The ‘double empathy problem’: Ten years on

Milton, Damian; Gurbuz, Emine; Lopez, Betriz

doi:10.1177/13623613221129123

Cited by 77 publications

(43 citation statements)

References 21 publications

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“…Historically, autistic people have been described as having ‘deficits’ in their ability to communicate with others; indeed, this is the terminology used within the diagnostic criteria. Recently, this assumption has been challenged, aided by Milton’s explanation of the double empathy problem (Milton, 2012; Milton et al, 2022). Milton highlighted that disconnection in communication between those of differing ‘neurotypes’ is mutual, reciprocal, and a shared responsibility.…”

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confidence: 99%

How can psychologists meet the needs of autistic adults?

Jellett

Flower

2023

Autism

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In a recent editorial, Mandy declared an autism mental health crisis and proposed six ideas for how this might be addressed, with which we agree. However, we propose that for these ideas (e.g. training for mental health professionals) to be implemented for psychologists, assumptions about best practice need to be assessed considering the evolving conceptualisation of autism. The formation and development of a therapeutic alliance between a psychologist and client has been established as an important ‘common factor’ that impacts the efficacy of therapy. If one considers the double empathy problem and views autism through a neurodiversity lens, the development of a therapeutic alliance between a psychologist and client of different neurotypes might require an alternative approach to standard practice. We propose that psychologists (if they are, for example, non-autistic and working with an autistic client), are at risk of misinterpreting their clients’ communication and needs. As such, we consider the notion of cultural competency, and how the profession of psychology can move forward to help psychologists work effectively with autistic clients, learning from autistic people, including autistic psychologists. Lay abstract In a recent editorial, Mandy described an autism mental health crisis because autistic people are more likely to experience mental health concerns, yet they are less likely to get help. When autistic people do seek support, services tend not to be well matched to their needs. Alongside the six ideas Mandy suggested for addressing the mental health crisis, we think it is essential for psychologists to start changing the way they work to improve the person-environment fit for autistic clients. The relationship between a psychologist and their client influences the gains a client makes from engaging in therapy. The way psychologists are trained to build an effective working relationship with clients is based on neurotypical communication styles. The double empathy problem tells us that autistic clients relate to others differently to non-autistic clients, and so we propose that psychologists, especially when not autistic themselves, need to build the therapeutic relationship in a different way. We feel this is important, as the relationship between a psychologist and client is understood to be an important factor in how much the client can benefit from therapy. In this letter, we draw upon Bulluss’ call for cultural competency when working with autistic clients, and further insights from autistic psychologists, and propose that psychologists rethink some taken-for-granted aspects of practice to be better able to create a sense of interpersonal safety when working with autistic clients.

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confidence: 99%

How can psychologists meet the needs of autistic adults?

Jellett

Flower

2023

Autism

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“…Regular discussions took place between the first, second and last authors about the interpretation of the interviews during coding and theme development and revision. To minimise the risk of misinterpreting the experiences participants reported due to the first author being an 'outsider researcher', and given established differences in communication between autistic and non-autistic people (see Milton, 2012;Milton et al, 2022), the first and third authors discussed the themes at length. We approached the study as proponents of the social model of disability and neurodiversity movement.…”

Section: Discussionmentioning

confidence: 99%

‘If I’m just me, I doubt I’d get the job’: A qualitative exploration of autistic people’s experiences in job interviews

