Understanding the Double Empathy Problem in Neurodivergent Therapy

The following article is taken from our Autism-Informed Practice course.

In therapeutic work, especially when engaging with neurodivergent individuals, communication challenges can deeply impact the therapeutic process. The Double Empathy Problem, a concept introduced by Dr. Damian Milton in 2012, offers a valuable lens through which therapists can approach interactions with autistic and neurodivergent clients.

This theory proposes that communication gaps between autistic and non-autistic individuals are bidirectional, originating from differing cognitive frameworks rather than a single party’s deficits. This blog explores the Double Empathy Problem and its implications for practitioners, with practical advice on creating an inclusive and understanding therapeutic space.

Learning Outcomes

By the end of this article, you will:

• Understand the concept of the Double Empathy Problem and its implications for neurodivergent communication.
• Know how to recognise and mitigate psycho-emotional harm and internalised oppression in autistic clients.
• Be able to adapt therapeutic modalities to foster a respectful and collaborative environment for neurodivergent clients.

Exploring the Double Empathy Problem

Dr. Damian Milton’s Double Empathy Problem theory suggests that communication difficulties between autistic and non-autistic people arise from differing perceptions and experiences of the world. This difference often results in a dual-frame situation, where each person may struggle to understand the other’s perspective. Milton challenges the notion that empathy deficits are specific to autistic individuals. He highlights that non-autistic people frequently find it difficult to empathise with autistic viewpoints as well.

Example: The Misinterpretation of Symbols

Consider a scenario where someone mentions, “I had a bat in the back of my car.” This might evoke an image of a baseball or rounders bat, aligning with general societal expectations for a non-autistic person. An autistic person, however, might interpret this as a small nocturnal animal, given that these implicit social assumptions don’t shape their worldview.

This disparity underscores the importance of clear, context-aware communication that checks assumptions and confirms mutual understanding.

Internalised Oppression and Psycho-Emotional Harm

The concept of psycho-emotional disablement, highlighted in Milton and Lyte’s work, refers to the psychological harm caused by forcing neurodivergent individuals to fit within rigid, often non-autistic frameworks. Historically, therapeutic approaches have attempted to “normalise” autistic behaviours through interventions like Applied Behavioural Analysis (ABA).

This inadvertently reinforced the idea that autistic individuals are “broken” or “abnormal.” This approach can contribute to internalised oppression, where clients begin to feel that their natural ways of being are inherently flawed. Such feelings can exacerbate stress, anxiety, and depression, posing significant barriers to therapeutic progress.

Practical Applications for Therapists

Creating a Co-Created Therapy Space

Neurodivergent clients benefit from a co-created, flexible therapy environment that does not impose neurotypical norms as the standard. Therapists can ensure they remain aligned with their client’s unique needs by encouraging open discussions on communication preferences and regularly confirming understanding.

Adapting Communication Approaches

Counsellors may need to adapt their communication methods, such as using verbal and nonverbal cues, simplifying language, or providing visual aids. Asking clarifying questions is helpful to avoid misunderstandings and demonstrate an openness to different interpretive frameworks. For example, in person-centred therapy, traditionally low on direct questioning, therapists might need to adopt a more Socratic approach to gain a clearer insight into the client’s worldview.

Critically Evaluating Therapeutic Modalities

Traditional therapeutic methods, including ABA, have received criticism for attempting to alter neurodivergent behaviours rather than adapting to them. As a therapeutic community, we are urged to reassess whether our methods serve the client’s needs or inadvertently attempt to conform them to neurotypical standards. Consider whether your approach respects neurodivergent perspectives, avoiding rigid normative pressures. Neurodivergent clients should feel validated in their uniqueness, just as a therapist would accommodate a physical disability with accessible facilities.

Building Empathy Through Curiosity

Developing a collaborative approach to empathy is vital. Practitioners should cultivate curiosity about neurodivergent ways of thinking, using Socratic questioning to explore clients’ unique perspectives. By encouraging clients to share their interpretations openly, without fear of judgement, therapists create a sense of safety and mutual understanding.

This bi-directional empathy helps bridge the communication gap, ensuring that both client and therapist are on the same page. This is a foundation for meaningful therapeutic work.

Final Thoughts

The Double Empathy Problem reminds counsellors and psychotherapists that empathy is a mutual endeavour that requires flexibility, curiosity, and a commitment to seeing beyond neurotypical norms. As therapists, embracing this bi-directional empathy enables us to create a supportive environment for neurodivergent clients. This helps them to feel understood, respected, and valued for their unique perspectives. By critically assessing and adapting our practices, we can move toward more inclusive therapy that honours neurodiversity as a part of the human experience.

This approach provides a pathway for practitioners to meaningfully engage with neurodivergent clients, offering insights to bridge communication gaps and create stronger therapeutic relationships.

References and Further Reading

Milton, D. A. (2012a). On the ontological status of autism: the Double Empathy Problem. Disability & Society. Available here.

Milton, D. A., & Lyte. (2012b). The Normalisation Agenda and the Psycho-Emotional Disablement of Autistic People. Autonomy: The Critical Journal of Interdisciplinary Autism Studies. Available here​​.