Relationships, Not Rankings: Why Relational Pedagogy Matters in Occupational Therapy Education

What if the most powerful tool in a university lecture hall is not the curriculum, the technology, or even the expertise of the lecturer, but the quality of the relationship between teacher and student? A new rapid communication published in the Scandinavian Journal of Occupational Therapy argues exactly that, positioning relational pedagogy—an approach that places interpersonal, ethical, and dialogical dimensions of teaching at the very centre of learning—as a critical yet underused framework in the education of future occupational therapists. Written by Qarin Lood of the Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, the paper draws on interviews with senior lecturers at a Swedish university to describe what relational pedagogy looks like in practice, what it achieves, and what threatens its survival in modern higher education. The findings arrive at a moment when universities worldwide are grappling with rising student mental health concerns, expanding cohorts, and digital learning formats that can leave students feeling like, in one lecturer’s striking phrase, “squares on a screen.”

The theoretical foundations of relational pedagogy run deep. The approach is grounded in the ethics of care, most famously articulated by Nel Noddings, and in dialogical philosophy, particularly Martin Buber’s distinction between I-Thou relationships—characterised by authenticity, openness, empathy, and presence—and I-It relationships, marked by detachment and objectification. It also draws on Emmanuel Levinas’s ethics of responsibility to the other. Within this tradition, education is conceived as a lifelong relational process shaped through ethical encounters between persons, in which knowledge, learning, and teaching exist within a shared reality co-constructed by students and educators. The educator’s intuitive and ethical responsiveness to students’ situated experiences becomes nothing less than a moral core of pedagogy. Rather than treating students as passive recipients of transmitted content, relational pedagogy invites them to become active partners in the learning process, establishing trust, engagement, and reciprocity as the mechanisms through which understanding develops.

The empirical case for such an approach is considerable. Pedagogical relationships shape how students perceive their study environment, influence academic achievement, and have even been regarded in some research as more significant than the lecturer’s subject knowledge. Yet contemporary academic cultures—defined by workload pressures, expanding student numbers, and mounting administrative demands—often constrain lecturers’ capacity to engage relationally. Mental health and well-being problems are reported across the academic hierarchy, from early-career faculty to senior positions, reflecting widespread institutional and structural stressors. Students face parallel challenges. Recent Swedish studies indicate that final-semester students in healthcare and social work programmes reported declining sense of coherence and reduced health-promoting behaviours over time, while students across cohorts continued to report low general health and well-being. These converging trends, Lood argues, highlight an urgent need for educational environments that support meaningful relational engagement, belonging, and shared responsibility.

Occupational therapy is a particularly fertile ground for this pedagogical philosophy. The discipline’s core values—meaning-making, participation, and relationality—mirror the principles of relational pedagogy almost exactly. Students are expected to develop not only theoretical and practical knowledge but also relational capacities such as reflexivity, presence, and attuned communication, capabilities that echo the therapeutic use of self long described in clinical practice. The approach also overlaps with sociocultural learning theory, which frames learning as participatory and dialogical, and with constructivist perspectives that view learners as active agents constructing knowledge through experience and reflection. Relational pedagogy builds on these traditions by foregrounding the ethical and affective dimensions of educational encounters, positioning relational quality as a key mechanism through which students engage, participate, and ultimately learn. It resonates too with broader shifts in healthcare toward person-centred and integrated care, reinforcing the importance of cultivating relational competence before practitioners ever reach a clinic.

To explore how these ideas translate into everyday teaching, Lood conducted four individual interviews with senior lecturers at a Swedish occupational therapy programme built on student-activating pedagogy, which encourages students to actively search for knowledge and take responsibility for their own learning. The lecturers had between nine and thirty years of teaching experience, and the interview guide addressed what relational pedagogy means, views on lecturer-student relationships, relationships in an era of digitalised education, and the facilitators and barriers to human connection and dialogue in higher education. Transcripts were analysed using qualitative content analysis as described by Graneheim and Lundman, with preliminary categories refined through collegial discussion, engagement with previous literature, and reflexive notes informed by the author’s own eight years of teaching experience. The analysis yielded two central categories: learning as a co-created occupation, and relational pedagogy as a foundation for deep learning and professional development.

