When the Definition of “Critical” Becomes Critical for Occupational Therapy
A recent mixed-methods study in the Australian Occupational Therapy Journal examines how occupational therapy educators across different countries think about and define critical thinking. The authors found something I have long suspected and have previously documented: occupational therapy educators do not all mean the same thing when they use the term 'critical.' Some define critical thinking in concrete, clinical, pragmatic terms: reasoning, evidence appraisal, decision-making, and reflective practice. Others define it in broader sociopolitical terms: questioning knowledge production, identifying oppressive structures, pursuing social transformation, and taking “critical action.”
There is a wide chasm between these definitions.
It matters because “critical thinking” is not a minor curricular phrase. The term 'critical' appears everywhere in higher education, accreditation language, learning outcomes, rubrics, and faculty conversations. I think that most would agree that students should develop critical thinking. The problem is that this apparent consensus can hide deep disagreement about what we are actually teaching and assessing. So what does critical thinking even mean? That is a problem.
And here is my concern: occupational therapy should not cede the definition of critical thinking to critical theory.
My definition, apparently aligned with many English-speaking educators in the study, is that critical thinking is a method of judgment - generally attached to what we traditionally label as 'clinical reasoning.' It involves questioning assumptions, evaluating evidence, identifying logical errors, considering alternative explanations, recognizing bias, interpreting context, and making defensible decisions. It is how practitioners decide what matters, what risks exist, and how occupational performance can be supported in real life. It is the heart of competent practice.
A therapist working with a child with handwriting difficulty, a worker recovering from a hand injury, an older adult returning home after a stroke, or a family navigating developmental disability services is already operating in a complex world. The therapist must consider bodies, environments, routines, culture, motivation, caregiver burden, reimbursement, equipment, safety, evidence, and goals. That is critical thinking in practice.
Of course, students should also learn to examine systems and how associated barriers impact occupational therapy practice. These are also legitimate objects of critical thinking, but they are not the definition of critical thinking itself.
That distinction is essential because critical thinking can be applied to social justice claims. It can be applied to medical claims. It can be applied to professional assumptions. It can be applied to insurance policy. It can be applied to research evidence. It can also be applied to critical theory itself. Any framework that exempts itself from critique is not functioning as a tool for thinking; it is functioning as an authority structure.
So what does 'critical' really mean?
If a curriculum teaches students that “critical thinking” means arriving at a particular sociopolitical conclusion, then we have stopped teaching critical thinking. We are teaching a doctrine - perhaps a sincerely held doctrine and perhaps just a fashionable doctrine. It may contain useful insights, but it is still a framework that should be examined rather than smuggled into the profession's definition of critical thinking itself.
The study is useful because it exposes this definitional drift. It shows a spectrum, from concrete and clinical understandings of critical thinking to abstract understandings. It is fine that different definitions exist, but there is a danger that some within the profession may begin to treat one pole of that spectrum as morally or intellectually superior to the other.
Clinical reasoning should not be dismissed as merely “technical” or as “positivist reductionism.” Competent clinical judgment is not diametrically opposed to or even exclusive of social awareness. In fact, decontextualized occupational therapy has very little to offer anyone.
There is also a serious problem with internationalization and I have extensively documented this as well (Chapter 12 on Globalization of Occupational Therapy in my theory text). International scholarship can enrich a profession by helping us see assumptions we did not know we had, and it can expose cultural blind spots.
But internationalization also creates risks when language is treated as if it travels cleanly across cultures. Words do not simply translate - they carry histories, philosophies, political traditions, professional assumptions, and local academic meanings. The word “critical” may not mean the same thing in English, Portuguese, Spanish, or in the academic traditions attached to those languages. Even within English, “critical thinking” and “critical theory” are very different things, although the shared word “critical” allows them to be blurred.
That blur is dangerous and we are not talking enough about it. That is my dissatisfaction with the article. It tends to treat all definitions as equally situated along a spectrum, when we should also be asking which definition of “critical” is germane to occupational therapy and which definitions represent newer ideological additions that may not fit our actual social contract as a profession.
The term 'critical' may be carrying different intellectual baggage in different settings. One educator may mean “can the student justify this intervention?” Another may mean “can the student identify oppressive structures and engage in emancipatory praxis?” Those are not the same learning outcome.
