As occupational therapists, we often pride ourselves on supporting people to live the lives they want to lead. But there is one word that has crept into our everyday language and professional documents that I believe we need to pause and challenge: independent.
At first glance, “independence” seems like a positive goal. It appears in so many of our policies, assessments, and conversations. Yet the more I reflect on it, the more I see the ableism wrapped up in that word.
Independence as a False Ideal
The idea of independence assumes that the best life is one where you can do everything by yourself. Yet none of us truly live that way. My own life is full of interdependence: I use a wheelchair, I rely on support for some daily activities, and I depend on accessible technology to do my work. None of that makes me less capable, or my life less meaningful.
When occupational therapy frames independence as the gold standard, it risks suggesting that those who need assistance are somehow falling short. Hammell (2023) highlights that our profession can unintentionally reinforce ableist ideals by promoting independence as though it is the only measure of a “good” life.
The Ableism Hidden in “Independent”
Language matters. It shapes how services are delivered and how people see themselves. When “independence” is set as the main goal, what message are we sending to people who will always require support? Are their lives considered incomplete, or somehow less valid?
Yao et al. (2022) remind us that ableism is not always obvious. It can be built into the very concepts we use without thinking.
I have recently joined TikTok, and I see many students at the beginning of their occupational therapy journey describing the profession as one that “gives people back their independence.” I understand why this phrase feels powerful and appealing, but it troubles me. I often hear independence spoken about as the ultimate outcome, and I find myself challenging it: But what if independence is not possible, or even wanted? What if the goal should be participation, choice, or dignity instead?
It can feel repetitive to raise this again and again, but over time I have noticed a shift. Colleagues begin to pause, reflect, and reframe. Instead of “independent living,” I now hear people talking about autonomy, agency, or meaningful participation. Small changes, but important ones.
What Students Already See
Interestingly, occupational therapy students are already recognising this issue. Darton, Wadey and Laver-Fawcett (2025) found that many students described the profession as inherently ableist, particularly because of the way independence is framed. If our next generation of therapists can see this so clearly, then surely it is time we acted.
Rethinking Our Language
Instead of independence, we could talk about:
• Autonomy, being able to make your own choices
• Agency, having control over the direction of your own life
• Participation, being part of meaningful occupations however support is structured
• Interdependence, valuing the shared human connections we all rely on
Collins, Maher and Sandover (2017) proposed a framework that does not erase dependence but recognises independence, interdependence, and dependence as equally valid. That, to me, reflects reality far more honestly than holding up independence as the only measure of success.
Final Reflection
This is not just about semantics. It is about belonging. When independence is used uncritically, it risks reinforcing ableist norms and marginalising people whose lives will always include support.
As Hammell (2023) urges, we need to resist ableist ideals and instead use language that celebrates the diversity of ways people live. Occupational therapy should not be about pushing people towards an unrealistic standard of independence. It should be about enabling people to live lives that are meaningful on their own terms, whether those lives are independent, interdependent, or dependent.
So each time I hear the word “independent” used without question, I challenge it. Not to be awkward, but because words matter. They shape practice. And I want a profession that sees me, and others like me, as whole, exactly as we are.
References
Collins, B., Maher, C. and Sandover, S. (2017) ‘Proposing an initial framework for occupational therapy independence (OTIF)’, Scandinavian Journal of Occupational Therapy, 24(6), pp. 462–470.
Darton, H., Wadey, A. and Laver-Fawcett, A.J. (2025) ‘Exploring ableism and occupational therapy: Occupational therapy students’ perspectives’, British Journal of Occupational Therapy, May, 88(5), pp. 281–291.
Hammell, K.W. (2023) ‘A call to resist occupational therapy’s promotion of ableism’, Scandinavian Journal of Occupational Therapy, 30(3), pp. 163–174.
Yao, D.P.G., Sy, M.P., Martinez, P.G.V. and Laboy, E.C. (2022) ‘Is occupational therapy an ableist health profession? A critical reflection on ableism and occupational therapy’, Cadernos Brasileiros de Terapia Ocupacional,
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