found that when shown emotion-related pictures, a highly alexithymic group had less neural activity in the medial prefrontal cortex than did a group with low alexithymia. However, there were no group differences in brain activation within areas that have a vital role in emotional responding to simple perception and association of stimuli (that is, the amygdala, hippocampal formation, and the hypothalamus). Similarly, Moriguchi et al. (2006) found highly alexithymic participants to have low neural activity in the medial prefrontal cortex when describing the actions of two triangles moving like humans in a silent visual animation.

   Moriguchi et al. (2007) compared the neural responses of groups with high and low alexithymia when viewing pictures of human hands and feet in painful situations.
   Individuals with high alexithymia had less activation in the left dorsolateral prefrontal cortex, the dorsal pons, the cerebellum, and the left caudal anterior cingulate cortex, and greater activation in the right anterior and posterior insula and inferior frontal gyrus (areas associated with emotion processing). This group also reported lower ratings of the pain being depicted, suggesting impairment in the ability to take the perspective of another person.

   In an excellent review of the neuroimaging studies conducted on alexithymia, Moriguchi and Komaki (2013) evaluated the findings from studies that have utilised the four experimental paradigms of: 1) External emotional stimuli; 2) Imagery and fantasy; 3) Somatosensory or sensorimotor stimuli; and 4) Stimuli containing a social context (p. 2).
   Their conclusions were that individuals with high levels of alexithymia show reduced emotional arousal to external stimuli, disturbed voluntary cognitive functioning such as creating an image inside one’s mind spontaneously (not triggered by external events), hypersensitivity (amplification) to physical level sensations and stimuli, and reduced cognitive processing in social contexts requiring mentalizing ability or theory of mind, indicating impairments in empathy (p. 7).

   In other words, highly alexithymic people “exhibit either dullness to external affective triggers or hypersensitivity to internal and direct physical sensations, or both”, they “rely on a lower level of emotional awareness (i.e., physical/action level)”, and “their higher cognitive awareness is rather compromised” (Moriguchi & Komaki, 2013 p. 8). As the authors noted, these findings fit well with the theoretical conceptions of emotion proposed by Lane and Schwartz (1987) in which emotional awareness can be viewed as a developmental process and graded at different levels. I also suggest that the findings are aligned with Damasio (1999) in terms of alexithymia reflecting a disruption in the interaction between emotion and cognitive representations, leading to impairment in the feedback information system, which affects the person’s imaginal ability. Together these processes prevent a conscious sense of self-awareness, which results in an inability to ‘feel their feelings’ (see Damasio, 1999, p. 282).

   In addition to research into aetiological influences of alexithymia, measurement of alexithymia was greatly assisted by the establishment of cut-off scores for the TAS instruments, which has enabled comparative studies across diverse samples. This has facilitated information to be obtained regarding associations between alexithymia and sociodemographic information, and prevalence rates in both general non-clinical populations and in samples with medical and psychological conditions.

   Sociodemographic Information
   In terms of sociodemographic information, alexithymia has been found to be unrelated to vocabulary skills and general intellectual ability (Parker, Taylor, & Bagby, 1989).
   However, findings concerning age, gender, educational level, socioeconomic status, and marital status have shown relational inconsistencies. Where some studies have shown no significant associations between alexithymia and these five variables (Bach & Bach, 1995; Joukamaa, Saarijarvi, Muuriaisniemi, & Salokangas, 1996; Luminet, Bagby, & Taylor, 2001; Parker et al., 1989), others have shown positive associations between alexithymia and age (Honkalampi, Hintikka, Tanskanen, Lehtonen, & Viinamaki, 2000; Joukamaa, Sohlman, & Lehtinen, 1995; Lane, Sechrest, & Riedel, 1998; Lane et al., 1996; Salminen, Saarijarvi, Aarela, Toikka, & Kauhanen, 1999).

   With respect to alexithymia and gender, males have been found to score higher than females on the TAS-20 scale (Franz et al., 2008; Fukunishi, 1994; Lane et al., 1998; Parker, Bagby, Taylor, Endler, & Schmitz, 1993; Parker et al., 1993b; Parker et al., 2001; Salminen et al., 1994; Salminen, Saarijarvi, Aarela, Toikka, & Kauhanen, 1999; Taylor, Parker, Bagby, & Bourke, 1996), on the difficulty describing feelings factor (Parker et al., 2001), and the externally oriented factor (Parker et al., 2001; Salminen et al., 1999; Taylor et al., 1996). Conversely, females have been found to score higher than males on the total TAS scales (Mason, Tyson, Jones, & Potts, 2005; Wise, Mann, Mitchell, Hryvniak, & Hill, 1990), and the difficulty describing feelings factor (Pandey, Mandal, Taylor, & Parker, 1996).

   Furthermore, education level has been found to be negatively associated with alexithymia (Franz, et al., 2008; Joukamaa et al., 1995; Lane et al., 1998; Salminen et al., 1999; Taylor, Parker, Bagby, & Acklin, 1992), as has socioeconomic status (Franz et al., 2008; Joukamaa et al., 1995; Lane et al., 1998; Lane et al., 1996; Salminen et al., 1999; Taylor et al., 1992). Being in a white-collar profession has been found to be associated with less difficulty identifying feelings and difficulty describing feelings (Kooiman, et al., 1998).

   In research that has examined alexithymia and marital status, there has been disparity in the findings. Some studies have shown no significant associations between high and low alexithymia and whether people are single, married, divorced, or widowed (Joukamaa, Saarijarvi, et al., 1996; Kooiman et al., 1998), or whether they are married or living in a de facto relationship (Honkalampi et al., 2000). However, other studies have found a higher degree of total alexithymia in single men (Franz et al., 2008; Kokkonen et al., 2001).
   Conversely, both Joukamaa et al. (1995) and Joukamaa, Karlsson, Sohlman, and Lehtinen (1996) found high alexithymia to be least common in unmarried persons.

   Also, Joukamaa et al. (1995) found alexithymia to be highest in those who were divorced, and this was supported by Franz et al. (2008) who reported that compared to married persons or those who cohabited with a partner, divorced individuals without a partner showed significantly higher total alexithymia. Joukamaa, Karlsson, et al. (1996) found high alexithymia to be most common in those who were widowed, with the divorced group ranking second to the widowed group. In addition, Salminen et al. (1999) found married women to be significantly less alexithymic than unmarried women, and Franz et al. (2008) found married women to have low total TAS-20 scores. Thus, in terms of sociodemographic information, the relationships between alexithymia and age, gender, educational level, socioeconomic status, and marital status remain varied.

   Alexithymia Prevalence Rates
   Studies that have included reporting of the prevalence of high alexithymia have shown rates in general population non-clinical adult samples ranging between 10% (Franz, et al., 2008; Honkalampi, et al., 2001; Mason et al., 2005) and 34% (Joukamaa, Saarijarvi, et al., 1996). In medical samples, rates have been between 25% (Barbosa, Freitas, & Barbosa, 2011; Fortune, Richards, Griffiths, & Main, 2004; Porcelli, Tulipani, Di Micco, Spedicato, & Maiello, 2011; Porcelli, Zaka, Leoci, Centonze, & Taylor, 1995) and 66% (Porcelli, Taylor, Bagby, & De Carne, 1999). In adult psychological/psychiatric samples, reported rates have been between 12.5% (Celikel et al., 2010; Nowakowski, McFarlane, & Cassin, 2013; Parker, Taylor, Bagby, & Acklin, 1993) and 68.8% (Bourke, Taylor, Parker, & Bagby, 1992).

   In terms of prevalence rates of high alexithymia for each gender, Franz et al. (2008) reported rates of 11.1% for men and 8.9% for women, which were comparable to findings by Honkalampi et al. (2000) of 12.8% for men and 8.2% for women. Kokkonen et al. (2001) reported rates of 9.4% for men and 5.2% for women, Montebarocci, Codispoti, Baldaro, & Rossi (2004) found rates of 9.5% for men and 7.2% for women, and Salminen et al. (1999) found rates of 17% for men and 10% for women. In contrast, Mason et al. (2005) found prevalence to be 7.7% for men and 20% for women. Studies examining married couples and alexithymia have reported prevalence rates of 21% for husbands and 18% for wives (Eizaguirre, 2002) and 7.5% for husbands and 6.2% for wives (Frye-Cox & Hesse, 2013). In addition to these fundamental aspects of alexithymia, research has established a number of features that are associated with the construct.

   Associated Features of the Alexithymia Construct
   The characteristics of alexithymia identify a pervasive way of functioning (Lesser, 1985), and evidence has indicated that “the structure of the construct is equivalent across many cultures, thereby supporting the view that alexithymia is a universal trait” (Taylor & Bagby, 2013, p. 107). As such, alexithymia does not define a particular ‘type’ of person (Taylor & Bagby, 2013). An important feature of alexithymia is that it is not an all or nothing trait as it can be distinguished by low, moderate, and high dimensions (Bagby & Taylor, 1997a). The dimensionality of alexithymia has gained strong support through the use of taxometric methodologies with large samples of English-speaking community members and students, a smaller psychiatric outpatient sample (Parker, Keefer, Taylor, & Bagby, 2008), and a large community Finnish sample (Mattila et al., 2010). The dimensional nature allows for variations in the degree of the affect deficits, and therefore, the presenting characteristics. Of course, the degree of alexithymia can vary from one person to another; however, at times, it may also vary within the same person in response to stressful situations such as multiple losses or traumatic experiences (Krystal, 1982-83).
   This suggests that alexithymia may be a personality trait that can vary according to a particular state.

   The view of Krystal (1982-83) is associated with an earlier debate within the literature regarding whether alexithymia should be construed as a stable personality trait that is independent of a specific cause, or a stress-related state that resolves as the stressful situation abates (Bagby & Taylor, 1997a). Early authors were unclear about their position on the trait-state issue (i.e., Nemiah & Sifneos, 1970); however, research has since found that alexithymia remains stable despite changes on psychological and/or medical indices (Martinez-Sanchez, Ato-Garcia, Adam, Medina, & Espana, 1998; Porcelli, Leoci, Guerra, Taylor, & Bagby, 1996; Salminen et al., 1994; Taylor, Bagby, & Luminet, 2000), particularly when the absolute and relative stability of alexithymia are taken into account (Luminet et al., 2001). Furthermore, although some researchers have proposed the existence of distinct subtypes of alexithymia (Bermond et al., 2007), a large-scale confirmatory investigation failed to provide empirical support for this distinction (Bagby et al., 2009).

   In considering the various ways in which alexithymia may present in individuals, a range of characteristics has been identified. Highly alexithymic people have an empty emotional life and a limited sense of their own needs (Kraemer & Loader, 1995). They generally respond unemotionally and calmly to emotional experiences and psychologically serious events (McDougall, 1985), and they often use a wall of language to put a screen between themselves and others rather than to communicate their ideas and emotional experiences (McDougall, 1985).

   Although those who are highly alexithymic are unable to identify and communicate specific feelings, they know when they do not feel good (Ogrodniczuk, 2007); however, with their thinking focused on facts, details, and events that are external to the self, there is minimal inner reflection. Consequently, there is an inability to link emotional experiences to any associated thoughts and feeling sensations, or to utilise this process as a source of information to guide decisions and modulate mood states (Taylor & Bagby, 2000). In accordance with the proposal by Damasio (1999), this seems to suggest that emotional awareness in high alexithymia is fixed at the level of the broad background emotions (for example, a calm versus tense state), with the lack of cognitive processing prohibiting higher order specificity of feelings, inner reflection, and affect regulation.

   It is a misconception that highly alexithymic individuals are completely unable to express feeling states. Rather, it is more accurate to regard these people as having emotions that are “poorly differentiated and not well represented mentally” (Taylor & Bagby, 2000, pp. 42-43). Those with high levels of alexithymia may communicate emotive words such as ‘sad’, ‘angry’, or ‘frightened’, exhibit emotional outbursts of rage, crying, and/or slamming of doors (Krystal, 1979; Nemiah et al., 1976; Thompson, 1988), and experience dysphoria and emotional turmoil (Taylor et al., 1992). However, the sudden outbursts can stop as abruptly as they start, and there will be an inability to elaborate and reflect on the associated feelings, or identify the source of the feeling state (Taylor & Bagby, 2000).

