kawa model for ot

Using the Kawa Model in Occupational Therapy

If you enjoy unique ways of learning about occupation and how to convey its importance to others, you will love the Kawa Model. Not unlike other occupational therapy frames of reference, the Kawa Model focuses on the intersection of person, occupation, and environment. But this model’s Eastern roots offer a unique approach to illustrate these concepts.

Kawa, meaning river in Japanese, is intended to represent a person’s life and each factor that influences it. This model’s intent is to help people better understand these aspects and use them to achieve a calm and free-flowing “river”.

The Kawa Model Consists of Four Components:

  • Water in a river: the flow of a person’s life
  • River banks: natural contexts, including social and physical environments
  • Rocks: barriers to function and life flow
  • Driftwood: assets and resources that promote function and happiness

The Meaning of the Kawa Components

Since the river itself is formed by the river banks, this means that the places where a person exists and interacts with others are strongly tied to their life’s journey. Rocks represent life issues that are usually deep-rooted and can impact the water from flowing through the river. The idea behind this is to get people to understand what is holding them back from meeting their goals.

Driftwood symbolizes assets and things people use to their advantage. In the imagery of the Kawa Model, driftwood is positioned off to the side of the river since it is intended to give someone reprieve from a rocky current.kawa model river

How Therapists Can Use the Kawa Model

As a therapist, your job is to maximize the spaces between the rocks by focusing on treatment. Rocks are often ingrained and a major part of the river system so they may not be easily removed, if at all.

But the idea behind treatment is not necessarily to remove the rocks (since not all of life’s obstacles can go away). Rather, therapists should help clients modify the current ahead by gaining a healthy balance between rocks and driftwood. This allows the water to flow more easily, which increases harmony and quality-of-life. People can then integrate better within the river system, or their life as a whole.

Each of these metaphors has multiple and simultaneous interactions with one another over a person’s life. This makes it very client-centered. It can be used to increase awareness and reasoning skills by allowing people to play an active role in improving their performance.

Clinical Uses of the Kawa Model

The Kawa Model is suitable for use with adolescents, adults, and older adults in rehabilitation settings. It can be used as a supplement to individual treatments focused on physical deficits or as a psychoeducational group to benefit multiple people at a time.

This model can benefit clients with a range of health concerns, but its focus on reasoning does require a base level of insight into one’s own relationships, level of contentment with life, environments, and occupations. The use of the Kawa Model may particularly be of interest to people who enjoy nature and those who are able to think abstractly. Clients who are visual learners would also benefit from images and drawings to help understand the relationship between each factor.

Kawa Model Research

Several studies done on the effectiveness and implications of the Kawa Model show its versatility.

Multiple Sclerosis

One case study analyzed the impact of a pre- and post-treatment interview based on this approach. This study aimed to determine the impact of the Kawa Model on the rehabilitative status and progress of two clients living with Multiple Sclerosis (MS). Results showed that the Kawa Model helped clients more easily reach their goals and focus on occupation during treatments. But researchers also found that client hesitancy and therapist bias had an impact on the progress, so these are areas to be mindful of.

Mental Health

When viewed in the context of an outpatient mental health program, participants experienced the same initial hesitancy to engage in a new form of treatment. But results showed improvements in client-therapist relationship, increased client motivation, and more willingness to try new approaches and extend the boundaries of therapy.

A pilot program also found that the Kawa Model was a holistic way to enhance occupational therapy’s role in settings such as school-based transition programs for at-risk youth. This same study also identified its benefit for community partnerships of the same nature.

The Kawa Model was also used to aid in the development of a social skills group to assist individuals experiencing self-image concerns, low motivation, and depression. The model was found to help clients reduce or remove problems, examine their environment, and identify or utilize assets.

Perhaps due to its Eastern roots, the Kawa Model has also been regarded as a tool to assist in culturally-competent therapy. One case study in particular shows promise regarding the use of the Kawa Model to address stress related to combat and operations in the military.

Teambuilding for Providers

Research also shows the Kawa Model has some utility in encouraging interprofessional collaboration in skilled nursing facility providers. After training on and activities related to the Kawa Model, two focus groups were conducted to determine other potential uses.

Participants determined that this conceptual approach could also be used in groups to facilitate team building, resolve issues among multiple providers, and identify larger organizational barriers that may impact treatment. This model can also assist with performance reviews by addressing barriers to a particular provider’s productivity.

Low vision

A Malaysia-based study compared the benefit of the Kawa Model with that of the Canadian Occupational Performance Measure (COPM) for those with visual impairments. Findings showed that in addition to a focus on occupation, the Kawa Model was equally as effective in addressing client priorities such as self-worth, independence, and adjustment to life changes.

The Pros and Cons of the Kawa Model

As you can see, the Kawa Model can not only benefit students and providers but also clients who need to gain a deeper understanding of the union between person, environment, and occupation. By using a unique series of metaphors, this approach helps clients look at the bigger picture while separating their lives into more manageable and concrete parts.

There are many advantages and some drawbacks associated with clinical use of the Kawa Model. It appears one of the largest obstacles that therapists encountered was client hesitancy to engage in a new, unfamiliar treatment model. This can be remedied by a therapist focusing more on increased education and preparation of relevant materials to enhance retention and carryover.

The Kawa Model is a great way for therapists to creatively emphasize the importance of personal values such as patience and kindness as well as resources such as self-care strategies to help them through life. It’s a basic but creative and thought-provoking way to elicit self-awareness, making it worth checking out!


If you want to explore the Kawa Model more, it’s a great learning activity to do based on your own life. By increasing the awareness you have of yourself, you can not only gain creativity but also a better perspective for the concerns that you help others with.

What populations do you envision benefitting from the Kawa Model? Do you see yourself potentially using this model with clients? Let us know in the comments!

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