1. 1. Introduction – ‘Life is like a river’ Driftwood/personal factors
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 .
1. Introduction – ‘Life is like a river’
3. Methods
The Kawa (‘river’ in Japanese) Model uses the metaphor of a river to describe a person’s life 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.
Four basic concepts:
Life flow and well-being = river water
Environmental factors (e.g. physical, social, cultural) = river sides and riverbed
Life circumstances and problems/challenges = rocks/obstacles
Personal factors and resources (e.g. strengths and barriers) = driftwood
Each person’s 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)
The Kawa Model was introduced to members of a creative expression group at the Day Hospital.
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.
The cross section of his river enables the therapist to understand how his life is now.
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.
‘An optimal state of well-being in one’s life or river can be metaphorically portrayed by an image of a strong, deep unimpeded flow’. (Iwama 2006, p143)
Client’s Kawa
(cross-section)
Kawa ‘river’ – Life story
Kawa cross-section – The here and now a b c
Rocks/challenges
Lost
Self-destructive
Lack of qualifications
No transport
Financial difficulties
Poor concentration
Lack of opportunities and interests
Reduced motivation
Unable to find enjoyment in anything d
River sides/river bed
Employed
Family supportive (helpful but can be too much)
How society is constructed
Why?
Confusion
Poor mental health
Emptiness
2. Objectives
Driftwood/personal factors
Self-awareness
Creative
Capable
Fear of failure
Lack of confidence
To use the Kawa Model to increase understanding of the client’s personal life story and current occupational circumstances, clarifying their meaning to help facilitate improvement in life flow.
To develop a truly person-centred occupational therapy intervention plan and formulate goals based in collaboration with the client.
To encourage and facilitate clear communication between the client and the multi-disciplinary team.
To promote and maximise the client’s health and well-being.
4. Results
Assessment:
Allowed further insight into the client’s 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 client’s 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 client’s 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.
Client
29-year-old male
Diagnosis of chronic depression
Lived independently in the past
Maintained full-time employment
Troubled by frequent feelings of hopelessness and paranoia
Aim of occupational therapy - maximise life flow
5. Conclusion
The potential for occupational therapy intervention was limited in this case and the client’s 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 client’s 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.
References:
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
Acknowledgements:
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.