   Paradoxically, although highly alexithymic individuals lack the cognitive, expressive, and reflective skills associated with emotion states (Krystal, 1988), as with people who are colour-blind, they may have learned from others that they have the deficits (Lane et al., 1996). Despite differing from other people in terms of emotion skills and emotional reactions to events, the alexithymia deficits themselves do not appear to prevent the ability to complete self-report instruments such as the TAS-26 or TAS-20. The value of these instruments is that the items tap into indicators of emotional difficulties rather than requiring awareness of emotions per se. The validity of the measures is supported by findings of significant correlations between the TAS-20 and its three-factor scales of difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking and non-self-report measures of alexithymia (Porcelli & Mihura, 2010), and an observer-rated measure (Bagby, Taylor et al., 1994).

   In addition to the features detailed above, alexithymia has been investigated in association with other developmental and personality constructs such as autism spectrum disorder, defense mechanisms, emotional inhibition, psychological mindedness, and emotional intelligence. A brief overview of this research is presented below.

   Autism Spectrum Disorder
   Within the alexithymia and Autism Spectrum Disorder (ASD) literature, similarities between the features of alexithymia and those comprising ASD have been noted and empirically investigated. Prevalence findings indicate that between 40 and 65% of adults with autism meet the criteria for alexithymia (Berthoz & Hill, 2005; Hill, Berthoz, & Frith, 2004). Moreover, studies have found that, compared to a control group, and a group of relatives, adults with high-functioning forms of ASD had significantly higher alexithymia (Hill et al., 2004), and that the TAS-20, DIF, DDF, and EOT scores for those with ASD demonstrated temporal stability (Berthoz & Hill, 2005). Furthermore, Bird, Press, and Richardson (2011) found that the ASD aspect of reduced eye fixation (when looking at social scenes) was predicted by the severity of alexithymia and not by the autism symptom severity, suggesting that there is a sub-group of adults with ASD who have the emotional deficits of alexithymia in addition to the social deficits of ASD. These findings have provided some evidence that, although alexithymia and ASD are significantly related, they are separate constructs.

   A review by Bird and Cook (2013) lends some strength to the findings noted above.
   These authors referred to alexithymia as a “subclinical condition”, and they proposed a theory called “the alexithymia hypothesis” (p. 1). This theory “suggests that, where observed, the ‘emotional symptoms of autism’ are in fact due to the greater proportion of individuals with severe alexithymia in the autistic population” (p. 2). In other words, the empathy and emotion recognition deficits often seen in those who have autism are due to severe alexithymia rather than autism per se (pp. 5-6). In support of their hypothesis, Bird and Cook cited a series of studies comprising individuals with autism, and individuals without autism, who had varying degrees of alexithymia. The cited research examined autism and alexithymia in association with aspects of facial emotion recognition, recognition of vocal or musical affect, and included fMRI studies of empathy or emotional introspection. The conclusion was that “in every case … alexithymia, but not autism, has been associated with emotional deficits” (p. 6). The emerging findings in this area are important because, as Bird and Cook indicated, if ongoing research continues to show consistent support for the alexithymia hypothesis, the findings will have significant implications for the diagnostic markers of autism, research into autism, and the clinical practise with individuals who have the disorder.

   Alexithymia and Defense Mechanisms
   Throughout the alexithymia literature, there has been conjecture regarding whether the deficits should be viewed as ego defenses against anxiety and neurotic conflicts. For instance, examination of associations between alexithymia and the repressive coping style have shown inconsistent findings, with some investigators arguing that the two constructs are similar and differ only in magnitude (Lane et al., 2000) and others finding that they are separate and distinct constructs (Myers, 1995; Newton & Contrada, 1994). Furthermore, although the characteristics of alexithymia were once thought to be influenced by individuals’ needs to exhibit socially conforming or acceptable behaviour (Horney, 1952; Ruesch, 1948), studies have indicated that alexithymia is not influenced by social desirability (Fukunishi, 1994; King, Emmons, & Woodley, 1992), self-deception (King et al., 1992; Linden, Lenz, & Stossel, 1996), or impression management (Linden et al., 1996).

   Over time, empirical studies with clinical and non-clinical populations have found consistent evidence that alexithymia is correlated positively with the use of immature defenses, and negatively with the use of adaptive or mature defenses (Helmes et al., 2008; Joyce, Fujiwara, Cristall, Ruddy, & Ogrodniczuk, 2013; Kooiman et al., 1998; Parker et al., 1998; Wise, Mann, & Epstein, 1991). However, despite the more consistent findings of associations between alexithymia and the use of immature defenses, Parker and Taylor (1997b) proposed that “this does not mean that alexithymia itself should be conceptualized merely as a primitive defense” … “rather, one must view alexithymia as a more complex construct and ask what are the developmental and psychic structural elements that prevent an alexithymic individual from employing more neurotic or mature defenses to manage affects” (p. 91). As Kennedy-Moore and Watson (1999) stated, “the limited emotional expression of alexithymics is characterized by struggle rather than denial” (p. 81).

   Alexithymia and Emotional Inhibition
   Another construct that has been viewed as conceptually similar to alexithymia is that of emotional inhibition, and indeed, the two constructs do have similarities. Based on the General Adaptation Syndrome established by Hans Selye (Selye, 1976), Pennebaker and Beall (1986) developed the theory of behavioral inhibition and psychosomatic disease.
   Their theory suggests that inhibiting the expression of distressing emotions is an active process that involves not thinking about the associated emotion, and requires an increase in both psychological and physiological effort and energy (Pennebaker & Beall, 1986; Pennebaker, Hughes, & O’Heeron, 1987). Over time, the continual physiological effort required with inhibition places cumulative stress and wear and tear on the body, and it is this process that adversely affects physiological functioning and potentially leads to the development of psychosomatic disorders (Pennebaker & Beall, 1986; Selye, 1976).

   Investigation of alexithymia and inhibition of emotional expression has found low to moderate positive correlations between the two constructs, indicating that they are related yet separate (Davies, Stankov, & Roberts, 1998; King et al., 1992). Therefore, although inhibition and alexithymia may seem similar, their conceptual nature differs in that inhibition may be viewed as an unwillingness to express emotion (Horowitz, Markman, Stinson, Fridhandler, & Ghannam, 1990), whereas alexithymia can be viewed as an inability or difficulty that is associated with [emphasis added] expressing emotion (Taylor, 1997a).

   Recommended Citation
   McNeill, P. D. (2015). Duet for life: Is alexithymia a key note in couples’ empathy,
   emotional connection, relationship dissatisfaction, and therapy outcomes?. https://ro.ecu.edu.au/theses/1670

   https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2671&context=theses

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6. Bob Rijs

   April 8, 2023 at 1:11 pm

   Dysfunctional generations versus natural and guiding parenting style:
   Intergenerational transmission of trauma and intergenerational transfer of psychopathology as dissociogenic agents

   Abstract
   Intergenerational psychosocial transformation functions in two opposite directions, “intergenerational development” and “intergenerational fossilization”, and the main
   factor in this dynamic process is family dynamics and child-rearing styles. In psychosocial terms, every family can teach their children compassion, loyalty, honesty and
   strategies to effectively cope with traumatic experiences, on the other hand, they can traumatize and dissociate their children with their violence-oriented and unempathetic
   negative child-rearing styles, which they use as a punishment tool.

   Family psychopathologies show a negative relationship with “intergenerational development” and a positive relationship with “intergenerational transmission of trauma” and “intergenerational transfer of psychopathology”, that is, the “intergenerational fossilization”. In a wide space from normality to psychopathology, family dynamics and communication patterns are discussed in three categories: “normal family model”, “dysfunctional family model” and “pathological family model”. From past to present, traumatic experiences and negative child-rearing styles have been used in all nations of the world to both put oppression on and control individuals and societies. Because individuals and societies, by dissociating the people and masses they traumatized and psychopathologized, are able to control and manage more easily. In this context, intergenerational traumatic and psychopathological experiences are transmitted to the next generation at similar rates by people living in the same age in a revictimization cycle. The natural and guiding parenting style, developed by Ozturk, is structured both as a
   functional family model focused on psychosocial development and as a long-term prevention strategy against childhood traumas and closely related dissociative disorders
   and post-traumatic stress disorder. In this study, the “dysfunctional generation” defined by Ozturk and dysfunctional family models, dysfunctional family dynamics and dysfunctional communication patterns are discussed in detail.

   Click to access l40VSvddyufBo4Dij7aEFDuYobNRT2BLxCcFr8Px.pdf

   Understanding and Working with the Effects of Parental Pathological Projective Identification

   The concept of pathological projective identification

   Projective identification refers to the process whereby one individual employs projection of emotional experience while evoking, through interpersonal behavior, an analogue emotional experience in another individual. Projective identification was originally introduced by Melanie Klein and elaborated by psychoanalysts working in the Kleinian tradition (Heimann, 1950; Hinshelwood, 1991; Klein, 1946). It is thought to be a common – and often benign – occurrence when relational communication needs to happen without language. For example, imagine a dog who makes eye contact with his owners, then turns around and deliberately walks away while keep his eyes locked on the owner as if the owner is about to give chase. The owner finds himself in a sudden playful state and gives chase. Ogden cites ways that an infant with a “good-enough” parent might perceive his distressful states in the parent instead of himself and act accordingly (1979). This process allows the receptive and care-minded parent to respond in a way that shows s/he is not damaged by the infant’s distress and remains motivated to care for the child. In this way, the infant may learn that his distressful states are not destructive and can still be responded to. Thus, projective identification is a useful and needed mode of relating in relationships that are marked by a disparity in power – such as parent and child – when the more powerful party’s care for the other allows for him or her to be used as needed by the less powerful party. This has been referred to as a process of containment, whereby one person functions as a “container” for the “contained” (i.e., that which is projectively identified), in order to render intolerable affects more digestible and amenable to reflection (Bion, 1962; Ogden, 2004). The process can also be useful in relationships of more equal footing – objectively speaking – between patient and therapist. In this context, a patient may use projective identification to “relocate” feelings that have been historically intolerable by evoking them in the therapist (Seligman, 2018). Then the help-minded therapist can experientially understand the patient’s experience and respond in ways that allow the patient to know his experience is survivable and comprehensible (Chescheir, 1995; Kealy, 2013; Ogden, 2004).

   Projective identification has not featured prominently in the CMT literature. However, the concept bears some similarity to a particular type of testing activity described by CMT as “turning passive-into-active.” In this kind of testing, aimed at disconfirming pathogenic beliefs associated with traumatic experience, a patient “does to the analyst those traumatizing things a parent had previously done to him” (Weiss & Sampson, 1986, p. 107). An optimal therapeutic response would provide the patient with an experience of “containment” (projective identification) and/or “mastery” (turning passive-into-active) of that which the patient had been struggling with and enacting in relation to the therapist. However, projective identification is not always benignly employed for the purpose of mastery. Some individuals may use projective identification to deal with difficult affects in a more destructive manner, to the detriment of those around them. Indeed, many patients may experience themselves on the receiving end of pathological projective identification (e.g., from a parent), and may benefit from the therapist highlighting and explaining such phenomena. In this way, the concept of projective identification––particularly its maladaptive expression––may be useful for therapists practicing from a CMT perspective.

   Understanding the effects of pathological projective identification in patients’ development can alert therapists to this potential source of pathogenic beliefs. Moreover, therapists can explain how pathological projective identification works to facilitate the patient’s insight that the mistreatment they received from a parent was not their fault. Therapists can also consider ways in which the patient might test and attempt to overcome pathogenic beliefs stemming from a parent’s use of pathological projective identification. The patient may not necessarily reenact this in therapy. While some patients may turn passive-into-active to help the therapist understand their plight, others may work to dispel their deep confusion about what is true about themselves versus a sense of self adopted in compliance to the trauma.

