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

Alexithymia is an emotion-related construct involving difficulties identifying, describing, and processing emotion, which hinder the capacity to provide empathy, and the development of emotionally connected intimate relationships. To date, there has been minimal investigation of the impact of alexithymia on community couples’ relationships, no associated examination of clinical couples, and no consideration of therapists’ knowledge of alexithymia as a source of influence in couple therapy outcomes. Studies 1 and 2 investigated alexithymia in 170 community couples and 17 therapy couples, respectively, in association with their empathy provided, empathy received, emotional connection components (i.e., turn toward, turn away, turn against, positive emotional connection), and relationship dissatisfaction. Study 3 examined 61 couple therapists’ knowledge and experience of alexithymia. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20), which generates a total alexithymia score, and three subscale scores of difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT) (Bagby, Parker, & Taylor, 1994). Empathy provided and empathy received were measured with the Barrett-Lennard Relationship Inventory (BLRI MO and OS; Barrett-Lennard, 1986). A scale was developed to assess the emotional connection components. Relationship dissatisfaction was measured with the revised Marital Satisfaction Inventory (MSI-R; Snyder, 1997). Therapists’ data were gathered via personal interviews. Findings for the community couples indicate that husbands’ and wives’ own TAS-20, DIF, and DDF predicted all of their own outcome variables in the expected positive and negative directions; their EOT predicted decreased empathy provided and increased turn against. Relationally, husbands’ and wives’ TAS-20 and DDF predicted lower empathy provided and empathy received in each other, and DDF also predicted higher partner relationship dissatisfaction. Clinical husbands’ TAS-20, DDF, and EOT were associated with decreases in their own empathy provided. These variables, plus DIF, were related to lower turn away in their wives. Clinical wives’ DIF was associated with their own decreased empathy provided and increased relationship dissatisfaction, and EOT was associated with increased turn away. Wives’ DDF was related to higher turn away in their husbands. Discrepancy analyses with the community couples found that husbands’ outcomes were predicted by discrepancies in TAS-20, DIF, DDF, and EOT, and wives’ outcomes were predicted by TAS-20 partner differences. The discrepancies between the partners predicted their empathy and emotional connection, and the effects varied for husbands and wives. Mediation analyses with the community couples indicate that for husbands, two pathways fully mediated the association between alexithymia and relationship dissatisfaction. One pathway was through lower empathy received, leading to higher turn away. The second pathway was through lower empathy received, leading to lower positive emotional connection. Two partial mediation pathways were found for wives. Comparisons between the community and clinical couples found no significant betweengroup differences on the alexithymia variables; however, a greater proportion of clinical husbands and wives had a high level of total alexithymia. Clinical partners were also significantly lower than community partners on empathy provided, empathy received, turn toward, and positive emotional connection, and higher on turn against, and relationship dissatisfaction. Additionally, clinical partners had significantly greater TAS-20 and DDF discrepancies when wives’ scores were higher than their husbands’ scores. Interviews with couple therapists found that, although therapists recognised the emotionrelated features of alexithymia, the majority of therapists had minimal awareness, or understanding, of the alexithymia construct. The findings are discussed in relational terms and with a focus on their potential to advance therapeutic practise and treatment outcomes for couples. Therapists’ low awareness of alexithymia is emphasised, as is the need to disseminate clinically based education about alexithymia.

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