By Adam Ferry, The OT Service

As a paediatric Occupational Therapist (OT) the word ‘independence’ is part of my daily vocab, but it’s never quite sat comfortably with me as many of the children I work with are so affected by their disability, that independence will never be possible for them. In these instances, my priority is always safety and dignity.

So, let’s explore this a bit further …

The dictionary definition of independence is: “the freedom to organise your own life, make your own decisions, etc. without needing help from other people” (1)

With this in mind, it’s a concern that for many clients OT’s work with, we are setting them up to fail by using the word independence to start with.

Interestingly the Royal College of Occupational Therapists (RCOT) no longer use the word ‘independence’ in their description of what OT is, instead they say  “Occupational therapy helps you live your best life at home, at work – and everywhere else. It’s about being able to do the things you want and have to do”. (2)

Young girl wheelchair user laughing. An older man stands behind her smiling, pushing the wheelchair.

I contacted RCOT directly, querying their rationale for removing the word ’independence’ and this was their response:-

“We removed the word independence on the website on the public page descriptor for occupational therapy in response to concerns about ableism. It is in recognition that for many people who may benefit from OT, independence is not the goal but greater and meaningful participation is. The change in wording reflects this.”

Both the dictionary definition and RCOT’s description of OT, both have a common theme around control and choice. The dictionary definition mentions “making your own decisions” and RCOT talks about “the things you want and have to do”.

Young disabled child being hoisted in a sling by a female adult.

And this has always been a part of my practice with clients who can not achieve independence, a conversation has to happen about how they want to be cared for, what care looks like to them and who they want to care for them.

This is particularly important for children as they move into adolescence and adulthood. Female client’s I’ve worked with no longer want their dads to bathe them, they feel a level of embarrassment about their parents seeing them naked and having to deal with very intimate care when they are on their periods. Similarly for male clients, they haven’t wanted their mums to touch their penises during washing in case they become aroused.

So perhaps the focus for OT needs to shift from independence to ‘choice’ and ‘giving people a voice’ about who, when and how they are cared for. Also, greater consideration of meaningful occupations, the “things you want to do” not just focusing on the physical care but supporting our clients to engage in activities that fill their souls and make them feel good. For surely, clients who are in control of their lives will no doubt feel empowered and happier.

[1] Oxford dictionary, available at :-

[2] RCOT, about occupational therapy, available at:-