   Projective identification can become pathological when the more powerful individual––not necessarily the psychologically healthier party––employs it upon the less powerful and more dependent participant. Consider a psychologically compromised parent who has his or her own intolerable affective states that s/he must find in his or her child and then influence that child to identify with such feelings. Projective identification brings a compelling mandate to comply with what the initiating party is finding––and evoking through behavior––in the other. Factor in the parent’s authority and the child’s need to maintain the relational tie to that parent and the child may have no option but to identify with the parent’s unwanted feelings. The valence and intensity of the projected feelings can also elevate the pathological nature of this process. If the more powerful party has coped with their own traumatic experience by dissociating from the often associated feelings of worthlessness, abandonment, and undeservedness, then such contents may be projected onto the less powerful party. In these cases, a child could be induced to think about himself or herself as worthless, abandoned, and/or undeserving in order to give the parent what s/he psychologically needs in that moment (i.e., to see this experience in the child instead of himself or herself).

   Being the chronic recipient of a parent’s pathological projective identifications can undermine the child’s sense of connection to and self-worth in relationship to the parent. The child’s self-worth suffers by going unresponded to for who s/he really is, treated as though his or her needs do not matter to the parent and sent the message that the relationship is contingent upon the child experiencing himself or herself as the parent dictates. Moreover, the parent is implicitly unavailable to be used for the child’s attempts to communicate via projective identification. Bion (1959) describes an infant-mother scenario where the feeling behind the infant’s cries can’t find a psychological home in the mother who is either too destabilized by the infant’s feeling or denies it. As a result, the child is left profoundly alone with a feeling that is overwhelming, with no one to contain it with him.

   Features of parental pathological projective identification

   The parent MUST be right

   A parent who employs pathological projective identification in relation to his or her child has to be right about his or her perceptions of the child (Ogden, 1979). There is a lot at stake for both parties when a parent dislocates an internal state into his or her child. The parent may fear psychological extinction if s/he had to consciously claim this aspect of self, with the intensity of shame, terror, or despair feeling too great to bear. The parent may be convinced at a deep level that s/he would have nobody to safely express these feelings to so that s/he could feel more regulated and able to be soothed.

   Instead, the feelings must be ejected and found––communicated with absolute certainty––in the child. There is no set of verbal counterarguments that can convince the parent otherwise in such moments. As Ogden succinctly puts it, the parent’s logic goes something like: “I can only see in you what I put there, and so if I don’t see that in you, I see nothing” (1979, p. 360). In order to occupy a shared reality with a parent under these circumstances the child must go along. Refusal to comply would threaten to obliterate the only form of connection that is available––something the child must avoid at all costs.

   Negation of the child’s subjectivity

   The child may feel abjectly negated as a subjective self in the course of a parent coercing him or her to identify as something intolerable to that parent. Part of the demand that the child think about himself or herself the way the parent insists is that anything the child independently feels, thinks, or cares about is wholly disregarded by the parent. All that can matter is the parent’s psychology and what s/he needs to stay intact in these moments. The parent does not have the capacity to notice her own feelings and remain responsive to the child’s subjectivity. This can lead to a chronic sense for the child that relationships require a great deal but offer little in return. The child may also be compromised in his or her ability to recognize and relate to his or her self. In the child’s compliance with the parent’s pathological projective identification, his or her subjective self becomes a liability. In order to adapt successfully – i.e. identify with what the parent cannot – the child must find a way to inhibit his or her own agency and subjectivity. S/he may have to practice this so thoroughly that it becomes difficult to know what they really desire, believe, and find personally meaningful.

   Feeling harassed from within

   The child’s experience of the relationship with a parent who uses pathological projective identification may involve feelings of being invaded, in that the parent’s projections are unbidden yet the child has little choice but to absorb and abide by their content. Thus, the child is prevented from establishing and asserting boundaries regarding what will and will not be taken in. Rather, the mandate to comply with the parent’s projective perceptions requires the child to feel defined from the outside––often in noxious terms––rather than from within. In this way, the child is in a position of repeatedly granting entrance to something that is alien to the self: the parent’s projective content. Such content becomes internalized, manifesting as thoughts, feelings, and beliefs about the self. Children may then have the experience of being harassed, intruded upon, and captured by very distressing thoughts about who they are––a kind of internal harassment.

   Impact on the child’s identity

   Despite inordinate pressure to identify with the parent’s projected, unmetabolized state of mind, the child may retain some sense of this identification being unreal, or not of his/her own making. Thus, feelings of inauthenticity may set in as an additional outcome of parental pathological projective identification, reflecting the coercion to adopt feelings or thoughts that are not truly his or hers. As a result, the child’s actual qualities go ignored as s/he is responded to as if s/he is someone s/he is – in truth of fact – not. Winnicott’s concept of the ‘false self’1 reflects this process, whereby the child suppresses the actual core of the self for protective purposes, building up in its place a compliant “version” of the self to deal with the impingements of the parent.

   In extreme cases where the child has few other relationships with a trustworthy adult or peers, this may be the only identity available to the child. Just as a bad relationship is preferable to no relationship with a needed other, an inauthentic identity is far better than no identity (Fairbairn, 1952).

   Resulting dysphoria in the child

   The entirety of parental pathological projective identification makes for a grim life for the child. S/he is faced with the Catch-22 choice of accommodating foreign noxious states and claiming them as his/her own or rejecting this alien intrusion and feeling unknown to the parent and bereft of a parent who is capable of knowing him/her. The child may experience a range of dysphoric reactions to this predicament and may feel depleted, listless, numb, ineffectual, and/or aimless. Such feelings could be the product of becoming “someone” to the parent through the process of the parent’s pathological projective identification, briefly relieving the terror of having and being no one––though with the cost of a despairing and joyless experience of his/her internal life.

   Conversely, if the child seeks to hold onto his own experience in the face of his parent’s attempt to induce feelings in the child that the parent cannot bear then s/he could feel a panicked sense of estrangement, fear an annihilating retaliation, and/or grow enraged at the way s/he is being deprived. To the child, the predicament of these overwhelming affects involves having no one to help make sense of and regulate these feelings. The very moment when the child needs an ally to help contain overwhelming affect may be fraught with danger as a consequence of the parent’s psychological unavailability (i.e., the parent’s reliance on projective identification precluding empathic responsiveness). Masterson and Rinsley (1975) have termed this set of dysphoric reactions the “abandonment depression” marked by feelings of panic, rage, guilt, helplessness, depression, and emptiness.

   Through repeated cycles of being induced into his/her parent’s pathological projective identification, the child’s dysphoria may take hold as chronic affective disturbances that continue through adulthood. The strategies used to cope with this dysphoria may offer immediate relief but make for a constricted quality of life. One such strategy involves the maintenance of beliefs about the self that preserve the fragile sense of relatedness organized around the parent’s projective identification. Associated strategies may include impulsive self-regulatory behaviors aimed at transient relief, though often with self-damaging consequences (e.g., substance misuse). The ongoing dysphoric affect and associated constriction of living can lead to the seeking of treatment. If therapists can be aware of these effects and their origins they may facilitate opportunities for patients to heal and free themselves from such constraints. The following case example attempts to illustrate this possibility.

   https://www.researchgate.net/publication/360815743_Understanding_and_Working_with_the_Effects_of_Parental_Pathological_Projective_Identification

   Intergenerational Transmission, Projective Identification, and Parent Work:
   A Theoretical and Clinical Study
   Cecilia Conolly

   https://researchdirect.westernsydney.edu.au/islandora/object/uws%3A52054/datastream/PDF/view

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7. Bob Rijs

   April 8, 2023 at 1:43 pm

   (Second part)

   Duet for life: Is alexithymia a key note in couples’ empathy, emotional connection, relationship dissatisfaction, and therapy outcomes?

   Pamela D. McNeill
   Edith Cowan University

   Alexithymia and Empathy

   There has been longstanding clinical reporting of associations between alexithymia and a lack of empathic ability, and it makes intuitive sense that if a person is unable to understand and connect with their own emotions, they will struggle to do so with the emotions of others. These views are supported by findings of strong negative associations between alexithymia and psychological mindedness (Bagby, Taylor, et al., 1994), and alexithymia and dimensions of emotional intelligence (Dawda & Hart, 2000; Khodabakhsh & Fatehi, 2012; Parker et al., 2001). They are also strengthened when taking into account the evidence of associations between alexithymia and impaired recognition and labelling of emotional facial expressions (e.g., Grynberg et al., 2012; Jessimer & Markham, 1997; Karlsson et al., 2008; Lane et al., 2000; Lane et al., 1996; Mann, Wise, Trinidad, & Kohanski, 1994; Moriguchi & Komaki, 2013; Moriguchi et al., 2007; Parker et al., 1993b).

   Such impairment has been found to be particularly prevalent in the detection of anger, sadness, and fear (Prkachin & Prkachin, 2001), and when the requirement is to rapidly recognise and label non-verbal emotion expressions (Parker et al., 2005). Individuals with high alexithymia have also reported inaccurate interpretations of non-verbal behaviours that are biased toward anger, dominance, and beliefs that the average person would react less strongly to events depicted (Berenbaum & Prince, 1994).

   These impairments with alexithymia and recognition and labelling of emotion parallel the neurological findings presented earlier (Moriguchi & Komaki, 2013), and as with emotion (Damasio, 1999), empathic ability has been found to be associated with neurological functioning. For example, Decety and Moriguchi (2007) conceptualised empathy as “a multidimensional construct to account for the sense of sharing and understanding of the subjective experience of others. Thus, empathy includes aspects of emotion communication, self-awareness and theory of mind” (p. 2). They have suggested that responding empathically is reliant on cognitive as well as emotional factors, and “flow and integration of information between specific brain circuits” (p. 17). These authors reported that current theory indicates that empathy “involves partly dissociable components, including shared neural affective representations, self-awareness, mental flexibility, and emotion regulation” and that these are “mediated by specific and interacting neural systems” (p. 18). Within the neural systems, two key areas in the brain that are involved in emotional processing in general, and empathy in particular, are the anterior insula and anterior cingulate cortex (ACC). Decety and Moriguchi (2007) also indicated that disturbances “to different cortical and sub-cortical structures or circuits can lead to an alteration of empathy or even a lack of empathic ability” (p. 14). With reference to alexithymia, the empathy deficits are viewed as involving “aspects of mental flexibility to adopt the subjective perspective of the other and executive and regulatory processes that modulate the subjective feelings associated with emotion” (p. 17).

   Throughout the relevant literature, empathy has often been conceptualised, measured, and defined as a unitary construct involving either emotional (Mehrabian & Epstein, 1970) or cognitive (Hogan, 1969) responses to another person’s experience. However, other investigators have acknowledged that empathic responding is a multifaceted process encompassing cognitive, affective, communicative, and interactive dimensions (Barrett-Lennard, 1981, 1986, 1997, 2003; Davis, 1983).

   Some of the studies investigating alexithymia and empathy have arisen from research examining alexithymia in relation to other constructs such as temperament and character (Grabe et al., 2001), and emotional intelligence (Davies et al., 1998; Dawda & Hart, 2000; Parker et al., 2001), with empathy forming an incidental component to the major findings. Grabe et al. (2001) found the TAS-20 total score, and each of the three factors (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) to be significantly and negatively correlated with the empathy subscale on the German Version of the Temperament and Character Inventory (TCI). Parker et al. (2001) found the total TAS-20, and all three factors, to be significantly and negatively correlated with the EQ-i (Bar-On, 1997) empathy subscale. Although Dawda and Hart (2000) did not specify findings on specific EQ-i subscales, they found the TAS-20 total score for both males and females to be significantly and negatively correlated with the EQ-i interpersonal scale (which includes the empathy subscale).

   Davies et al. (1998) utilised the TAS-20 as an emotional intelligence measure, and found the Mehrabian and Epstein (1970) scale of emotional empathy to be negatively correlated with the externally oriented thinking factor of the TAS-20. However, despite the significant result, Davies et al. (1998) questioned the reliability of the TAS-20. Further investigation indicated that the findings from that study must be regarded with caution because a True/False response format on the TAS-20 was used instead of the instrument’s five-point rating scale (see Davies et al. 1998), and there was a failure to reverse score the negatively keyed items on the TAS-20 (Parker et al., 2001). Subsequent analytic correction resulted in higher, and satisfactory, reliability of the TAS-20 (Ciarrochi et al., 2000b).

