In occupational therapy, the Kawa model refers to a holistic approach to patient care: centred on the individual, this Japanese approach places great importance on their point of view. Through the drawing of a river, the person expresses their feelings, their strengths and weaknesses, the constraints of their environment and their quality of life. Overview.

The Japanese Kawa model

In the 2000s, several Japanese occupational therapists came together under the direction of Michael K. Iwama and quickly noted that most of the conceptual models used in their profession came from Western countries and did not suit their culture. In 2006, they devised both a model and an assessment tool, named “kawa”, meaning “river” in Japanese.

Together, they identified 4 concepts linked by the river metaphor: “Life is like a flowing river, from birth to the end of life.” Its source is the beginning of life, its course represents its stages, and its outcome in the sea represents death.

Based on this symbolic representation of life, there is:

  • The environment (physical or social context), represented by the riverbed and banks;
  • Problems, associated with rocks;
  • The individual’s personal determinants (strengths and weaknesses), symbolised by driftwood, which is both free to float on the water and liable to block the current;
  • The flow of life, health and energy, expressed through the water.

Kawa, a self-assessment tool in occupational therapy

The Kawa model is designed to facilitate the patient’s introspection and encourage discussion with occupational therapists, in order to define therapeutic goals. This distinctive approach relies on a self-assessment by the individual.

The professional will ask them to create two drawings or two collages:

  • A drawing of the river, flowing from the mountains down to the ocean. The person must then place themselves physically on this river.
  • A cross-section drawing showing the inside of the river at that present moment. The rocks, driftwood, riverbed, water and the spaces between these elements will all be indicators of the patient’s state of mind.

Following this graphic exercise, the patient explains and analyses their drawings, in their own words, relating them to their own experience.

The occupational therapist’s support in the Kawa model

After this self-assessment, the occupational therapist has a complete view of their patient: this allows them to identify therapeutic priorities and think about possible approaches for intervention. They set the goals together with the patient and draw up a list of the means to put in place.

Where relevant, they will not hesitate to refer the patient to other professionals (psychoanalyst, speech therapist, hypnotherapist…).

The whole analysis process encourages discussion and an equal footing between the patient and the occupational therapist, even allowing for genuine negotiation of the work. The goal of the Kawa model is indeed to adapt to the individual rather than the other way round.

Some time after the occupational therapy actions are put in place, the patient returns to see the professional, redoes the two drawings, in order to review their progress.