The conceptualisation and application of co-occupation in occupational therapy and occupational science across various situations – a scoping review
This scoping review maps the conceptualization and application of co-occupation in occupational therapy and science, revealing that while it is an established analytical concept characterized by interdependence and shared meaning, its theoretical boundaries remain unsettled and its direct application to practice is limited.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Human beings rarely live in isolation. From the moment we are born, our daily activities are woven into a tapestry of interaction with others. We eat, work, play, and care for one another in ways that are deeply intertwined. In the fields of occupational therapy and occupational science, researchers study these everyday activities, known as "occupations," to understand how they shape our lives and health. For decades, the focus has often been on the individual person and how they navigate their environment. However, a specific concept called "co-occupation" has emerged to highlight something different: the idea that two or more people can engage in an activity so deeply together that their actions shape and define each other in real time. It is not merely doing things side by side, but a state where one person's movements, emotions, and intentions directly influence the other's, creating a shared experience that neither could achieve alone. Understanding this dynamic is crucial because it challenges the traditional view of human activity as a solitary pursuit and offers a new way to see how we connect, heal, and grow through our relationships.
A team of researchers set out to map the current state of this concept, asking how "co-occupation" has been defined and used in scientific literature over the last fifteen years. They conducted a broad search, reviewing forty-nine published studies and reports from 2009 to 2024. Their goal was not to prove a single theory, but to see how the idea has traveled through the scientific community, who has been studying it, and where the gaps in knowledge remain. What they found was a picture of a concept that has become a standard tool for analysis, yet one that still lacks a single, unified definition. The research revealed that while the idea is widely accepted, its application has remained heavily concentrated in specific areas, leaving much of the human experience unexplored through this lens.
The review showed that the vast majority of research on co-occupation has taken place in North America, with the United States producing more than half of the included studies. This geographical concentration means that our current understanding is largely shaped by Western perspectives. Furthermore, the people studied were overwhelmingly families, specifically parents and their young children. The literature is dominated by the relationship between mothers and infants, reflecting the origins of the concept, which was first described by a researcher observing her own daughter. While the concept has slowly expanded to include other family members, such as spouses caring for aging parents, or groups in community settings like churches or music programs, these instances are far less common. The research also shows a heavy focus on caregiving and support, often in medical or home settings, rather than in the wider, more casual interactions of daily life.
When the researchers looked at how scientists have defined "co-occupation," they found that the field relies on a very small number of foundational ideas. Most of the forty-nine studies drew their definitions from just two or three original sources. These sources describe co-occupation through four main characteristics that often overlap. First, there is a shared physical and emotional presence, where people are physically engaged and emotionally connected in the same moment. Second, there is interdependence, meaning the actions of one person directly change what the other person does. Third, there is reciprocity, a back-and-forth flow where participants constantly adjust to one another. Finally, there is the creation of shared meaning, where the activity holds a specific, mutual significance for everyone involved. However, the review suggests that these characteristics are not always treated as strict rules; different researchers emphasize different parts of the definition depending on who they are studying.
A significant finding of the review is that "co-occupation" has become primarily an analytical tool rather than a practical guide for therapy. In most of the studies, researchers used the concept as a lens to look at and understand what was happening between people. They used it to describe how a mother and child play together or how a couple manages daily tasks. Yet, very few studies actually translated this understanding into specific methods for occupational therapists to use in their daily work. The concept helps explain the "what" and "how" of human connection, but the research has not yet fully answered the "what now" for clinical practice. The authors note that while the idea is established in theory, its direct application to helping people in therapy remains underdeveloped.
The review also highlights what is missing from the current body of knowledge. Because the research has focused so heavily on close family bonds and supportive relationships, we know very little about how co-occupation works in more complex or difficult situations. The studies tend to show positive, harmonious interactions, but the concept could also apply to relationships marked by conflict, power imbalances, or unwanted influence. The researchers suggest that future studies need to look beyond the comfortable settings of the family home and the clinic. They need to explore how this concept applies to diverse cultures, different types of relationships, and even situations where the interdependence between people is not beneficial. By testing the boundaries of the concept in these varied contexts, the scientific community can determine if "co-occupation" is a universal truth about human interaction or a description that fits only specific, familiar relationships. Until then, the concept remains a powerful but partially untested way of seeing how we are shaped by the people around us.
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