   Other studies conducted by Bekendam (1997 Dissertation cited in Taylor & Bagby, 2013), Grynberg et al. (2010), Guttman (2002), Guttman and Laporte (2002), Moriguchi et al. (2006, 2007), Sonnby-Borgström, 2009, and Teten, Miller, Bailey, Dunn, and Kent (2008), all utilised the TAS-20 to measure alexithymia and the Interpersonal Reactivity Index (IRI, Davis, 1983) to measure empathy. The IRI incorporates both cognitive and emotional aspects of empathy and evaluates an individual’s Perspective Taking (PT; the ability to see another person’s point of view), Fantasy (F; the ability to identify with fictional imagination), Personal Distress (PD; feeling anxious when in a tense emotionally negative situation), and Empathic Concern (EC; feeling sympathy and concern for others’ unfortunate circumstances).

   Alexithymia was found to be inversely associated with the IRI subscales of Perspective Taking and Empathic Concern (Bekendam, 1997 Dissertation cited in Taylor & Bagby, 2013; Sonnby-Borgström, 2009), with Sonnby-Borgström (2009) confirming the Perspective Taking association by also finding that, compared to individuals with low alexithymia, those with high alexithymia were less able to imitate facial expressions of negative emotion.
   A study by Grynberg et al. (2010) initially found significant negative associations between the TAS-20, DIF, DDF, and EOT and Perspective Taking (PT), negative associations between the TAS-20, DDF, and EOT and Empathic Concern (EC), and positive associations between the TAS-20, DIF, and DDF and Personal Distress (PD).

   Whilst DIF was positively correlated with Fantasy (F), EOT showed a negative correlation with Fantasy. However, controlling for anxiety eliminated the significance between the TAS-20, DIF, DDF, and Personal Distress. Controlling for depression did not negate any of the significant findings.

   Guttman (2002) investigated alexithymia and empathy in a group of women diagnosed with borderline personality disorder (BPD) and their parents. Findings indicated that a lack of empathic parenting negatively influenced attachment care giving, and that a greater degree of adaptive communication was associated with lower alexithymia in family members. In an extension to that study, Guttman and Laporte (2002) examined women with BPD, anorexia nervosa (AN), a non-clinical control group, and the families of the women. Negative associations were found between the alexithymia factor difficulty identifying feelings and the IRI scales of PT and PD, between difficulty describing feelings and PD and EC, and between externally oriented thinking (EOT) and PT, F, and EC scores.

   Moreover, women with BPD and AN were found to have higher alexithymia scores than those in the control group. Women with AN had higher alexithymia scores than their parents, and family members of women with BPD had the highest levels of alexithymia of all of the groups. In the families of women with BPD, there was also an association between high alexithymia in one of the parents and low levels of empathy in the other parent.
   Within the previously cited studies by Moriguchi et al. (2006, 2007), investigations of associations between the TAS-20 and the IRI found negative correlations between high alexithymia and PT, PD, and EC scores (but not the F scores). Also, Khodabakhsh and Fatehi (2012) found that the TAS-20 was negatively correlated with the total IRI measure.
   Teten et al. (2008) investigated middle-aged male war veterans recruited from a trauma clinic and found that, whilst deficits in Empathic Concern (EC) predicted general verbal aggression, alexithymia (measured with the total TAS-20) predicted impulsive aggression.
   Neither of the EC or TAS-20 deficits predicted general physical aggression. The association between alexithymia and impulsive aggression supports the view that those with high levels of the emotional difficulties are prone to ‘affect storms’ or episodes of explosive anger as a way of relieving unregulated emotion and tension (Krystal, 1979).

   These studies have provided consistent evidence that those with a high degree of alexithymia have difficulty with cognitive and emotional aspects of empathy; however, it is also important to consider that all of this research reflects only one side of the empathy process, that is, individuals’ perceptions of the empathy they provide. This raises a question of whether alexithymia is associated with the ability to receive empathy from others, which to date, appears to have been an absent area of empirical inquiry.

   Furthermore, although the findings that alexithymic individuals have limited empathic ability are of value, there appears to have been no investigation of whether the findings can be generalised in a way that provides clinical benefits to highly alexithymic individuals, or to couple partners who have alexithymic discrepancies. In order to contemplate this, however, it would seem judicious to examine firstly whether those with high alexithymia are able to receive empathy.

   To my knowledge, the only empathy measure able to capture individuals’ perceptions of the empathy they provide and the empathy they receive is the Barrett-Lennard Relationship Inventory (BLRI; Barrett-Lennard, 1986). In accounting for the multidimensional nature of empathy, Barrett-Lennard has developed “the most explicitly differentiated conceptualization of the interactive process of empathic responsivity” (Harman, 1986, p. 371). Originating from Carl Roger’s conditions of empathic understanding, positive regard, congruence, and unconditionality deemed optimal in therapeutic practice, Barrett-Lennard (1981, 1983, 1986, 1997, 2003) construes empathy as an intrapersonal, interpersonal, and multiphasic process, and he has expanded the concept of empathic understanding within the therapeutic setting to include a wider range of interpersonal relationships (Barrett-Lennard, 1997). From this view, empathy relates to having awareness of, and being sensitive to, one’s own inner thought and feeling processes, having the ability to act responsively to others from this awareness, and being able to receive empathy from others (Barrett-Lennard, 1983, 2003). In this sense, according to Barrett-Lennard (1997), “empathy or its lack not only has a profound bearing on relations with others but also has a crucial role in the person’s inner world” (p. 119).

   The multidimensional perceptual view of empathy developed by Barrett-Lennard (1962, 1981, 1983, 1986, 1997, 2003) seems to have similarities and differences to the empathic accuracy paradigm proposed by Ickes (1993). The two areas are similar in that they both relate to congruence between couple partners’ perceptions. However, where empathic accuracy is measured in terms of couples’ congruence in empathic content, Barrett-Lennard’s view of empathy is measured in terms of congruence between couples’ perceptions of whether the empathy provided to each other is actually experienced as being received. It is this concept of empathy that is of interest in the current research.
   Barrett-Lennard’s (1986, 1997, 2003) notions of empathy also seem to have similarities with the concept of reflective function proposed by Peter Fonagy and colleagues.
   Reflective function is “the capacity to envision mental states in the self and others” and includes “the ability mentalize, to represent behavior in terms of mental states, or to have a “‘theory of mind’” (Fonagy & Target, 1997, p. 679). Mentalization has been viewed as being founded in four polarities, with each polarity related to separate neural systems.

   “These polarities are (a) automatic-controlled, (b) internally focused-externally focused, (c) self-oriented-other-oriented, and (d) cognitive-affective” (Fonagy & Target, 1997, p. 106).
   Treatments have been developed for mentalizing problems, which include Metacognitive Based Therapy (MBT), aimed at assisting clients who have problems with affect regulation (Bateman & Fonagy, 2006), and Metacognitive Interpersonal Therapy (MIT), which was developed for specific use with clients who have poor emotional awareness (Dimaggio & Lysaker, 2010). Additionally, an expanding body of evidence linking biological systems and interpersonal understanding suggests that the use of intranasally administered oxytocin improves performance on mentalizing tasks, trust, generosity, and emotional attunement to observed suffering (see Fonagy & Target, 1997, pp. 99-100). In examining the mentalizing polarities, similarities can also be seen with alexithymia. Given the biological bases of emotion, and the links these have to the emotional deficits of alexithymia, a beneficial area of future investigation may be to examine whether MBT, MIT, and oxytocin have some applicability for those who are highly alexithymic. This idea is supported by Fonagy and Target (1997), who stated that “the polarities offer a framework for understanding the way mentalization relates to overlapping constructs such as theory of mind, empathy, mindfulness, alexithymia, emotional intelligence, psychological mindedness, and insight” (p. 106).

   The associated mentalizing literature notwithstanding, according to Barrett-Lennard (2003), empathic understanding is “an active process, not just a reflective mirroring” (p. 96), and it involves “a desire to closely engage with and know the other’s experience and to reach out to receive their feeling communication and meaning” [emphasis in original] (p. 96). As such, “empathic understanding is the most crucial kind of responsive knowing in interpersonal-relational life” (p. 34). Barrett-Lennard (2003) suggested that there are (at least) two ways in which empathic communication can be approached and treated. In one way, “we respond entirely to the literal content of the other’s statement”, and the second way is where “responding takes the other’s words as an expression of their inner experiencing, view and meaning, at the time” [emphasis in original] (p. 35). In both ways, however, the listener retains a background awareness that the other’s expressed communication belongs to that person, and “it is this awareness that helps to make empathy distinct from identification or sympathy” (p. 35).

   Within the total process of interpersonal empathy, Barrett-Lennard (2003) proposed that there are three main phases. Phase 1 is where one person is actively attending to or listening with an empathic attitude to another person who is in some way expressing his or her experiencing. The core aspect of the first phase is that, at some point, the listener has an inner recognition and understanding of the other person’s experience. In Phase 2, the listener communicates that empathic understanding in ways that may be voluntary or involuntary and/or verbal or non-verbal. Importantly, if the listener’s response does not emerge from an inner empathically felt process, and is merely a technical mirroring of the other person’s words, this is not truly Phase 2 empathy. Phase 3 empathy is the speaker’s experience of receiving the empathic understanding.

   The experience of being heard and understood can have a significant influence on the receiver; “whether of relief, of something at last making sense, a feeling both of inner connection and being less alone, and very possibly a sense of something further to express – which opens in the wake of having been understood” [emphasis in original] (Barrett-Lennard, 2003, p. 37). However, Barrett-Lennard (1997) did acknowledge that those who have limited scope for empathic responding, perhaps due to a developmental failure for such responsiveness, will be unreceptive to the “felt inner experiencing and meanings” of both the self, and of others (p. 104).

   The views of Barrett-Lennard (2003) seem to resonate with vital elements that are missing in the lives of those who are highly alexithymic. Consequential to the alexithymia emotional deficits, it may be that their inability to provide empathy is partly because this kind of responding is outside of their frame of reference and experience. Given the developmental, family of origin, and attachment influences involved in alexithymia, it seems likely that these people will have received little understanding from others. In addition, one might assume that the influences of their early experiences do extend into adulthood, and that their communicative styles continue to engender minimal empathic understanding from others. Therefore, in being unable to provide what has not been experienced, there will be a lack of knowledge about how to be empathically understanding, even though this would be limited to their cognitive or literal perspective.

   Barrett-Lennard (2003) stated “without activation of empathy, the individual lives in emotional isolation” (p. 50). Along with living a life of emotional isolation, there may also be a sense of loneliness, which may be unable to be expressed to others or may not even be recognised by the highly alexithymic person (Taylor, 2011). Taylor (2011) provided insight into the profound loneliness that can exist in those with severe alexithymia, which can be present despite being in a relationship with a significant other. Indeed, Frye-Cox and Hesse (2013) found that in married couples, “higher alexithymia was associated with greater loneliness, which predicted lower intimate communication, which was related to lower marital quality” (p. 203).

   From a clinical standpoint, it may be that educating highly alexithymic individuals, and their more emotionally competent partners, about the cycle of empathic understanding provided and received could be a fundamental way of helping these couples to interrupt the negative trajectory that may be occurring within their relationships. Although the alexithymic partner may not be able to respond from an emotional inner experiencing, if the desire and motivation are present, he or she may have the capacity to respond from a cognitive and literal perspective. Although this kind of responding would not represent true Phase 2 empathy (e.g., Barrett-Lennard, 2003), it could provide a communication method that is within their capabilities, and demonstrate to their partners a willingness to meet their needs as much as is possible. If more emotionally competent partners also learn to provide empathy, their understanding may increase of the emotional difficulties that are influencing the marital distress, and they may develop greater compassion for their alexithymic spouses. This, in turn, may have the potential to improve the quality of the couples’ relationships.

   Swiller (1988) stated that when treating highly alexithymic individuals, part of the therapists’ role will be that of a teacher. In educating couple partners who have alexithymic discrepancies, the well-known listener-speaker exercise detailed in the research purpose section seems to have merit. Although that method is often utilised in treatment with therapy couples, it may be particularly applicable for alexithymic-discrepant couples. The value of this exercise is that it is achievable for both partners, has the potential to engender greater understanding of their differing perspectives, requires partners to join together with a shared focus on the achievement of a common goal, and it can continue to have benefits as the process is practised and generalised to situations outside of the therapeutic setting. Moreover, it has the potential to create a sense of positive emotional connection within their relationships. As Barrett-Lennard (2003) indicated, it is through empathic understanding that emotional connection is possible.

