The Kawa River Model: Enhances Occupational Therapy and
The Kawa River Model:
Enhances Occupational Therapy and Communication in a UK Mental Health Setting
Beki Dellow . Occupational Therapist . Dorset HealthCare University NHS Foundation Trust . [email protected]
1. Introduction Life is like a river
The Kawa (river in Japanese) Model uses the metaphor of a river to describe a persons life
The Kawa Model was introduced to members of a creative expression group at the Day
journey. It enables them to describe their personal life story and current difficulties that are
significant using a familiar metaphor that others can easily understand and relate to.
The specific client drew metaphors of his Kawa river and a cross-section (here and now).
The river diagram allows the therapist to understand his life story, from his perspective.
Four basic concepts:
The cross section of his river enables the therapist to understand how his life is now.
a. Life flow and well-being = river water
The channels that the water flows through are opportunities for occupational therapy
intervention with the aim of maximising his life flow and promoting health and well-being.
b. Environmental factors (e.g. physical, social, cultural) = river sides and riverbed
An optimal state of well-being in ones life or river can be metaphorically portrayed by an
c. Life circumstances and problems/challenges = rocks/obstacles
image of a strong, deep unimpeded flow. (Iwama 2006, p143)
d. Personal factors and resources (e.g. strengths and barriers) = driftwood
Each persons experience of daily life is unique and should be the context that occupational
therapy should be adapted and delivered. The aim is to enable people from all streams of life
to engage and participate in occupations and processes that have personal value.
(Iwama 2005; Iwama 2006)
Kawa river Life story Kawa cross-section The here and now
River sides/river bed
1. To use the Kawa Model to increase understanding of the clients personal life story and
current occupational circumstances, clarifying their meaning to help facilitate
improvement in life flow.
2. To develop a truly person-centred occupational therapy intervention plan and formulate
Fear of failure
Lack of confidence
Family supportive (helpful but
Lack of qualifications
can be too much)
How society is constructed
Lack of opportunities and interests
Poor mental health
Unable to find enjoyment in anything
goals based in collaboration with the client.
3. To encourage and facilitate clear communication between the client and the multi-
4. To promote and maximise the clients health and well-being.
Allowed further insight into the clients life flow and health, personal assets/strengths and
liabilities, life circumstances/problems and impact of his environments.
All elements combined to form a unique picture of his life at that point in time.
Gained an understanding of the clients metaphorical representations and occupational
circumstances, clarifying their meaning and aiming to facilitate life flow.
Goal planning and intervention:
Opportunity to analyse images in collaboration with the client.
Identified the clients strengths, problems and personal challenges.
Set personal meaningful goals .
Communicated findings with the psychiatrist, in order to review medication and assess
level of suicide risk.
Aim of occupational therapy - maximise life flow
The potential for occupational therapy intervention was limited in this case and the clients
river was almost completely obstructed with rocks, virtually blocking the flow. He was
suicidal at the time of assessment and needed medical intervention.
Following assessment, the aim was to enable the clients life to flow stronger and deeper
despite residual obstacles. The Kawa Model can be used effectively as an outcome
measure during and post intervention.
More research is needed on the effectiveness of the Kawa Model in practice, particularly in
a Western context.
Iwama MK (2006) The Kawa Model: Culturally Relevant Occupational Therapy Philadelphia: Churchill Livingstone Elsevier
Iwama MK (2005) The Kawa River Model: Nature, life flow and the power of culturally relevant occupational therapy. In: Kronenberg F, Algado SA, Pollard N (Eds) Occupational Therapy Without Borders Learning from the Spirit of Survivors Edinburgh: Churchill Livingstone
Beki Dellow would like to acknowledge Dr. Michael K. Iwama PhD OT(C), Chair & Professor, Department of Occupational Therapy, Georgia Regents University for his inspiration, continuous support and encouragement and for allowing me to share his work.
Further thanks to Kee Hean Lim, Lecturer in Occupational Therapy, Brunel University; Jou yin Teoh, Occupational Therapist/Director, Burn Bariatrics, Kuala Lumpar, Malaysia and David Nixon for their professional support and friendship.
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