The Double Empathy Problem and It's Role In Occupational Therapy Practice

The Double Empathy Problem is a theory proposed by Dr Damian Milton, which challenges the traditional view that Autistic individuals inherently lack social skills or empathy. Instead, it suggests that communication breakdowns between Autistic and non-Autistic people are mutual—both groups struggle to understand each other, rather than the difficulty lying solely with the Autistic individual.

Key Aspects of the Double Empathy Problem

1. Mutual Misunderstanding – When people from different neurotypes (e.g., Autistic and non-Autistic) interact, both may find it difficult to interpret each other’s social cues, emotions, and communication styles.

2. Social Expectations – Non-Autistic (neurotypical) individuals often expect interactions to follow certain norms, but these norms are not universal. Autistic people may communicate differently (e.g., being direct, using different body language), which can lead to misinterpretation.

3. Empathy is Not Lacking—It’s Different – Autistic individuals may deeply empathise but express it in ways that non-Autistic people don’t always recognise. Likewise, neurotypical expressions of empathy may not resonate with Autistic individuals.

   

   Pastel image of a diverse group of people

Relevance to Occupational Therapy (OT)

For neurodiversity-affirming OTs, understanding the Double Empathy Problem is crucial because:

• It shifts the focus from "fixing" the Autistic person to improving mutual understanding.

• It highlights the importance of adapting communication styles rather than expecting Autistic clients to conform to neurotypical norms.

• It validates Autistic experiences, reducing stigma around perceived "social deficits."

• It informs therapy approaches, ensuring interventions respect neurodivergent communication rather than trying to "normalise" it.

• It supports Autistic individuals in navigating social spaces in a way that works for them, rather than forcing them to mask or suppress their natural communication style.

Practical Applications in OT

• Using clear, direct, and non-judgmental communication with Autistic clients.

• Encouraging social reciprocity in a way that is meaningful for the individual rather than enforcing neurotypical social norms.

• Supporting clients in self-advocacy and educating others (e.g., families, teachers, employers) about neurodivergent communication styles.

• Promoting co-regulation strategies rather than assuming Autistic individuals must "learn" neurotypical ways of engaging.

By integrating the Double Empathy Problem into practice, OTs can create a more inclusive, respectful, and effective therapeutic space for neurodivergent individuals.