   Emotional Connection

   In support of the importance of emotional connection within intimate relationships, Lewis (1998) reported findings based on three decades of clinical experience, and cross-sectional and longitudinal research conducted under the auspices of The Timberlawn Studies. Lewis (1998) concluded that the common characteristics prevailing in well-functioning marriages involve: (1) a strong emotional connection existing between the couple partners, (2) a balance between partners’ separateness and connection, and (3) the ability to repair connections following unavoidable times of low synchrony.

   Expanding on Lewis (1998), Gottman (1999), and Gottman and DeClaire (2001), stated that a major cause of divorce is the failure of couples to connect emotionally. To achieve such connection, an important relational element is that couples need to be mindful of, and attend to, the often-overlooked everyday moments of interpersonal interaction, as this can assist in regulating conflict within relationships Gottman & DeClaire, 2001).

   Past research examining marital disharmony has found that the most commonly given reason by couples for wanting to divorce is feeling unloved (Gigy & Kelly, 1992). This is consistent with Gottman (1999) who stated “the interactions of couples in treatment are often not characterized by intense fighting but by emotional distance and the absence of affect” [emphasis in original] (p. 24). Based on over 40 years of clinical experience and empirical investigation into the dynamics of successful and unsuccessful relationships, John Gottman and colleagues have examined the importance of emotion in relationships, how emotional distance is created, and the ways in which emotional connection can be strengthened (e.g., Gottman, 1999; Gottman & DeClaire, 2001; Schwartz Gottman, 2004).

   Gottman and DeClaire (2001) suggested that a large part of emotional connection involves emotional expression, which serves a number of functions. These authors suggested that the process of identifying and naming feelings activates areas in the brain that are related to logic and language. If such activation is followed by expression, there can be a greater sense of control over emotions, and use of emotional information to guide action. This can lead to the adoption of coping strategies aimed at regulating negative affect, gains in social support, a subsequent reduction in stress, and more adaptive outcomes. Moreover, having awareness and empathic understanding of one’s own emotions, and the emotions of one’s partner, provide a base for the kind of emotional connection possible, and the level of intimacy, support, and closeness that can be achieved within a significant relationship. All of these features resonate with the difficulties experienced by those with alexithymia.
   Within couples, there are two important emotion-related processes that occur that are highly predictive of the success or failure of their relationships. One process involves discrepancies in couple partners’ views, expression, and experience of emotion, and these mismatches alone create relationship problems and can predict divorce with 80% accuracy (Gottman, 1999; Gottman, Katz, & Hooven, 1996). The second process involves crucial interpersonal behaviours that can predict the success or failure of an intimate relationship with 91% accuracy (Gottman & Silver, 1999). This second process relates to “two simple truths” about improving intimate relationships (Gottman & DeClaire, 2006, p. 3). One truth is that with happy couples, “their relationships are characterized by respect, affection, and empathy”, they have a high ratio of positive to negative behaviours during conflict, and they feel emotionally connected (Gottman & DeClaire, 2006, pp. 3-4). These characteristics are related to the second truth, which suggests that happy couples “handle their conflicts in gentle, positive ways” (Gottman & DeClaire, 2006, p. 4).

   In line with the basic principles of successful relationships, Gottman (1999) developed a theory called The Sound Marital House, which was later renamed The Sound Relational House theory (SRH; Schwartz Gottman, 2004). The development of this theory was based on a 14-year longitudinal study involving over 700 couples, whereby primary relationship elements were identified in couples who stayed together. Findings indicated that couples who successfully stayed together approached their relationships with three main objectives: (1) their romance was kept alive through the fundamentals of friendship, (2) they managed their conflicts well, and (3) they created a shared sense of meaning that knitted their lives together (Schwartz Gottman, 1994, p. 2).

   Based on achieving these objectives, The SRH theory can be likened to a house that is subdivided into seven levels, with the first three levels representing the foundation for building strong relationships. Essentially, if couples do not have the first three levels, the rest of the house will be built on a tenuous base. Briefly, starting from the bottom, the levels involve: (1) Love Maps – these represent the knowledge we have about our partner’s internal and external worlds. Happy couples accept that each other’s lives are constantly changing and they actively seek to continually update their knowledge; (2) Fondness and Admiration – this involves voicing thoughts and feelings of care and respect for our partners; (3) Turning Toward – this is a vital element, which represents the nuts and bolts that hold the Sound Relational House together, and involves positively responding to a partner’s bid for connection; (4) Positive Sentiment Override – this is the positive bonus perspective that is attained when the first three levels have been solidly built; (5) Managing Solvable Problems – this involves regulation of conflict, recognising when problems are solvable rather than perpetual, discussing problems using a soft start-up rather than criticism (i.e., starting conversations with ‘I’ instead of a blaming approach of ‘you’), having the ability to repair the impact of negative or hurtful words and actions, being able to self-soothe when physiologically aroused, accepting influence from a partner, and showing compromise during conflict resolution; (6) Dialogue with Perpetual Problems and Honoring Each Other’s Dreams – this includes utilising the speaker-listener exercise to understand each other’s perspectives, with the aim of moving past conflicts that are perpetual and gridlocked; and (7) Creating Shared Meaning – this incorporates the concept of Love Maps whereby partners come to know each other on a deeply meaningful level (Gottman, 1999; Gottman & DeClaire, 2001; Schwartz Gottman, 2004, pp. 3-8).

   Although all of the levels are important, the focus in the current research with couples is the level three component of turning toward as it appears to be the ‘glue’ that holds the relationship house together, particularly in terms of sustaining the friendship and deepening the couple’s connection. The level of turning toward is incorporated into the SRH theory through a concept involving the behaviours that couple partners utilise in response to each other’s attempts to gain greater emotional closeness and connection.

   Gottman and DeClaire (2001) proposed that when attempting to connect with others, people make verbal and nonverbal bids (that is, gestures, facial and body expressions, questions, etc.) to each other for emotional closeness, and that individuals typically respond to others’ bids in one of three ways: (1) turn toward the other (responding in a positive and interested way); (2) turn away from the other (responding by ignoring the other person or acting preoccupied); or (3) turn against the other (responding in a belligerent or critical way). Reported findings from longitudinal research (at a ten-year follow-up time) indicated that couples who consistently turn toward each other “develop stable, long-lasting relationships rich in good feelings for one another” (Gottman & DeClaire, 2001, p. 16). The majority of couples who consistently turn against each other eventually separate and/or divorce. However, couples who consistently turn away from each other show the earlier divorces.

   Although the actions of turning against and turning away from each other are destructive to couples’ relationships, the most harmful communication pattern is that of unrequited turning. This occurs when one partner regularly turns toward the other whilst the other partner regularly turns away. Couples who engage in this style of connecting have the earliest divorces of all of the groups (Gottman & De Claire, 2001).

   Aligned with the processes involved in the emotional connection behaviours, Gottman’s (1998) relationship research review indicated that distressed and nondistressed couples differ in their interactional response patterns, and that seven dysfunctional interactional patterns appear to be predictive of relationship discord, separation, and divorce. Compared to couples in happy relationships, unhappy couples show patterns of: (1) greater reciprocal negative affect, which is believed to be related to failing to repair negative affect and interactions; (2) lower ratios of expressed positive to negative emotions, which has an optimal level of five positive interactions to every one negative interaction; (3) less positive sentiment override, which refers to global feelings of affection or disaffection for a partner; (4) interaction patterns containing criticism, defensiveness, contempt, and listener withdrawal; (5) greater female demand-male withdraw patterns; (6) persistent negative attributions about the partner, and negative narratives about the relationship; and (7) higher physiological arousal, for which distressed couples are unable to provide stress-reducing soothing.

   Gottman (1998) suggested that, although the seven interactional patterns represent vital elements in the quality of relationships, investigation into the origins of such patterns has resulted in psychologists seeking answers in the wrong place, which is, focusing on the area of conflict resolution. Consequently, Gottman (1998) proposed an alternative integrated aetiological relationship theory, called the Bank Account Model (BAM), to account for how the dysfunctional patterns of relating originate and interact. As will be shown below, the BAM theory incorporates the features of the first three levels in the Sound Relational House theory.

   The Bank Account Model (BAM) Theory

   The BAM theory is based on the view that within relationships, high rates of positive reciprocal connections (bids) accumulate over time, and result in a reservoir of good feelings and positive emotional ‘money in the bank’, which is then drawn upon to help de-escalate negative feelings during times of conflict (Gottman, 1999; Gottman & DeClaire, 2001; Schwartz Gottman, 2004).

   The BAM theory proposes that the seven dysfunctional interaction patterns reflect the final stage of a failure of three related processes: (1) the ratio of low levels of positivity to negativity when interacting about the day-to-day, mundane situations of life (i.e., the responses to bids when in nonconflict interactions); (2) the level of ‘cognitive room’ or thinking about the partner, his or her world, and the relationship (i.e., the couple’s Love Map); and (3) the level of spontaneous expressions of admiration and affection for a partner (i.e., the Fondness and Admiration System).

   Gottman (1998) suggested that the interrelatedness of the three processes occurs because a high ratio of low positivity to negativity in nonconflict interactions is associated with greater turning away than turning toward one’s partner, which can result in an accumulation of everyday moments to which a partner’s bids for emotional closeness are not responded. The lack of responsiveness can lead to criticism, which may lead to contempt, defensiveness, and listener withdrawal.

   Furthermore, a higher level of turning toward leads to positive sentiment override, whereas greater turning away leads to negative sentiment override. A central influence in positive sentiment override is providing physiological soothing to one’s partner during interactions concerning the day-to-day details of the couple’s life events. Physiological soothing can occur through using stress-reducing actions such as showing interest and affection, and providing validation, humour, and empathy. The amount of cognitive room or thinking allocated to one’s partner, his or her life, and the relationship, is an important predictor in the longevity of the relationship, particularly for males. This process involves knowing about one’s partner’s life, and continually updating that knowledge. The degree of spontaneous expression of admiration and affection to one’s partner also contributes to positive or negative sentiment override. Positive or negative sentiment override determines whether repair can occur when in conflict situations, and successful repair reduces negative affect reciprocity (Gottman, 1998).

   In examining the role that emotional connection plays in couples’ relationships, together with the BAM theory (Gottman, 1998; Gottman & DeClaire, 2001), there appear to be striking conceptual comparisons that can be made with high levels of alexithymia.
   Moreover, it is proposed that these views lend some explanatory power to the ways in which alexithymia may produce a negative impact on some couples’ relationships.

   Alexithymia, Emotional Connection, and the BAM Theory

   The alexithymia deficits, and the associated difficulties with empathy and relationships, may lead to difficulty demonstrating and responding to emotional bids, and a subsequent inability to form a deep emotional connection with a partner. Therefore, it may be that, in couples’ relationships involving alexithymic-discrepant partners, the relationship begins well due to the partner with high alexithymia presenting as a well-functioning and capable individual. However, difficulties may gradually arise because there is little empathic understanding provided by the alexithymic partner, misreading of non-verbal emotional cues, and because the partner who is more emotionally competent makes frequent emotional bids (turning toward) to which the highly alexithymic partner is unable to respond emotionally. The partner making the emotional bids may perceive this as continual turning away or turning against, thus resulting in an accumulation of everyday moments of unrequited turning, which leads to a sense of emotional disconnectedness and distance. The continual unrequited turning may begin a trajectory leading to failure of the three related processes identified in the BAM theory, and resulting in the seven dysfunctional interaction patterns that are predictive of separation and divorce.

   Given the importance of relationships to individuals’ well-being, and the empirical and conceptual linkages that have been made, there seems a compelling need to examine the effects of alexithymia on couples’ empathy, emotional connection, and relationship dissatisfaction. To date, despite consistent notation of the interpersonal difficulties created by high levels of alexithymia (e.g., Hesse & Floyd, 2008; Krystal, 1982-83; Montebarocci et al., 2004; Swiller, 1988; Taylor, 2001; Vanheule, Desmet et al., 2007a; Vanheule, Desmet, Rosseel et al., 2007b; Vanheule, Meganck, & Desmet, 2011; Vanheule et al., 2010), there has been comparatively little systematic investigation of the influences of alexithymia within couples’ relationships. It has been only over the past 12 years that a gradually emerging body of research has directed an empirical focus toward this area.

