If you have read some of my previous blogs, you will probably know that I often find myself exploring language. I am interested in the words we use within occupational therapy, health and social care and disability spaces, particularly when language that initially appears positive or inclusive can carry assumptions we do not always recognise.
Robert B. Pereira’s recent letter, Ableism within social inclusion descriptors: Ways forward through expanding on occupational dimensions, really made me reflect on this. Words such as participation, inclusion, engagement and contribution are words I would probably have instinctively thought of as inclusive. Yet Pereira’s (2026) examination of social inclusion made me think more critically about what can sit underneath them.
When inclusion becomes about doing
What particularly interested me was Pereira’s willingness to critique his own previous language. In 2017, he described social inclusion partly in relation to being a “contributing citizen”. Reflecting on his subsequent work alongside people with severe and profound disabilities, he now identifies ableism within this idea of contribution.
I found this powerful. Contribution can easily become associated with productivity, activity and what someone can visibly do. When doing dominates our understanding of participation, we risk overlooking other ways of experiencing occupation and being part of the world.
Drawing on the occupational dimensions of doing, being, becoming and belonging (Wilcock and Hocking, 2015), Pereira (2026) proposes connecting as a new and discrete occupational dimension. It was this idea that stayed with me most.
Being there but feeling at the edges
As I reflected on Pereira’s ideas, I realised how often I can be participating socially without necessarily feeling connected.
Recently, I attended two social events, one in a restaurant and another in a social club. I wanted to be at both and wanted to move between conversations and connect with people. I could physically access the venues, but once inside, the layout meant I could not easily move around in my wheelchair.
I found myself effectively stuck in one part of the room. I could see conversations happening elsewhere, while other people could simply move across the room, join another group and move on again. For me, those same interactions required much more negotiation and sometimes were not possible. From the outside I was participating, but my opportunities for spontaneity, choice and connection were restricted.
Interestingly, I can experience something similar even in my own home. I recently had a barbecue for my birthday. It was an occupation I had chosen, in a familiar environment where I had much greater control over the space. Yet as people moved around and formed different groups, I still found myself relying on others coming to me. Even at my own birthday celebration, I could experience moments of feeling at the edges of an occupation that was quite literally centred around me.
These experiences made me think about occupational alienation. Bryant, Craik and McKay (2004) explored occupational alienation in relation to meaningful occupation, belonging and people’s ability to influence their occupational lives, while Bryant (2016) further developed occupational alienation as a concept for understanding participation.
This helped me articulate something I had struggled to describe. I can be doing the occupation while simultaneously experiencing barriers to connection and belonging. When the environment restricts where I can move, it does more than restrict physical movement. It affects who I can speak to, which conversations I can join and how much agency I have within the occupation.
Physical access can get me through the door, but even when it is my own door, it does not automatically create connection.
Connecting, interdependence and co-occupation
Pereira (2026) proposes the 5Ps of connecting: people, place, purpose, planet and the personal. This helped me think beyond whether I could physically participate and towards everything surrounding the occupation.
I particularly notice the importance of people when my husband is with me at social events. He understands many of the barriers I experience without me continually having to explain them. He notices when an environment is making connection difficult, and we navigate those situations together. His presence does not make an inaccessible environment accessible, but it can change my experience within it.
For me, this reflects both interdependence and co-occupation. Pickens and Pizur Barnekow (2009) describe co-occupation through shared physicality, emotionality and intentionality, embedded within shared meaning. This provides another way of thinking about how occupations can be experienced and shaped together.
When my husband and I navigate a social environment together, or when someone comes across the room to spend time with me, I do not see this simply as somebody helping me to participate. We are participating and connecting together, with each person’s actions shaping the shared occupation.
None of us occupies the world entirely by ourselves. Our occupations are shaped through relationships, environments, resources and communities. Disability can make those interdependencies more visible, but interdependence is part of being human.
This is why Pereira’s focus on connecting feels so useful. I can technically access the same event as everyone else while experiencing very different opportunities to connect within it. Access, participation, connection and belonging are related, but they are not interchangeable.
More than doing
Within his own practice alongside people with severe and profound disabilities, Pereira (2026) describes reframing aspects of occupational therapy towards enabling being and connecting, including enriching environments and developing the capacity of support workers.
For me, his article has provided another lens through which to understand my own experiences. Connecting should not become something we value only when doing is not possible. Doing, being, becoming, belonging and connecting can coexist, with their significance changing between people, occupations and moments in our lives.
There may be times when simply being with other people matters and occupations where connection matters more than any observable outcome. A person’s value should never depend upon productivity, achievement or their ability to demonstrate contribution in ways society happens to recognise.
A reflection for occupational therapy
Pereira’s article has left me questioning language I have probably used many times without thinking deeply about it. We can describe someone as participating or socially included because they attended the group, entered the community space or took part in the occupation. What is much less visible is how that participation actually felt.
For occupational therapists, perhaps we need to remain curious about more than whether an occupation happened. We need to consider agency, meaning, connection and belonging alongside the physical, social and attitudinal environments in which occupation takes place.
It also reminds me to think carefully about where we locate the problem. If an environment restricts someone’s ability to connect, our attention should not automatically turn towards what the individual needs to change or overcome.
Access is not only about getting into spaces. It is about what those spaces enable us to do, be, become, belong to and, as Pereira proposes, connect with once we are there.
For me, that is the lasting reflection from this article. Something can look inclusive from the outside while feeling very different to the person experiencing it.
Being there is not the same as belonging. Participating is not necessarily connecting.
References
Bryant, W., Craik, C. and McKay, E.A. (2004) ‘Living in a glasshouse: Exploring occupational alienation’, Canadian Journal of Occupational Therapy, 71(5), pp. 282–289.
Bryant, W. (2016) ‘The Dr Elizabeth Casson Memorial Lecture 2016: Occupational alienation: A concept for modelling participation in practice and research’, British Journal of Occupational Therapy, 79(9), pp. 521–529.
Pereira, R.B. (2026) ‘Ableism within social inclusion descriptors: Ways forward through expanding on occupational dimensions’, Australian Occupational Therapy Journal, 73, e70078. doi: 10.1111/1440-1630.70078.
Pickens, N.D. and Pizur-Barnekow, K. (2009) ‘Co-occupation: Extending the dialogue’, Journal of Occupational Science, 16(3), pp. 151–156. doi: 10.1080/14427591.2009.9686656.
Van’t Leven, N. and Jonsson, H. (2002) ‘Doing and being in the atmosphere of the doing: Environmental influences on occupational performance in a nursing home’, Scandinavian Journal of Occupational Therapy, 9(4), pp. 148–155.
Wilcock, A.A. and Hocking, C. (2015) An occupational perspective of health. 3rd edn. Thorofare, NJ: SLACK Incorporated.