At the October session of Duke’s Interdisciplinary Rehab Research Seminar Series, Dr. Michael Iwama, Professor in the Occupational Therapy Division at Duke Orthopaedic Surgery and Assistant Director of Duke’s Health Center for Interprofessional Education and Care, delivered a compelling presentation titled “The Kawa Model: De-colonizing Occupational Therapy.”
Dr. Iwama introduced the Kawa Model—a culturally responsive framework in occupational therapy that uses the metaphor of a river to symbolize a person’s life journey and the factors that shape their well-being. Developed in collaboration with Japanese occupational therapists, the model challenges Western-centric approaches by centering the client’s cultural context and lived experience.
“The Kawa Model is practiced at Duke, allowing occupational therapists to yield power to our clients,” Dr. Iwama shared. “It validates their situation and empowers their narratives. The client becomes the theorist, and the therapist becomes the student.”
Born in Okinawa, a region famous for its cultural mix and the birthplace of karate, Dr. Iwama reflected on his personal journey as he navigated various institutional cultures across seven academic appointments. This ongoing negotiation of identity and belonging significantly shaped his development of the Kawa Model.
The model’s symbolic elements include:
- Water (Mizu): Life flow and well-being
- Riverbanks (Torimaki): Social and physical environments
- Rocks (Iwa): Life’s obstacles and challenges
- Driftwood (Ryuboku): Personal assets and liabilities
These metaphors enable therapists to engage clients in meaningful conversations, helping them identify what matters most and how to move forward. The Kawa Model is now included in more than 500 occupational therapy programs worldwide and is widely used in clinical settings to support care that is responsive to patients' varied lived experiences.
Dr. Iwama’s presentation underscored the importance of reexamining traditional therapeutic frameworks and embracing models that reflect the full breadth of human experience. His concluding remarks deeply resonated with attendees.
“Every person—every river—is unique. May your rivers flow powerfully and beautifully.”