   Recommended Citation
   McNeill, P. D. (2015). Duet for life: Is alexithymia a key note in couples’ empathy, emotional connection, relationship dissatisfaction, and therapy outcomes?. https://ro.ecu.edu.au/theses/1670

   https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2671&context=theses

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8. Bob Rijs

   April 8, 2023 at 1:45 pm

   (Third Part)

   Alexithymia and Couples’ Relationships

   Within the literature on alexithymia and couples’ relationships, an extensive search indicated that up until 2013, 12 studies had been conducted. Of these, 11 are published studies (Cordova et al., 2005; Eid & Boucher, 2012; Eid & Boucher, 2012; Eizaguirre, 2002; Foran et al., 2012; Frye & Feistman, 2010; Frye-Cox & Hesse, 2013; Humphreys et al., 2009; Mirgain & Cordova, 2007; Pérusse, Boucher, & Fernet, 2012; Wachs & Cordova, 2007; Yelsma & Marrow, 2003) and one is an unpublished dissertation (Dunham, 2008).

   Review of Previous Alexithymia and Couples’ Research Methodology

   Although the samples in all of the studies were non-therapy heterosexual community couples, the nature of the samples varied. Whilst some of the samples consisted of intact community couples who were living in marital and/or de facto relationships (Cordova et al., 2005; Dunham, 2008; Eizaguirre, 2002; Foran et al., 2012; Frye-Cox & Hesse, 2013; Mirgain & Cordova, 2007; Wachs & Cordova, 2007; Yelsma & Marrow, 2003), other samples comprised university students and their spouses (Eid & Boucher, 2012), university students and their intimate partners who had been dating for a minimum of three months (Frye & Feistman, 2010), married, cohabiting, and dating couples that contained one partner who was attending a university (Pérusse et al., 2012), and university students who were in a couple relationship, but not with each other (Humphreys et al., 2009).

   Seven studies examined alexithymia and couples’ relationship quality (Eid & Boucher, 2012; Eizaguirre, 2002; Foran et al., 2012; Frye & Feistman, 2010; Frye-Cox & Hesse, 2013; Humphreys et al., 2009; Yelsma & Marrow, 2003), and four studies indirectly tested this association through utilising facets of the TAS-20 alexithymia measure to assess ‘emotion skills’ in marriage (Cordova et al., 2005; Dunham, 2008; Mirgain & Cordova, 2007; Wachs & Cordova, 2007). Pérusse et al. (2012) examined alexithymia and couples’ relationships but did not include a measure of relationship quality.

   There were dissimilarities in the alexithymia variables tested, and despite all of the studies utilising the alexithymia TAS-20 measure, different aspects of that scale were employed. Variations included use of the total TAS-20 scale and its three factors of DIF, DDF, and EOT (Eid & Boucher, 2012; Eizaguirre, 2002; Foran et al., 2012; Humphreys et al., 2009; Pérusse et al., 2012), the total TAS-20 scale (Frye & Feistman, 2010; Frye-Cox & Hesse, 2013), and the DIF, DDF, and EOT factor subscales (Yelsma & Marrow, 2013).

   In addition, Foran et al. (2012) also tested partner-rated alexithymia using the Observer Alexithymia Scale (OAS; Haviland et al., 2000).
   In the four emotion skills studies, the TAS-20 DIF and DDF factor subscales were utilised and analysed as separate scales (Cordova et al., 2005; Dunham, 2008; Mirgain & Cordova, 2007; Wachs & Cordova, 2007); however, Mirgain and Cordova (2007), and Wachs and Cordova (2007) also summed and averaged the two subscales to produce a composite variable to measure self-reported emotion skills. Furthermore, Mirgain and Cordova (2007) used a composite DIF and DDF variable to assess observed emotion skills, and they also included DIF and DDF in two broader composite variables, one that included five emotion skills and one that included 10 emotion skills.

   The variable of empathy provided was included in two studies that utilised the TAS-20 and a marital satisfaction measure (i.e., Mirgain & Cordova, 2007; Wachs & Cordova, 2007). In both of these studies, the empathy instrument was the Interpersonal Reactivity Index (IRI, Davis, 1980). Both Mirgain and Cordova (2007), and Wachs and Cordova (2007), utilised the IRI subscales of Perspective Taking, Empathic Concern, and Personal Distress separately, and Mirgain and Cordova (2007) also constructed a composite measure whereby scores on the three subscales were averaged to create a global empathy score.

   In the research that has included an outcome measure of relationship quality, variations exist in the measures employed. Most studies used the Dyadic Adjustment Scale (DAS; Spanier, 1976) to assess relationship satisfaction (Cordova et al., 2005; Eid & Boucher, 2012; Eizaguirre, 2002; Foran et al., 2012; Wachs & Cordova, 2007; Yelsma & Marrow, 2003), and the revised DAS (RDAS; Busby, Christensen, Crane, & Larson, 1995) was used by Dunham (2008) and by Frye-Cox and Hesse (2013). Humphreys et al. (2009) used the Relationship Assessment Scale (RAS; Hendrick, 1988), and Frye and Feistman (2010) employed the Investment Model Scale (IMS; Rusbult et al., 1998). Mirgain and Cordova (2007) used the Global Distress Scale (GDS) of the revised Marital Satisfaction Inventory (MSI-R; Snyder, 1997), which provides a measure of relationship dissatisfaction. Foran et al. (2012) also included the GDS as an additional relationship quality measure.

   In examining the analytic strategies utilised in the above-cited research, a range of different methods were employed. Along with consideration of these strategies, it is important to take into account the issue of nonindependence, or relatedness, of couple data because, in dyadic research, the analysis is often guided by this feature (Kenny et al., 2006). Note that the salient features relating to nonindependent dyadic data are detailed in a later section.

   Within the research being reviewed here, the issue of dyadic data nonindependence was avoided in a number of ways. For example, by sampling unrelated couple partners (Humphreys et al., 2009), analysing intact husbands’, and wives’, data separately (Cordova et al., 2005; Dunham, 2008; Eizaguirre, 2002; Foran et al., 2012; Mirgain & Cordova, 2008; Yelsma & Marrow, 2003), and/or by combining the spouses’ data to form one group (Humphreys et al., 2009; Wachs & Cordova, 2007). As a result of these strategies, the analyses treated the ‘individual’ rather than the ‘couple’ as the unit of analysis.

   Three of the studies addressed data relatedness through utilising analyses that enabled the ‘couple’ to be the unit of analysis. These studies sampled intact couples, and assessed mutual influences between spouses through use of the Actor-Partner Interdependence Model (APIM; Kenny et al., 2006); however, this technique was used in various ways. Eid and Boucher (2012) used the APIM within Structural Equation Modeling (SEM) to test actor and partner effects, and to compare the findings from the APIM technique to findings based on simple correlational analyses. Frye and Feistman (2010) used the APIM within path analysis to test actor and partner effects, and Frye-Cox and Hesse (2013) used the APIM within SEM to test a mediation model to explain the association between alexithymia and marital satisfaction.

   With regard to alexithymia, emotional connection, and couples’ relationships, there does not appear to have been any research investigating this combination of variables with individuals or with couples.

   Review of Previous Alexithymia and Couples’ Research Findings

   The review of the findings from previous research pertaining to alexithymia and couples will commence with the studies that either did not include a relationship quality measure or did not sample cohabiting couples. This will be followed by the studies that included relationship quality measures and comprised samples of dating, married, or de facto couples. In the interest of concision, brief descriptions of the studies and the main findings will be presented.

   Pérusse et al. (2012) sampled a group comprising 75 married, cohabiting, or dating couples that contained one partner who was attending a university. Although a measure of relationship satisfaction was not included, couples’ alexithymia was examined in association with observations of couples’ communication behaviours of hostility, withdrawal, communication skills (in terms of identifying and expressing emotion), and support and validation (regarding positive listening and behaviours used to show support and understanding of a partner). Findings indicated that males reported greater DDF, EOT, withdrawal, and support-validation than did females, and females reported greater hostility and communication skills than did males. The APIM found that males’ DIF was positively associated with their own hostility, and the hostility, withdrawal, and decreased communication skills of their partners. Males’ DDF was associated with their partners’ hostility. For the females, there were no significant relationships found between DIF, DDF, or EOT and their own communication behaviours, or those of their partners.

   Mediation analyses indicated that males’ DIF was positively associated with their own hostility, which was then associated with a decrease in their partners’ communication behaviours.

   Humphreys et al. (2009) utilised a sample of 158 unrelated undergraduate students who were in couple relationships, and assessed alexithymia, relationship satisfaction, sexual satisfaction, and positive and negative affect. No gender differences were found between males and females on the TAS-20, DIF, DDF, or EOT. Total sample analyses found that the TAS-20, DIF, DDF, and EOT were all positively correlated with each other. The alexithymia variables were also all negatively associated with relationship satisfaction and with sexual satisfaction, and relationship satisfaction and sexual satisfaction were positively correlated. Negative affect was positively associated with the TAS-20, DIF and DDF.

   Frye and Feistman (2010) sampled 53 university students and their partners, who had been in a couple relationship for an average of 26.47 months. These authors assessed couples on the TAS-20 and relationship quality. No gender differences were found on either of the measures. Findings from APIM analyses indicated that males’ TAS-20 was negatively associated with their own, and their partners’, relationship satisfaction and level of commitment to the relationship. No significant effects were found for females.

   Eid and Boucher (2012) employed a sample of 84 university students and their partners (relationship status not reported), and investigated the TAS-20, DIF, DDF, and EOT in association with the Dyadic Adjustment Scale (DAS). Results indicated that males had higher scores than females on the TAS-20, DIF, DDF, and EOT, and there were no gender differences on the DAS. Males and females were positively correlated on the total TAS-20, DIF, DDF, and EOT. Analyses utilising the APIM found that males’ TAS-20 and DDF were negatively associated with their own relationship satisfaction, and that males’ TAS-20, DIF, and DDF were negatively associated with their partners’ relationship satisfaction.

   Females’ TAS-20, DIF, and DDF were negatively associated with their own relationship satisfaction, and their DDF was negatively associated with their partners’ relationship satisfaction.
   Eizaguirre (2002) examined 72 couples’ alexithymia and dyadic adjustment. The TAS-20, DIF, DDF, and EOT, and the Dyadic Adjustment Scale (DAS) measures were utilised.

   Findings indicated that there were no gender differences on the TAS-20, DIF, DDF, or EOT. Husbands’ DIF was negatively correlated with their own relationship satisfaction, and husbands with a high degree of alexithymia had lower relationship satisfaction than did husbands with a low degree of alexithymia. Wives showed no associations between the alexithymia and relationship satisfaction variables, and there were no differences in relationship satisfaction between those who had a high or low degree of alexithymia.

   James Cordova and colleagues (i.e., Cordova et al., 2005; Mirgain & Cordova, 2007; Wachs & Cordova, 2007) have been conducting a program of research examining the role of emotion skills in marital health. Although these researchers have not been assessing alexithymia per se, they have utilised the two TAS-20 subscales of difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) as measures of emotion skills.
   Cordova et al. (2005) explored associations between emotion skills (operationalised as DIF and DDF), intimate safety, and the DAS (marital adjustment/satisfaction) in 92 married couples. Findings indicated that husbands were higher on DDF than wives, and there were no gender differences on DIF. Husbands and wives were positively correlated on DIF and DDF. Significant positive correlations were also found between husbands’ DIF and wives’ DDF, and between wives’ DIF and husbands’ DDF.

   In addition, husbands’, and wives’, DIF and DDF were negatively correlated with their own marital satisfaction and intimate safety. Both husbands’, and wives’, DIF was negatively correlated with their partners’ relationship satisfaction. However, the association between husbands’ DIF and wives’ relationship satisfaction was fully mediated by wives’ intimate safety. Husbands’ DIF was negatively correlated with wives’ intimate safety. Wives’ DIF was not significantly correlated with husbands’ intimate safety.

   Husbands’ DDF was negatively correlated with wives’ relationship satisfaction and intimate safety. This association was fully mediated by wives’ intimate safety. Wives’ DDF was not correlated with husbands’ relationship satisfaction or intimate safety (Cordova et al., 2005).

