The Kawa Model: Occupational Therapy Practice Model

History

The Kawa Model was developed by a group of Japanese occupational therapists in response to a need for an occupational therapy practice model that was useful and appropriate in the Japanese culture (Iwama, 2003, 2005, 2006). Occupational therapy practitioners in Japan have struggled to interpret occupation and the social contexts of occupation. In many non-Western countries, the concept of occupation and the contextual meanings associated with it did not exist in similar social frames or in the vocabularies. Furthermore, the Western worldviews of individualism and independence, in which oneself and the environment are regarded to be discrete, separate entities, differ from the pluralistic world view in the Eastern culture in which selves are collectively integrated with the environment.

In response to the challenges, the group of Japanese occupational therapists were encouraged to redefine occupation from non-Western cultural perspectives and re-align the purpose of occupational therapy to the perceived wellness of a Japanese person. Through a process of qualitative research, participants employed a metaphor in nature to conceptualize the dynamic intricacies of the new model: a river or Kawa in Japanese (Iwama, Thomson, Macdonald, 2009).

Foundational Concepts

The foundational concepts of Kawa Model were strongly influenced by Eastern philosophies and ethics: naturalistic world view, social relativism, and the Confucian ethics (Iwama, 2003). Unlike the Western constructions of the cosmos, where a singular almighty Truth ranks the top over humans, society, and nature, the world does not revolve around oneself in the Eastern variation. Rather than a hierarchical continuum of defined entities that each operate individually, the Eastern counterpart views the universe as a single, inseparable entity made up of human beings, flora, fauna, and deities arranged in a tightly packed unity. A sense of interdependence predominates in the Eastern culture, compared to the Western notion of individual independence (Iwama, 2003).

In non-Western societies, where a collectivist social context prevails, one’s role is largely influenced by minor factors, such as age, seniority, and social connections. Compared to the Western perspective on role acquisition, where interests, will, and resources are within one’s disposal, oneself is oriented toward adapting and adjusting to the social environment to attain harmony in a collectivistic society (Iwama, 2003, 2006). Referred as ‘social relativism’ by Lebra (1976), the elements in the universe are related horizontally and mutually. Instead of a singular God that governs morality, a characteristic of Western ‘unilateral determinism’, Japanese people believe in social interdependence and there is no single way to universally view and judge a phenomenon (Iwama, 2003; Lebra, 1976). It was postulated that belonging is regarded to be the ethos of collectivist Japanese person, compared to doing (Wilcock, 1998) in the Western society of individualism (Iwama, 2003).

One’s wisdom and social relationships are the ideologies of Confucianism that are highly valued in the Japanese society (Iwama, 2003, 2006). Leadership figures in Japan are typically elderly individuals who have established seniority and broad social networks in the organization. Similarly, Japanese people hardly view success as one’s extraordinary ability, but as the interplay of many factors that happened at the right time. In a collectivist society, oneself is viewed as an inseparable entity of the greater social context (Iwama, 2003).

Influence on Perspective

The foundational concepts placed significant influence on the Kawa Model. The holistic construction of the universe in Eastern culture, where all entities are inseparable and interdependent. Similarly, the Kawa Model views self, society, and circumstances as one, inseparable whole (Iwama et al., 2009). Contrary to the individualism in Western culture, the Kawa Model values belongingness and interdependence to attain harmony with environment and life circumstances (Iwama, 2006; Iwama et al., 2009).

The use of structure and components of a river to describe one’s wellbeing in life, clearly illustrated how one strives to adapt and adjust self to attain harmony in a collectivist social context (Iwama et al., 2009). In the Kawa Model, water, represents the individual’s life energy. Iwama (2006) explained that the water flows in the river, being shaped by the rocks and banks, just as one’s life is bound by their social contexts. Consistent with the values of Confucianism, the Kawa Model uses river side walls/bottom and driftwood to depict aspects of one’s contextual environment and experience, respectively. These factors play an important role in shaping the one’s overall wellbeing.

Presence in Practice

Emerged from Eastern philosophies, Kawa Model’s foundational concepts were embedded in collectivist cultures. The concepts grant practitioners privileges to the voices of people from East Asian and indigenous cultures who may share the same sociocultural views on interdependence and sense of belonging (Nelson, 2009; Turpin Iwama, 2011). Although the adoption of the foundational concepts in appear scarce in literature, given its exclusive nature of the collectivist world view, the Kawa Model offered a medium through which clients from diverse cultures could express their narratives (Iwama, 2006; Iwama, Thomson, Macdonald, 2011). Using the river metaphor as a tool, the Kawa Model provided interdisciplinary health care professionals a common method of communication to better understand clients’ needs. Three studies reported the model’s ability to enhance interprofessional collaboration in various settings: skilled nursing, acute care, and forensic mental health (Lape, Lukose, Ritter, Scaife, 2018; Leadley, 2015; Ober Lape, 2019).