Kawa model

The Kawa model is an approach in occupational therapy that originated in Japan through the work of Michael Iwama and other occupational therapists in the late 1990s. Kawa, which means “river” in Japanese, refers to the technique’s visualization of the course of a person’s life as a flowing river. The Kawa model compares different components of the river and its surroundings—including its flow, its banks, nearby rocks and driftwood, and the overall space around it—to different aspects of human life.

By considering each aspect and examining how they interact to allow, or sometimes inhibit, the flow of the river, therapists and their patients may reach better understanding of a person’s physical, mental, and emotional state and develop new ways to bring improvements such as better health. The technique gained popularity because of its reliance on easy-to-understand symbols and language, rather than the complex scientific terminology involved in many modern therapeutic approaches.

Background

Occupational therapy is a branch of health care that focuses on people and the everyday activities, or occupations, they perform. These occupations may vary greatly, from jobs and sophisticated tasks to basic self-care and motor skills needed to live independently. They may include leisure activities, professional or academic duties, or even artistic endeavors. Generally, occupations are the tasks that help people define who they are and delineate people’s roles in a family, group, or society.

Occupational therapists may examine how a person’s physical, mental, and emotional health impacts that person’s occupation. At the same time, therapists may also explore how a person’s occupation may affect that individual’s overall health. In many cases, therapists develop new activities or alter existing activities so they may help treat a person’s health concerns and make the person better able to function in related tasks.

Many forms of health care focus on symptoms of a sickness or disorder or look for the causes of a specific concern. In occupational therapy, specialists take a more holistic approach, meaning they typically try to find broader-scale treatments that can help the patient as a whole person: physically, mentally, and emotionally. The goal of this treatment is not just to address a particular health problem, but to help a person better define their personal identity as well as role in the world.

Overview

The Kawa model is a technique in modern occupational therapy that uses the image of a river and its surroundings as a metaphor for a person’s journey through life. Various characteristics of the river and objects in its surrounding area may be seen as metaphors for other aspects of life, including both positive and negative forces that may improve or impede the water’s flow.

The primary element in the visualization is, as suggested by the name, a kawa, or river. The river’s main characteristic is its flow, which represents the ongoing forward motion of life. The river begins at its source (akin to the patient’s birth) and ends with its intersection with a sea or larger waterway (analogous to the conclusion of the patient’s life), thus encompassing the patient’s whole life experience—past, present, and future—into the holistic therapy approach. Maintaining the steady flow of the river is a main goal of the therapy, and correlates to a life of harmony, fulfillment, and accomplishment.

Two other critical factors in the Kawa model are the riverbanks and spaces around the river. In this model, the riverbanks represent the patient’s immediate environments—the context in which the patient’s life story is playing out. This can refer to physical or social environments and can take any number of twists, turns, shapes, or sizes, as appropriate to the individual. Meanwhile, the surrounding spaces, just beyond the river and its banks, may be seen as opportunities to expand beyond the past and present and flow more smoothly and widely; in other words, to expand one’s horizons.

The final major elements of the Kawa model are rocks and driftwood, common objects naturally found in and near rivers. Rocks may appear at any point along the river’s course on the riverbank or in the river itself. These represent the obstacles the person faces in life and could range from small pebbles easily passed over to giant boulders that seriously alter, or even dam up, the river’s progress. The size of a rock corresponds to the perceived size of a challenge. Finally, driftwood represents other factors that impact the course of a person’s life. The life/river carries these factors throughout some or all of its course. They can include skills, experiences, beliefs, or personal characteristics that make the person a unique individual. They can also represent material goods, such as property and wealth, that likewise help to define a person and impact their life experiences.

By identifying and studying each part of the Kawa model, therapists and patients may reveal important insights into the patient’s life as well as strengths and weaknesses. Analysis can reach new levels when therapists help patients explore how the different factors impact each other; for example, rocks might block the flow of water, but driftwood might push rocks out of the way.

The Kawa model originated with Japanese Canadian occupational therapist Michael Iwama. It was first publicized in 1999 and was refined over the coming years. Since that time, the concept has spread far beyond Japan. Hundreds of occupational therapists around the world have adopted the approach for several reasons. One reason is that it is a culturally adaptable approach to therapy; even though it is based on ideas from Japan, most people in most lands have some knowledge of rivers or similar waterways. The river concept is not only nearly universal, but it is also easily comprehended. Whereas many other approaches in occupational therapy and similar fields use complex scientific terminology and sophisticated techniques that might confuse or discourage patients, the Kawa model uses everyday words and images to help patients feel that understanding and improvement are accessible.

Moreover, the Kawa model is completely customizable, meaning that a therapist and patient can easily develop a unique image suited to the patient’s own circumstances. That includes, when necessary, broadening the scope of the visualization to include multiple patients or patients and other people related to them. This makes the experience feel more personal and relevant, and helps insights be closely correlated to the patient’s specific concerns.

Bibliography

“About.” Kawa Model Website, 6 Aug. 2016, www.kawamodel.com/v1/about/. Accessed 30 Aug. 2023.

Iwama, Michael. “Applying the Kawa Model in Occupational Therapy Practice.” Occupational Therapy, 6 Jan. 2018, www.occupationaltherapy.com/articles/applying-kawa-model-in-occupational-4133. Accessed 30 Aug. 2023.

Iwama, Michael K., N. A. Thomson, and R. M. Macdonald. “The Kawa Model: The Power of Culturally Responsive Occupational Therapy.” Disability and Rehabilitation, vol. 31, 2009, pp. 1125–1135. DOI: 10.1080/09638280902773711. Accessed 30 Aug. 2023.

Ober, Jayme L., Rebecca S. Newbury, and Jennifer E. Lape. “The Dynamic Use of the Kawa Model: A Scoping Review.” The Open Journal of Occupational Therapy, vol. 10, no. 2, 2022, scholarworks.wmich.edu/ojot/vol10/iss2/7/. Accessed 30 Aug. 2023.

Teoh, J. Y. and Michael K. Iwama. “The Kawa Model Made Easy: A Guide to Applying the Kawa Model in Occupational Therapy Practice, 2nd Ed.” Kawa Model Website, 2015, www.kawamodel.com/download/KawaMadeEasy2015.pdf. Accessed 30 Aug. 2023.

“What is Occupational Therapy?” American Occupational Therapy Association, Inc., 2023, www.aota.org/about/what-is-ot. Accessed 30 Aug. 2023.