   In summarizing the main findings by Cordova et al. (2005), husbands had significantly greater difficulty describing their feelings (DDF) than did wives, and both husbands’, and wives’, difficulty identifying feelings (DIF) negatively affected their own and their partners’ relationship satisfaction. Although husbands’ difficulty identifying feelings also negatively affected wives’ intimate safety, the wives did not have a reciprocal influence on their husbands. Both husbands’, and wives’, difficulty describing feelings negatively affected their own relationship satisfaction and intimate safety. Whilst husbands’ difficulty describing feelings negatively influenced wives’ relationship satisfaction and intimate safety, again, the wives did not have a reciprocal influence on their husbands. The negative associations between the husbands’ two emotion skills and wives’ relationship satisfaction were mediated by wives’ sense of intimate safety.

   Dunham (2008) replicated the study by Cordova et al. (2005) and examined a sample comprising 132 African American married couples who were recruited primarily from local area churches in North and South Carolina. Consistent with Cordova et al. (2005), Dunham operationalised emotional skillfulness as DIF and DDF but utilised revised versions of the DAS and intimate safety measures.

   In comparing and contrasting the findings by Dunham (2008) and Cordova et al. (2005), where both studies found no significant gender difference on DIF, in contrast to Cordova et al., Dunham also found no significant gender difference on DDF. Both Cordova et al. and Dunham found positive correlations between husbands and wives on DIF, but in contrast to Cordova et al., Dunham did not find a correlation on DDF.

   In both studies, husbands’, and wives’, DIF was negatively associated with their own and their partners’ relationship satisfaction. Contrasting with Cordova et al., Dunham found that both husbands’, and wives’, DIF was negatively associated with their own and their partners’ intimate safety. Similarly to Cordova et al., Dunham found that husbands’ DDF negatively affected their own and their wives’ relationship satisfaction, and wives’ DDF negatively affected their own but not their husbands’ relationship satisfaction. Both Dunham and Cordova et al. found that husbands’, and wives’, DDF was negatively associated with their own intimate safety, and that husbands’ DDF was negatively associated with their wives’ intimate safety. In contrast to Cordova et al., Dunham found that wives’ DDF also negatively affected husbands’ intimate safety. Finally, where Cordova et al. found that only wives’ intimate safety fully mediated the associations between husbands’ DIF, DDF, and wives’ relationship satisfaction, Dunham found that intimate safety fully mediated the associations between both husbands’ and wives’ own DIF, DDF, and their partners’ relationship satisfaction.

   Mirgain and Cordova (2007) expanded examination of associations between couples’ emotion skills, intimacy, and relationship dissatisfaction (MSI-R global distress scale), and also initiated development of an observational measure of emotion skills. Participants were 76 married couples who were assessed on a range of emotion indices that included DIF and DDF (which were averaged to create a global measure of emotional difficulties), emotion control, comfort with emotional expression, and empathy (utilising the IRI; Davis 1980). The empathy subscales of perspective taking, empathic concern, and personal distress were analysed separately, and also averaged to create a global empathy score.

   Mirgain and Cordova (2007) also included DIF and DDF in two broader composite variables that included 5 emotion skills and 10 emotion skills.
   Findings by Mirgain and Cordova (2007) suggested that there were no gender differences on DIF or DDF. Observations indicated that, compared to husbands, wives expressed more non-hostile negative emotions, named their feelings more often, and showed less defensiveness. With the self-report measures, compared to husbands, wives showed greater empathic concern, less discomfort with others’ personal distress, and less inhibition of emotional responses (p. 995). Both wives’, and husbands’, emotion skills were negatively associated with their own and their partners’ relationship dissatisfaction.

   Furthermore, although feelings of intimate safety partially mediated associations between emotion skills and relationship dissatisfaction, emotion skills were also shown to have direct effects on relationship dissatisfaction (on both observational and self-report measures). Overall, wives had greater emotional skillfulness than husbands.

   Wachs and Cordova (2007) examined the theory that “mindfulness contributes to greater intimate relationship satisfaction by fostering more relationally skillful emotion repertoires” (p. 464). The sample comprised 33 married couples who had taken part in the study on emotional skillfulness conducted by Cordova et al. (2005). Participants’ previous responses on relationship satisfaction and emotion skills (DIF and DDF) were included in the study, as well as additional measures of empathy (using the IRI), life satisfaction, mindful awareness, and relationship quality indices, which were completed via telephone.

   With the empathy subscale of personal distress, the authors changed the directionality to reflect a lack of personal distress.
   The results indicated that there were no significant gender differences on the mindfulness and marital quality scales. Wachs and Cordova (2007) stated that analysing husbands’, and wives’, scores separately did not change the results substantially and they therefore collapsed the couples’ scores by taking the mean. Couple-level analyses were utilised to test mindfulness and the other study variables.

   According to Wachs and Cordova (2007), findings indicated that couple-level DIF was positively associated with DDF, anger in, anger out, impulsivity, and aggression, and was negatively associated with relationship satisfaction, lack of personal distress, and control of anger out. DDF was positively associated with anger in and impulsivity, and negatively associated with relationship satisfaction and control of anger out. Relationship satisfaction was positively associated with lack of personal distress and control of anger out, and was negatively associated with anger out, impulsivity, and aggression. Additional findings were that mindful awareness was positively correlated with relationship satisfaction, empathic concern, perspective taking, lack of personal distress, control of anger in and control of anger out. Mindfulness was negatively associated with DIF, DDF, anger out, lack of aggression control, impulsivity, and aggression.

   With regard to the empathy subscales, empathic concern was positively associated with perspective taking, control of anger in, and control of anger out, and negatively associated with lack of aggression control. Perspective taking was positively associated with lack of personal distress, control of anger in, control of anger out, and anger in, and negatively associated with lack of aggression control and impulsivity. Lack of personal distress was positively associated with control of anger in and control of anger out.

   Foran et al. (2012) sampled 104 couples who were either married or living in a de facto relationship. These authors utilised a large battery of measures that assessed a variety of variables. Relevant to the current research, the alexithymia measure was the TAS-20, and the DIF, DDF, and EOT factors, and the relationship quality scales were the DAS and the relationship dissatisfaction scale (GDS) of the MSI-R.

   Foran et al. (2012) found positive correlations between husbands’ TAS-20 and wives’ DIF, DDF, and EOT, and between wives’ TAS-20 and husbands’ DIF, DDF, and EOT.
   Positive correlations were also found between husbands’ DIF and wives’ DDF, husbands’ DDF and wives’ DIF and EOT, and between husbands’ EOT and wives DIF and DDF.

   In addition, for both husbands and wives, their own TAS-20 scores were correlated with their own decreases in relationship satisfaction and increases in their own relationship dissatisfaction. Husbands’ TAS-20 was not associated with wives’ relationship satisfaction or dissatisfaction; however, wives’ TAS-20 was negatively correlated with husbands’ relationship satisfaction and positively correlated with husbands’ relationship dissatisfaction.

   Frye-Cox and Hesse (2013) sampled 155 married couples, and assessed them on the TAS-20, the revised DAS, loneliness, and intimate communication. Findings indicated that for husbands, and wives, their own TAS-20 was negatively related to their own, and their partners’, relationship satisfaction. Also, wives’ loneliness was associated with decreases in their own, and their husbands’, relationship satisfaction. Husbands’, and wives’, own loneliness was associated with their own lower degree of intimate communication. Mediation analyses indicated that for both spouses, their own alexithymia was associated with greater loneliness, which predicted less intimate communication, which was related to lower marital quality. For both husbands, and wives, their own loneliness mediated the association between their own alexithymia and intimate communication. It is noteworthy that Frye-Cox and Hesse (2013) were the only authors to test both direct and indirect effects when utilising the mediation analyses, which adds considerable rigour to the study and its findings.

   It seems that to date, there has not been any investigation of couples’ TAS-20 discrepancies and their influence on relationship (dis)satisfaction. However, Yelsma and Marrow (2003) explored couple partners’ differences on the TAS-20 factors, and their effects on partners’ relationship satisfaction; the differences were examined in terms of which spouse had the higher score on the factors. Yelsma and Marrow (2003) sampled 66 couples (58 married and 8 cohabiting), and examined associations between husbands’ and wives’ differences in their emotional expressiveness (operationalised as the TAS-20 factors difficulty identifying feelings (DIF); difficulty describing feelings (DDF), and difficulty personalizing feelings, which relates to the externally oriented thinking factor of EOT) and relationship satisfaction (utilising the DAS).

   Yelsma and Marrow (2003) initially found no gender differences on DIF, DDF, EOT, or on relationship satisfaction. However, after examining mean differences between the couples, significant differences were found between husbands and wives’ DDF and EOT, but not for DIF. No significant difference was found between husbands and wives’ relationship satisfaction mean scores (pp. 53-54). Further analyses found that DIF, DDF, and EOT predicted husbands’, and wives’, marital satisfaction, and that 12% of the variance in marital satisfaction was accounted for by the three measures.

   With regard to emotion-related discrepancies between partners, 36 wives (54%) reported greater DIF than did their husbands, and 29 husbands (44%) reported greater DIF than did their wives. Twenty five wives (37%) reported greater DDF than did their husbands whereas 38 husbands (60%) reported greater DDF than did their wives. Twenty wives (30%) reported greater EOT than did their husbands, and 40 husbands (66%) reported greater EOT than did their wives. Also, some couples had the same levels of emotion-related difficulties: one couple had the same levels of DIF; three couples had the same levels of DDF; and six couples had the same levels of EOT (Yelsma & Marrow, 2003, p. 53). In examining husbands’, and wives’, specific emotion-related differences when each gender was higher in emotional expressiveness than the other, Yelsma and Marrow (2003, pp. 54-55) reported the following findings:

   When husbands had greater DIF than did wives, there was no significant influence on husbands’, or wives’, relationship satisfaction. When husbands had greater DDF and EOT than did wives, only the husbands’ own relationship satisfaction decreased. Although Yelsma and Marrow (2003) reported that wives’ relationship satisfaction also decreased with husbands’ higher DDF, the p value was .06, indicating that if utilising a significance level of .05, the finding may be better described as ‘approaching significance’.

   Unfortunately, the authors did not state the overall study significance level against which the findings were evaluated. Furthermore, when wives had greater DIF than did husbands, both wives’ and husbands’ relationship satisfaction decreased. When wives showed greater DDF and EOT than did husbands, there was no significant influence on wives’, or husbands’, relationship satisfaction.

   Thus, it appears that discrepancies between couple partners’ alexithymia-related difficulties adversely affect both their own, and their partners’, relationship satisfaction.
   Of particular interest is that Yelsma and Marrow (2003) found that, of the two genders, husbands were more influenced by their own, and their wives’, emotion-related difficulties than were wives by their husbands’ difficulties.

   This body of research has importance to the alexithymia literature; however, there are some limitations of note. As can be seen, all of the studies utilised community samples of couples, with no consideration given to the impact of alexithymia within couples who are having relationship therapy. Also, some of the methodological and analytic strategies contain aspects that warrant enhancement. Although the inclusion of empathy in the studies by Mirgain and Cordova (2007), and Wachs and Cordova (2007), is of value, the method of collapsing multiple emotion-related variables to form composite measures creates a lack of specificity in the findings, particularly regarding associations between alexithymia, empathy, and relationship satisfaction; thus, these associations remain unclear. Additionally, the aspect of empathy received was not tested, and there also appears to have been no previous research examining the influence of alexithymia on couples’ emotional connection.

   Limitations notwithstanding, this previous research has provided a sound foundation for further investigation into alexithymia within couples, and the ways in which it influences partners and their sense of satisfaction or dissatisfaction with their relationships. The findings have also provided a base of evidence indicating that alexithymia and its emotion-related factors can have deleterious effects on couple partners’ relationship satisfaction; although, at times, the effect may be indirect. In addition, the discovery that partners’ DIF, DDF, and EOT factor discrepancies have negative influences on their relationship satisfaction shows some support for the work of Swiller (1988), and Gottman (1999), in terms of the adverse effects that couple partners’ emotional mismatches can have on their relationships: This has particular relevance to the clinical field.