The first category reframes learning itself as a shared, jointly produced activity. Lecturers described relational pedagogy as an active, mutual process built on engagement, trust, and responsiveness—a deliberate shift away from traditional, authoritative teaching toward collaboration and participation. Lecturers and students share responsibility for the learning process, and outcomes emerge through dialogue rather than unilateral delivery. One lecturer summarised this reciprocity as “a giving and taking all the time,” capturing the distributed expertise and shared decision-making at the heart of the approach. In practice, this meant cultivating safe and inclusive environments by being relationally present, inviting students’ experiences into discussions, and using dialogical prompts to stimulate two-way communication. As another lecturer put it, “It concerns not just the what but the how in our work”—pedagogical content and relational quality were treated as inseparable. Importantly, this relational work extended beyond individual lecturer-student encounters to the wider relational ecology of the programme, including relationships within and between student groups and among colleagues, where shared pedagogical aims and collegial coherence reinforced collaboration and collective responsibility.

The second category connects relational teaching to deep learning and professional identity formation. Deep learning, in this framing, means the integration of theory and practice, critical reflection, and understanding that becomes personally meaningful within occupational therapy contexts. One lecturer described the shift from factual acquisition toward professional and personal becoming: “It is about getting the students to understand that it is not only about knowledge, but also about a different approach. To develop as a human being and that it is a road you travel together.” This echoes established research showing that supportive, dialogical environments promote deep approaches to learning, characterised by integrated understanding rather than superficial reproduction. Lecturers also noted that modelling relational engagement—presence, attentive listening, ethical sensitivity—positions relational competence as an integral part of becoming an occupational therapist. The benefits flowed back to educators as well: relational encounters sparked reflection on teaching values and were described as sustaining and mutually enriching, with students reportedly able to “feel when we talk to each other and have shared goals.”

Yet the study is equally clear about the forces working against relational pedagogy. Large cohorts and heavy workloads limited opportunities for dialogue and personalised engagement. Hybrid and digital learning formats weakened relational attunement, with lecturers mourning the loss of body language, informal pre- and post-class interactions, and spontaneous dialogue, and expressing uncertainty about students’ engagement when cameras stayed off. These challenges align with concerns raised by Felten and Lambert that hybrid education can intensify disconnection if relational structures are not deliberately designed. Lecturers responded experimentally, with small-group formats, guided reflection, and open online “drop-in” spaces that supported informal contact—and proved valuable on campus as well. Institutional pressures compounded the difficulty: efficiency demands, standardisation, and surveillance-oriented performance cultures reduced the time and space needed for relational teaching. The approach also exacted a personal toll, demanding emotional labour and vulnerability as lecturers balanced openness with professional boundaries and navigated group conflicts under workload pressure.

The overall conclusion is that relational pedagogy must be understood simultaneously as practice, ethos, and challenge. It can be enacted through intentional strategies—attentive listening, shared reflection, relational availability, and facilitation of peer collaboration—and it demonstrably supports deep learning and professional formation. But its sustainability depends on institutional and collegial support, because it requires time, emotional investment, and pedagogical intentionality rather than discretionary individual effort. Lood argues that higher education systems should move beyond competitive and individualistic approaches and recognise the relational dimensions of teaching and learning as central rather than peripheral. When institutions acknowledge the time, care, and emotional labour involved, lecturers can draw on their professional and experiential knowledge to treat students as credible contributors of knowledge, cultivating inclusive and collaborative learning environments that align with occupational therapy’s core values—and offering a model that other health professional disciplines, and perhaps higher education more broadly, would do well to study.

Subject of Research: The application of relational pedagogy in occupational therapy education

Article Title: On relational pedagogy in occupational therapy education: What it is and why it matters

Article References: On relational pedagogy in occupational therapy education: What it is and why it matters. (n.d.). https://doi.org/10.1080/11038128.2026.2613622

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2613622

Keywords: relational pedagogy, occupational therapy education, higher education, ethics of care, dialogical philosophy, student engagement, collaborative learning, deep learning, professional identity, digital learning, emotional labour, co-creation of knowledge