I don't think that the problem is international scholarship. The problem is the assumption that shared terminology means shared meaning.
The study seems to recognize definitional variation, but the profession needs to be careful about what it does next. We should not respond by searching for a universal definition that quietly imports one ideological framework into every curriculum. Nor should we assume that more abstract or more politicized definitions are automatically more advanced.
Sometimes abstraction clarifies. Sometimes it obscures ideological importation under the language of global inclusiveness. The irony is that professional importation of knowledge is often criticized in only one direction. I am not arguing that importation always needs criticism. I am arguing that it requires honest appraisal whenever it happens, in any direction.
There is another danger here, and it may be the most important one: the academy’s disengagement from practice.
This is not primarily a critique of individual educators. It is a critique of academic incentives. Higher education rewards abstraction, publication, theoretical alignment, and specialized discourse. Practice rewards judgment, usefulness, safety, adaptation, and outcomes. When those worlds drift too far apart, the language of the academy can begin to replace the practical obligations of the profession.
Practicing clinicians are held accountable by the real patients and families and billing systems and service contexts that are right in front of them. They have to produce value in accordance with their social contract to exist (licensing and service).
An academy disengaged from that reality may begin to redefine “critical reasoning” in ways that are less clinical, less practical, and less accountable to occupational outcomes. Critical thinking becomes less about competent judgment in practice and more about adopting the language of critique. Students learn the vocabulary of power, oppression, coloniality, and transformation, but may not develop equal skill in intervention planning, outcome measurement, environmental adaptation, assistive technology selection, caregiver training, or clinical decision-making.
That is not progress. And it is not progressive, although some might like to use that label. I am not even certain that some of these newer definitions remain sufficiently anchored in occupational therapy’s practice obligations.
Occupational therapy does not need graduates who can only critique systems. It needs graduates who can think, act, adapt, measure, explain, and help. It needs clinicians who can see the whole person in context, but still know what to do next. It needs practitioners who can be aware of procedural justice issues around reimbursement and access without losing the ability to fabricate a splint, teach a transfer, adapt a feeding routine, support regulation, analyze a job task, or document why an intervention is medically necessary.
We should not banish sociopolitical content from OT education because that would be an intellectually weak position to take. Students should learn about systems, and they can debate theories and question assumptions. All of those things do shape occupation.
But educators should name these frameworks honestly. Can we agree on the following?:
Critical theory is not the same thing as critical thinking.
Social occupational therapy is not the same thing as clinical reasoning.
Advocacy is not the same thing as evidence appraisal.
Political agreement is not the same thing as intellectual development.
A strong occupational therapy curriculum that respects the profession’s social contract must not collapse them into one vague moralized phrase called “critical thinking” (as defined in one ideological context).
The profession needs a cleaner vocabulary. We should teach clinical reasoning, ethical reasoning, scientific reasoning, and systems reasoning. We should teach students to reflect on assumptions and examine context. We should also teach them that every framework, including critical theory, is subject to critique.
That is the real test.
If students are allowed to critically examine biomedical assumptions but not critical theory assumptions, then we are not teaching critical thinking. If students are allowed to question professional tradition but not current academic ideology, then we are not teaching critical thinking. If students are rewarded for reaching approved conclusions rather than for demonstrating disciplined reasoning, then we are not teaching critical thinking.
Few may interact with this argument publicly because higher education has cultivated a culture of fear around dissent. That is not just an occupational therapy problem. But it is a serious problem for any profession that claims to value critical thinking.
How is that a good thing?
Critical thinking belongs to no ideology. It is not owned by the political left or right. It is not owned by positivists, postmodernists, clinicians, activists, academics, or administrators. It is a disciplined method of thinking that should make all of us less certain, more honest, more careful, and more accountable.
The profession should welcome broader conversations about culture, power, and systems, but it should not allow those conversations to consume the definition of critical thinking itself.
Once critical thinking stops meaning thinking and once it demands conformity, we have a problem.
, , , , & (2026). Critical thinking in occupational therapy education: A mixed-methods study. Australian Occupational Therapy Journal, 73(4), e70108. https://doi.org/10.1111/1440-1630.70108
Comments