Recommended reading

Lim, H. & Iwama, M.K. 2006. Emerging models- An Asian perspective: The Kawa (River) Model. In Duncan, E.A.S. (ed). 2006. Foundations for practice in occupational Therapy. 4th Edition. Elsevier Limited: London.

Introduction

The Kawa (River) model was developed by Japanese occupational therapists in the 1990s in response to a need for an occupational therapy framework that socially and culturally communicated their worldview of occupation and well-being. This model is a framework that embraces the issue of culture in occupational therapy. The model serves as a departure point from Western based models of practice that strongly value and strive for the client's independence and autonomy in occupational performance. On the contrary, the Eastern perspective focuses more on collective shared interest and consensus between the client and the environment. For example, the self is seen not as an individual, but a part of a larger whole, which could be a community, the environment or family. This indicates that the individual according to this perspective is inextricably linked to the larger whole, therefore the actions and experiences of an individual cannot be separated from the whole.

The Kawa Model aims to provide a framework that would enable therapists and students to understand and be sensitive to the client's circumstances in context. This would enable development and use of intervention strategies that are truly client-centered. Occupational therapy is faced with a challenge of having culturally relevant conceptual models and ideas about occupation or doing, as well as appropriate methods of delivery of therapy. Therefore, the Kawa model also presents an opportunity for critical reflection on occupational therapy frameworks and their applicability in diverse cultural settings. Occupations and occupational performance have different meanings to people from different spheres of life and who have different experiences or circumstances. Therefore, occupational therapists need frameworks that are conscious of cultural differences between the people that they serve, so as to plan intervention appropriately. Kawa means river (in Japanese) and the Kawa model uses it as a metaphor for life flow.

The central concept of the Kawa Model is harmony, which is described as a state of being, where the individual or community is in balance, which relates to the presence of coexistence and interdependence within the context that one is part of. The essence of the harmony is life flow. Wellbeing is characterized by a state in which all elements coexist in harmony within the context and disruption of harmony interferes with the coexistence or life flow. Therefore occupational therapy intervention would be focused on enabling the client to enhance balance in the life flow.

Structure and Components of the Kawa Model

Harmony between self and context in life is a complex dynamic in the Eastern perspective. Therefore a metaphor of a river was used to communicate the complexity. The river itself represents the life that flows through time and space. A state of well being is said to be portrayed by a strong unobstructed flow of the river. The flow could be affected by structures within the river that form inseparable part of the river and these represent environmental aspects and life circumstances. The following structures were identified, namely:

Water (Mizu) - depicting person's life flow or life energy. Water affects all elements and structures of the river and they also affect the water flow. This indicates that people's lives are shaped and bound by the environment and life circumstances. Weakening of the life flow or energy indicates a state of disharmony and unwellness of the client. The release of the river into an ocean depicts the termination of flow, hence the end of life.

Rocks (Iwa) - depicting life circumstances. Rocks are problematic life circumstances that are difficult to remove. Depending on how big they are they can obstruct flow. For example, congenital conditions, illness, disability, injury or trauma. In therapy the client has to identify the rocks and the therapist identifies appropriate intervention strategies to remove or break the rocks, so as to increase flow. If client cannot identify the rocks, family or connected community could.

River side walls (Kawa no soku-heki) and bottom (Kawa no zoko)-depicting the environment. Environmental issues affect the flow of the river; they determine the boundaries, shape and flow of river. The environment is a very important aspect as it constructs the self, the experience of being and meaning for action. The river side can represent the most important members of the social environment such as family, community or colleagues, depending on the person. Collectively orientated people are influenced by the social context and they value the self within relationships, just like the volume, flow, clarity and form of water. They place great value in belonging and interdependence. The driving force of one's life is interconnected with others sharing the same social frame. As water touches and connects the elements within a river, the elements affect the flow of the river. Harmonious relationships complement and enable life flow. Increased flow can remove rocks and create new flow channels. The environment can enable or hinder creation of a new flow or overcoming rocks, e.g. physical, social, political or economic.

Driftwood (Ryboku) -depicting personal assets such as material or immaterial resources e.g. skills, training, personal character, personality, values, friends, family, assets, money etc. these can positively or negatively affect circumstances. These assets are particularly important in treatment as they could be used to shift the rocks out of the way, therefore increasing flow, thereby enhancing and restoring harmony.

Occupation is metaphorically represented by the space between the obstructions in the river (sukima). These spaces are potential channels for life flow and in occupational therapy they provide an opportunity for both the therapist and the client to consider multiple focal points for intervention. Spaces represent opportunities for problem-solving. The spaces could relate to what matters to the client that is meaningful and important. A space between a rock and environment may represent a medical condition and important social roles.

Qualities of the Model

The Kawa model is unique in that it encourages the therapist to think and does not prescribe ways of addressing problems, but encourages exploration and discussion between the therapist and the client or community. This promotes a client-centered approach to intervention in which the client's experiences and concerns are valued and the client is recognized as a partner and not a passive recipient of therapy. Lastly, the main aim of occupational therapy intervention according to the model is to enable and enhance life flow, whether interpreted at individual or at community level. It is important to keep in mind that the self is embedded in the context and is not a separate entity.

The complex dynamic that characterizes an Eastern perspective of harmony in life between self and context might be best explained through a familiar metaphor of nature. The river is employed as a symbol for the life course. It has its beginning at higher elevations and its termination somewhere, lower down along the course of time. Rivers can cease to flow by drying up, by being dammed by natural or man-made actions, by flowing into a terminal lake or into the vast sea. Wherever the river flows, the profound and complex inter-relation of other elements of nature become apparent. As other elements of nature participate in the life or flow of a river, so the river also participates in the other. Vital relationships form between all elements in a context/frame and a balance or 'harmony' comes into being. It is a balance that reflects the inter-related nature of the elements quite unlike the artificial, mechanical metaphor of the individual as a (mechanical) 'system' oriented to subdue and exert control over circumstance and an objectified environment.

Case studies

Positive Living
Johnny Appels (used with permission from Silver Bullet Productions and SABC)
Journey of Hope - Rebecca Baloyi
Multiple Sclerosis Support Group
Fingerprints of poverty - South Africa

Was selected to depict how environmental factors could disrupt the lives of families. It was also identified for the strong sense of collectiveness that it potrays and how that could become an asset or an inhibitor.

References

For more information on the development and application of the Kawa (River) Model visit the website: www.kawamodel.com