When we utilize and think about occupational therapy (OT) conceptual models of practice, we are often thinking about our caseload of clients’. We take the information we have gathered about an individual and decide what models we should use to help frame our thinking and drive our intervention plans, all with the idea to help that individual overcome obstacles in their lives. The truth is though, we all have obstacles. As an OT we spend so much of our time focused on helping other overcome their barriers and obstacles, that we tend to sometimes forget about our own well-being. There is one fascinating occupational therapy model that is unique in the sense that it cannot only be used for clients, but also for ourselves to help with our own life journey.
The Kawa model was created in 2006 by a group of occupational therapists from Japan who sought out to create an occupational therapy model of practice that both socially and culturally focused on all aspects of one’s occupations and well-being in their life. This model uses the natural metaphor of a river to understand one’s journey through life. Its versatility makes it a useful model to use for OT clients, groups, families, organizations, or again just for yourself, to understand your own life journey.
There are 4 constructs that make up the Kawa model: river flow, riverbank, driftwood and rocks. It can be used as a model of practice, frame of reference, modality or assessment. I will describe this model in such a way that helps capture how it can be used as an assessment tool for both your own personal journey and a potential client. I encourage you as you read about the constructs to think about your own life and channel the details of your own journey. Using this model helps gather information to enable, assist, restore and maximize an individual's’ life flow by helping unblock obstacles.
RIVER FLOW: Imagine your life as a river. The river starting when you were born and opening up to the ocean at the end of life. Your river flow equates to your life flow. The river flow represents your life priorities and the occupations/activities that make up your life. Areas to question when focusing on this construct with a client or yourself include asking questions relating to what you typically do in a day or determining if there have been any significant changes in your life. Maybe you recently got a new job. Maybe you have a set routine of working out every single night, going to weekly yoga class, carpooling your kids to different sporting events. What fills your day, week, life? All of these aspects represent the water flowing in your river.
RIVERBANK: The riverbank determines the boundaries and shape of the river, which affects the river flow. It includes the physical and social environments; both supports and barriers. It can represent the most important members of the social environment such as family, friends, colleagues, classmates, and community. Determining who you spend most of your time with, who you are living with, and thinking about who your supports are socially all play a role in shaping your riverbank. Your physical environment may include thinking about your work environment, living environment, access to parks and recreational places nearby, and geographical location. Another example of a barrier would be a client not having the modifications they need in their house and community after a recent physical impairment.
DRIFTWOOD: Driftwood includes your personal assets and resources, both material and immaterial. Driftwood can both positively and negatively affect life circumstances. Some examples to help you think about what your driftwood contains might include thinking about your existing skills, training, education, money, personality traits, values, friends and family, etc. Some general questions to ask yourself or clients when using this model to determine their driftwood could include the following: How do you see challenges in life? How do you typically cope with stress? How would you describe yourself? Do you have any special skills or abilities? Can you tell me about your education/work skills? What do you value?
ROCKS: Rocks typically are seen as the negative obstacles that impede on the river flow and includes occupational performance difficulties, fears and concerns, inconvenient life circumstances, and impairments or medical concerns. These are usually the reasons we are seeing our clients, but it's important to remember we all have our own rocks. Questions to consider when determining what are your rocks (or your clients) include: Are you having any difficulties right now? Why do you think (those things) are difficult for you? How is it difficult? Do you have anything in particular that you would like to do but you are unable to do because of your current situation? Why do you think you are unable to do them? How are these things typically done? The point is to really dig deep into understanding what are your obstacles. Find within yourself what is holding you back from having the most powerful flowing river.
Using this model to understand your own life journey may lead you to thinking about your life on a level of detail you never have before (at least it did for me). It helps identify areas and opportunities to enhance flow. This leads for a fifth construct, creating spaces in your river flow. You could think of this as the intervention process. Every single river and space have the potential to flow more powerfully. Intervention measures and goals are created and used to accomplish this. Some examples of how this can happen includes making rocks smaller, adjust/widening the river banks, or using driftwood or creating new driftwood to push away rocks. Rocks might become smaller for clients because you have used interventions to help their dysfunction become less severe and more function has been regained. Maybe you have met a new supportive group of coworkers and friends at a new job and they have helped widen your river bank becoming an important part of your social environment. Maybe you have learned meditation and it has helped reduce work stress (rock). There are so many ways to adjust your river flow, and you have the ability as occupational therapists to do this not only for your clients, but also yourself.
This model has brought me so much insight to my own life journey and hope that it can help you with yours as well. People use this in various different ways by just critically thinking about these constructs or even drawing their river and the constructs out so they can visually see what their personal river looks like. I encourage you to use this model as a tool to not only help your clients, but also yourselves. Always remember in order to provide the best care and help to others, we must first take care of ourselves.
The Celtic Maze pattern symbolizes the journey of life and the path of experience, & learning. It symbolizes that there are twists, and turns, the challenges and obstacles in life, but that there are always open doors.