   Clinically, when a couple with alexithymia-related distress attends for relationship therapy, it is probable that their fundamental issue will be that of marked differences in their levels of alexithymia, and hence, their emotional competencies: Such couples may present citing ‘communication problems’ and ‘a lack of closeness’ as their main concerns (Swiller, 1988). Although experienced clinicians may be familiar with the emotion-related features that characterise alexithymia (Taylor & Bagby, 2013), they may not be aware of the alexithymia construct, its scope, or that it differs from having the emotional capacity to identify and express feelings and feeling inhibited to do so (e.g. Pennebaker & Traue, 1993). Therefore, therapists’ knowledge of alexithymia is necessary to enable accurate distinction between different emotional capabilities in clients, and to understand the therapeutic processes that may be involved when treating highly alexithymic individuals and couples.

   Summary

   The review of the alexithymia-related literature has aimed to provide a sound basis of information that may facilitate understanding of alexithymia and the implications it can have for individuals, couples, and their therapeutic outcomes. The primary intention has been to assist clinicians who may have little knowledge of alexithymia or the scope of the construct.

   Alexithymia is not considered a disorder per se as the emotional difficulties can exist in the general population as well as in people with medical, developmental, mental health, and relational issues. As such, it may be viewed as an underlying comorbid feature that can exacerbate any condition or relational problem that an individual may have. Furthermore, the presence of high alexithymia may have serious consequences for the well-being of the affected individuals, their partners, and the processes that occur when they seek professional help for their distress.

   Throughout the process of therapy, the main sources of influence are the client, the therapist, and the alliance that is able to be formed. Within this triad of influence, it appears that therapists hold the pivotal position, and that their responses to the interpersonal styles of highly alexithymic individuals can adversely impact on all three elements. In this, the importance has been emphasised of therapists having awareness and knowledge of alexithymia.

   Within the alexithymia literature pertaining to couples and therapists, some important empirical gaps have been identified. These gaps pertain to investigating couples’ alexithymia in association with empathy received, emotional connection, and alexithymia discrepancies between couple partners. Examination is also warranted of the feasibility of utilising empathy and emotional connection behaviours as treatment strategies through testing their mediation between partners’ alexithymia and relationship dissatisfaction.

   Furthermore, there has been an empirical absence concerning alexithymia and couples who are having therapy, and therefore an inability to compare community and therapy couples to ascertain if group differences exist. In extending the clinical focus, it seems essential to explore therapists’ awareness of alexithymia, which may reveal a previously unrecognised source of influence in the poor treatment outcomes that have been noted.

   These areas of investigation represent new research directions, and they aim to expand the general, relational, and therapeutic literature on alexithymia in addition to offering possible guidelines for future clinical endeavours. An outline of the research is presented in Chapter 3.

   Recommended Citation
   McNeill, P. D. (2015). Duet for life: Is alexithymia a key note in couples’ empathy, emotional connection, relationship dissatisfaction, and therapy outcomes?. https://ro.ecu.edu.au/theses/1670

   https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2671&context=theses

   This Subject has a Really Big (very important) Role in all Chapters in the DSM & ICD but is suppressed by the APA & WHO because you can’t find ”alexithymia” in DSM-V-TR (2022), but once in the DSM-V (2013), it’s really unbelievable

   428 Sexual Dysfunctions

   Risk and Prognostic Factors

   Temperamental. Neurotic personality traits may be associated with erectile problems in col-
   lege students, and submissive personality traits may be associated with erectile problems in
   men age 40 years and older. Alexithymia (i.e., deficits in cognitive processing of emotions) is
   common in men diagnosed with “psychogenic” erectile dysfunction. Erectile problems are
   common in men diagnosed with depression and post-traumatic stress disorder. Course modifiers. Risk factors for acquired erectile disorder include age, smoking tobacco, lack of physical exercise, diabetes, and decreased desire.

   Women and Violence: Alexithymia, Relational Competence and Styles, and Satisfaction with Life: A Comparative Profile Analysis (2021)

   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615153/

   Intergenerational Transmission of Alexithymia as a Predictor of Child Posttraumatic Stress Outcomes during COVID-19 (2022)

   https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=8033&context=etd

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9. Bob Rijs

   April 10, 2023 at 10:50 pm

   Dark Personalities and Induced Delusional Disorder, Part I:
   Solving the Gordian Knot of Conflict in the Family and Domestic Violence Courts

   https://www.researchgate.net/publication/369741224_Dark_Personalities_and_Induced_Delusional_Disorder_Part_I_Solving_the_Gordian_Knot_of_Conflict_in_the_Family_and_Domestic_Violence_Courts

   Dark Personalities and Induced Delusional Disorder, Part II:
   The Research Gap Underlying a Crisis in the Family and Domestic Violence Courts

   https://www.researchgate.net/publication/363197057_Dark_Personalities_and_Induced_Delusional_Disorder_Part_II_The_Research_Gap_Underlying_a_Crisis_in_the_Family_and_Domestic_Violence_Courts

   Dark Personalities and Induced Delusional Disorder, Part III:
   Identifying the Pathogenic Parenting Underlying a Crisis in the Family and Domestic Violence Courts

   https://www.researchgate.net/publication/368330924_Dark_Personalities_and_Induced_Delusional_Disorder_Part_III_Identifying_the_Pathogenic_Parenting_Underlying_a_Crisis_in_the_Family_and_Domestic_Violence_Courts

   Fading affect bias in Mexico:
   Differential fading of emotional intensity in death memories and everyday negative memories

   https://onlinelibrary.wiley.com/doi/10.1002/acp.3987

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10. JBryant

    April 18, 2023 at 9:38 pm

    Hi, Karen –

    Many thanks for the continued enlightenment on this horrific psychological abuse happening in families across the globe.

    My actual comment is for the poster, identifying himself as a Mr. Rijs:

    With all due respect, sir, I’m imagining that the majority of us who are here, come to read what Karen Woodall has to say. Perhaps I’m mistaken. In any case, I kindly suggest you create a blog of your own, rather than fill up such space in the Reply section of Ms. Woodall’s posts.
    If one wishes to find an answer to a question we have posed, for example, we are forced to scroll through your multiple and absurdly lengthy paragraphs…

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    1. karenwoodall

       April 20, 2023 at 7:05 pm

       Hi JB, thanks for your comment, I am glad what I write helps – Mr Rijs is actually incredibly helpful to this work, his research provides me with many links and helps me to dig deeper into the different subject areas. He has done some magnificent work in developing a methodology which will, if it can be seen by the right people, contribute to significant improvements in the court process in terms of assisting judges so please forgive the lengthy paragraphs, they are forming a depth research foundation. K

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       1. Bob Rijs

          May 7, 2023 at 3:00 am

          Dear Karen,

          Through my research, I have come across something that can probably be a very confrontational conviction with your connection, which may become an entrance because that person is then really confronted that all judges cannot rely on any institution, professional, body or organization or can count and no one will help them to solve these situations.

          I just can’t post the content here, because it is quite sensitive information that is not appreciated and can even have a big impact, because this person still has a lot of influence due to the rehearsal he has built up over the years.

          I’ll forward it by email.

          yours sincerely,

          Bob Rice

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11. DISORGANIZED Attachment Style (#2) | HEAL & GROW for ACoAs

    October 3, 2023 at 12:01 pm

    […] & psychological differentiate from herself (S & I) . This results in the child’s self-alienation (be the ‘good one’ by disowning their wounded part) & identity diffusion […]

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12. dartcree

    June 2, 2024 at 2:49 pm

    Need to know more.

    I feel alienated. I want to move away from people. Push them away. Hide. I’m in therapy, and it’s a mixed bag. 4 steps forward 2 back, 3 to one side. I think I’m somewhere on the spectrum between CPTSD and OSDD. I don’t think I have full alters. No memory gaps.

    I don’t want to be me. I have been ace most of my life, with flashes of hetero or gay orientation. I call myself gay at present, because men are more attractive to me than women: Breasts and soft curves are repellant. I am a gay virgin.

    In a fit of body dysmorphia, I tried to constuct in my mind’s eye a version I liked better. I couldn’t do it, not really. I knew I wanted a body that was strong, skinny to the point of gauntness, fast. But missing sexual characteristics, both primary and secondary. The perfect androgyne. This makes me a true alien. I want to create beauty. I want to BE beauty. Even for people who are ace, sex underlies so much of our culture, and also so much of creativity.

    Other parts of my wish to be hypersexual. They have never really tried. Still too much embedded shame.

    No, I’m not from a broken home. My mom and dad were together until he died.

    But I had no attachment bond to either parent. Parents weren’t with it for “Dr. Spock” Old school: Kids were sources of germs. Handle as little as possible and wash your hands after. Bottle baby from day 1. Mom had depression, uncontrolled diabetes with it’s vicious emotional cycles, postpartum psychosis, I think. Most kids, when distressed, run toward a caregiver. I ran away to hide.

    I had a bit of an intellectual bond to my dad. Chess. Math. Talks of history, economics, science while we did the dishes or laundry together. Then he got cancer. I was 11. Operation successful, but he was more remote. At 14 he had heart surgery. 10 weeks in the ICU after. When he finally came home, he didn’t know who I was. Series of micro strokes.

    Sis was kicked out for getting pregnant. She was my main caregiver as a kidlet. I didn’t know why she left at the time. Just vanished.

    Sex was never talked about, except in church, and then it was always a sin, unless making babies. I was certain I was going to hell. And there was no one I could talk to. More self reliance. More independence.

    At puberty, my childhood friends looked at each other differently. I didn’t understand. By grade 8, I had one friend left. Another boy who was as strange as I was. Never dated. Too ashamed. PE was hell. I got lightning fast at changing. Hated being seen. Hated seeing other boys naked. After pe would rinse fast in the showers, and dress wet. When we did dance class, I refused. I wouldn’t explain. Coach sent me to run laps. More self-reliance.

    I learned all sorts of skills. I could camp in any weather, almost start a fire with jsut rocks. Read the sky for weather. Later, wire a kitchen, plumb a bathroom, lay tile, build a shed, make, fix, improvies. Learned to sing. Still learning. Try to compose.

    I am alien.

    I don’t think I am really human.

    Not sure if I ever was.

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13. dartcree

    June 2, 2024 at 2:51 pm

    Dead

    They are DEAD.

    I do not mourn

    I was used 

    As a toy

    Made of meat

    Muffled cries

    Helpless terror

    Not just once

    They are DEAD.

    I was slammed

    Against the door.

    Whiplash neck

    Blazing stars

    Breath knocked out.

    Not just once

    They are DEAD.

    One of them

    Picked me up

    Tried to throw me 

    Shrieking, screaming

    At the wall

    Not just once

    Stopped by sis

    They are DEAD.

    Ones who knew

    At the time

    Did not tell

    What went on

    Fear of scandal

    Could have helped

    They are DEAD.

    I am  broken

    Damaged goods

    Lost and lonely

    Left to heal

    On my own.

    They are DEAD.

    One by cancer

    Long and slow.

    Mind had gone

    Did he know?

    He taught me shame

    Men don’t show

    Their emotions

    Strong and silent

    Pain within.

    Men don’t show

    Their affections

    Men don’t hug

    Their lonely sons

    Other choking

    Emphysema   

    6 months dying

    On her back

    Tube in neck

    Fight for breath

    Now half blind

    Blurred TV

    She taught well

    Taught that trust

    Cannot be given

    Should not be given

    Never fully.

    Betrayal follows

    Rejection follows

    Abandonment certain.

    Words unspoken

    Can’t be spoken

    Words unwritten.

    Can’t see notepad

    Gasp and gurgle

    Six times a day

    Fluid sucked out

    From her lungs

    Still conscious.

    Afraid of Death.

    Both taught me

    By word and deed

    By word unspoken

    Deeds undone

    Sex is shameful

    Sex is bad

    Do not speak.

    Shame is emotion.

    Emotion is bad.

    Emotion is pain.

    Rot in hell

    They

    Are

    Dead.

    I do not mourn

    I did survive

    I will heal

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14. People who grew up hearing 'don't tell dad/mom' tend to develop these 10 traits later in life, according to psychology

    July 18, 2025 at 2:31 pm

    […] follows us into adulthood. Research shows that children caught in loyalty conflicts struggle with authentic self-expression later in life. We become shape-shifters, adapting our personality to each environment, never quite […]

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