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 . beki.dellow@dhuft.nhs.uk

1. Introduction Life is like a river
2. Objectives
3. Methods
4. Results
5. Conclusion
The Kawa (river in Japanese) Model uses the metaphor of a river to describe a persons 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:
a. Life flow and well-being = river water
b. Environmental factors (e.g. physical, social, cultural) = river sides and riverbed
c. Life circumstances and problems/challenges = rocks/obstacles
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)
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
goals based in collaboration with the client.
3. To encourage and facilitate clear communication between the client and the multi-
disciplinary team.
4. To promote and maximise the clients health and well-being.
Kawa river Life story Kawa cross-section The here and now
Aim of occupational therapy - maximise life flow
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

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.


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 ones life or river can be metaphorically portrayed by an
image of a strong, deep unimpeded flow. (Iwama 2006, p143)
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.
Assessment:
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.
Clients Kawa
(cross-section)

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

Driftwood/personal factors
- Self-awareness
- Creative
- Capable
- Fear of failure
- Lack of confidence
River sides/river bed
- Employed
- Family supportive (helpful but
can be too much)
- How society is constructed
- Why?
- Confusion
- Poor mental health
- Emptiness
a
b
d
c