Finn

Flower

Leong

et al. 2023

Autism

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Autistic people face many challenges entering the workforce, for example, during job interviews where performance is reliant on particular social skills. To be competitive during job interviews, autistic people may experience pressure to conceal or ‘camouflage’ their autistic traits and behaviour. This qualitative study used semi-structured interviews to explore the job interview experiences of 10 autistic people. Based on the literature, we were curious as to whether participants would report behaviour consistent with the camouflaging hypothesis. Thematic analysis identified six themes reflecting individual and environmental factors. Participants reported engaging in camouflaging behaviour during job interviews, with external factors (e.g. avoid being treated differently) cited as the primary reason. Participants reported that camouflaging required effort, leading to stress, anxiety, exhaustion and feeling ‘burnt out’. They expressed a desire for an inclusive, understanding and accommodating environment where they would feel more comfortable disclosing their diagnosis without feeling they needed to conceal their autistic traits and behaviour. These preliminary findings add to the current literature regarding autism, camouflaging and employment. Lay abstract When applying for a job, autistic job candidates are likely to face a number of challenges. Job interviews are one of these challenges – they require communicating and relationship-building with unfamiliar people and involve expectations about behaviour (that may vary between companies and are not made clear to job candidates). Given autistic people communicate differently to non-autistic people, autistic job candidates may be disadvantaged in the interview process. Autistic candidates may not feel comfortable or safe sharing with organisations their autistic identity and may feel pressure to hide any characteristics or behaviour they feel might indicate they are autistic. To explore this issue, we interviewed 10 autistic adults about their job interview experiences in Australia. We analysed the content of the interviews and found three themes that related to the individual person and three themes that related to environmental factors. Participants told us that they engaged in camouflaging behaviour during job interviews, feeling pressure to conceal aspects of themselves. Those who camouflaged during job interviews reported that it took a lot of effort, which resulted in increased stress, anxiety and exhaustion. The autistic adults we spoke to reported a need for inclusive, understanding and accommodating employers to help them feel more comfortable disclosing their autism diagnosis in the job application process. These findings add to current research that has explored camouflaging behaviour and barriers to employment for autistic people.

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“…We speculate that conceptualizing conversations as complex adaptive systems might provide a more inclusive perspective and ultimately a deeper understanding of such atypicality, and the interactional failures and successes involved. Neurodiversity might pose diverse constraints on conversations, including mismatched expectations (Milton, 2012; Milton, Gurbuz, & López, 2022), which might lead to diverse and perhaps mismatched use of conversational strategies across both interlocutors (Di Paolo, Cuffari, & De Jaegher, 2018). By developing a more nuanced and systematic understanding of conversational patterns across diverse constraints, we can provide a much better insight into how these patterns might differ in conversations involving neurodiverse people and the potential impact of this diversity. More generally, the current study emphasizes the importance of cross‐linguistic perspectives on the study of conversations, either within one study or cumulatively by more explicitly building upon previous studies and comparing the findings.…”

Section: Discussionmentioning

confidence: 99%

Language‐Specific Constraints on Conversation: Evidence from Danish and Norwegian

Dideriksen,

Christiansen,

Dingemanse

et al. 2023

Cognitive Science

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Establishing and maintaining mutual understanding in everyday conversations is crucial. To do so, people employ a variety of conversational devices, such as backchannels, repair, and linguistic entrainment. Here, we explore whether the use of conversational devices might be influenced by cross‐linguistic differences in the speakers’ native language, comparing two matched languages—Danish and Norwegian—differing primarily in their sound structure, with Danish being more opaque, that is, less acoustically distinguished. Across systematically manipulated conversational contexts, we find that processes supporting mutual understanding in conversations vary with external constraints: across different contexts and, crucially, across languages. In accord with our predictions, linguistic entrainment was overall higher in Danish than in Norwegian, while backchannels and repairs presented a more nuanced pattern. These findings are compatible with the hypothesis that native speakers of Danish may compensate for its opaque sound structure by adopting a top‐down strategy of building more conversational redundancy through entrainment, which also might reduce the need for repairs. These results suggest that linguistic differences might be met by systematic changes in language processing and use. This paves the way for further cross‐linguistic investigations and critical assessment of the interplay between cultural and linguistic factors on the one hand and conversational dynamics on the other.

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The ‘double empathy problem’: Ten years on

Cited by 77 publications

References 21 publications

How can psychologists meet the needs of autistic adults?

How can psychologists meet the needs of autistic adults?

‘If I’m just me, I doubt I’d get the job’: A qualitative exploration of autistic people’s experiences in job interviews

Language‐Specific Constraints on Conversation: Evidence from Danish and Norwegian

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