Kawa Model has to be the topic that I’ve been asked to do an episode on the most. As well versed as I am in the model and its application I’ve held out for 2 1/2 years until this very moment when I could bring the one and only Dr Michael Iwama on to talk about it himself. This has been on my list since before I even started Occupied so I’m soooo happy that we finally made it happen!
I’ve known Michael for quite a number of years through various online networking and he has always been an incredible support to me and my career. Clinically the Kawa changed how I worked with and viewed peoples situations and the role of OT. The aim of this episode was to create a grassroots resource about how the Kawa came to fruition as I strongly believe that in order to get the most out of the model, understanding its roots is imperative. For those already familiar with the Kawa, you’ll know how ironic that statement is.
Please do enjoy this episode and I’d absolutely love to hear how you’ve used the Kawa model in your life/practice.
Referenced during the podcast:Iwama, M. (2003) Toward Culturally Relevant Epistemologies in Occupational Therapy, American Journal of Occupational Therapy, (57), 582-588. https://doi.org/10.5014/ajot.57.5.582
Dr Iwama’s details: https://twitter.com/michael_iwamahttp://www.kawamodel.com/v1/https://www.facebook.com/KawaModel
Keep Occupied
Brock@brockcookOTbrock.cook@me.comwww.occupiedpodcast.com
Automatic Transcription
101 Comprehensive Kawa ft Dr Michael Iwama
00:00:00 – 00:05:18
All right, I suppose it took a while but I you know, my family emigrated to Canada in the early 1970s and I attended High School in Vancouver, British Columbia Canada. And so for my first studies when I went to college and it’s typical for I think it’s stereotypical for Asian families that have immigrated to other places that it’s just imperative that everybody goes to college or university. There’s this unspoken expectation that somehow your supposed to be supposed to be better than the past generation. Yeah, and so I went and studied. I think what people these days call Kinesiology or Sports Sciences. Yep, exercise physiology job. So I went and and studied for my first bachelor’s degree in a program called Human Performance. So I got a Bachelor of Science and Human Performance. And by the time I graduated I was working with Elite athletes and you know for the I’ve had stents working with the Canadian national men’s and women’s basketball teams, the men’s and women’s volleyball teams. I’ve even you know Fitness tested the professional hockey team and in fact that side of Canada called the Vancouver Canucks and so, you know Varsity athletes, I you know worked as a trainer for many of the Varsity Sports that the universities that have been at so that that was where I was but however, I I started to realize that Elite athletes are probably some of the most egocentric people on Earth birth You know, it’s all about me me me and how can I get the best performance out of me? And how can I win and and that and and so I began to bring it on my career Outlook and I guess I I sought to really want to work instead of working with people at normal levels of performance trying to reach normal levels. I wanted to work with people at sub normal levels of performance trying to reach some semblance of normalcy. I wanted to work with Ordinary People. Yep from all walks of life wage. And so the natural progression was to go into physical therapy or physiotherapy as we call it in Canada and probably in Australia and what it is. Yeah, okay. And so I applied to go to physiotherapy school. I got accepted and I was well on my way to becoming a physical physiotherapist until home in one of my clinical experiences. I was posted at a small Hospital on Vancouver Island and was called a Gorge Road hospital and I remember as I was working with client counting repetitions of hip extensions bored out of my mind wondering whether I was going to spend the rest of my life counting repetitions of people doing exercises, of course physiotherapy is far more than that, but you know, that’s what I thought, you know, this student was was too but I noticed across the gymnasium floor stump OTS working with a person who age For two stroke and what was remarkable was that as I watched these these OTS at work.
00:05:18 – 00:10:08
They were the same two people they happen to be husband and wife and they were not even Canadians were from the United States. They moved up from California and they were working in this little Hospital in Canada. And so I noticed that every day they were doing something different with the client. So while I was counting repetitions with the same client on a daily basis here, you know, they were doing things with objects and cones and balls and you know from one day to the next they’ve been doing something different and I became really intrigued with that and I got to know I’d befriended this couple and I didn’t know it at the time but well they were talking about occupational therapy. Like they were a couple of Crusaders, you know, they were so excited and passionate about what they were doing and log So I became really intrigued with with the whole professional occupational therapy at that point. We used to laugh at them from the physiotherapy side saying that oh, they’re just a bunch of basket Weavers home, you know people not addressed, you know, all of these things that anybody can do and so I found out I didn’t even know very much about o t at the time but I found out that they had studied at a place called the University of Southern California and they were there teachers were people like Bob Barry Riley and rude and Jean airs and others now, I know what those names mean they were just well, so what? Yeah, and then one day I guess that was so enthralled by by this relationship that I was developing with this couple that they invited me to move into their basement. So I was living with them and eating dinner with them and one day at dinner. I looked up and I saw this carving over the lintel of the door way to the to the kitchen and I guess that’s a really nice carving which one of you did that and they said oh we didn’t do that that was done by one of our classmates in school in California, and they said the person who carved that was a guy named Gary kielhofner. Yeah, of course. So so talk about finding me, you know, I couldn’t have asked for a more a better introduction to the profession. Yeah. That’s I was so enthralled by the by the end of that month so clinical experience that that I went back and I quit my plans to become a physiotherapist and I did the most audacious thing. I moved from physiotherapy to occupational therapy. All of my physiotherapy friends thought that it was crazy. You know, why was I leaving this sophisticated world of tienes and ultrasound and you know this and that. Um to a world where I’d be leaving baskets and teaching people how to dress and put on their shirts and things like that. But but I knew Brock at that time that way just the ability to manipulate a button, you know was the fine line between whether a person saw themselves as being able or disabled wage and and that really spoke to me and and so anyway, I enrolled in the program in occupational therapy at the University of British Columbia and the ice, you know graduated as with a bachelor’s degree in occupational therapy, and then I was invited to come back and teach vocation. Yep. Rehabilitation because that’s the field that I entered back into okay that I started in and I should say. Yep and I was doing some Innovative things at the time in that area and the then director of The Rehabilitation medicine program that British Columbia was an American fellow whose name was Charles Christensen and he gave me my first job teaching occupational therapy at the post-secondary level. And so, you know, I’ve had really good mentorship thumb good role models. And and so that’s so that’s my long-winded story about how I became an OT and I it was the best decision I ever ever made and if I could go back and do things over again, I do it exactly the same way, or maybe I wish that I would have found occupational therapy sooner.
00:10:09 – 00:15:16
So it’s been it’s been a wonderful Journey so far and that’s that’s there’s so many names in there that most people here would have probably found in textbooks and that sort of stuff we’ve had child child has been on the podcast before so people would would hopefully have heard his story. But yeah, that’s that’s an incredible like palm tree into the profession. I mean, yeah, so when I so when I look back I realize okay and and you know, I another thing that I kind of took leave and in terms of my own values is that you know, the more that you’ve been given the more the greater is a responsibility to do good with it. Yep. And and so that has certainly been the impetus to go forward and to try to squeeze as much as I can out of whatever abilities inoperative. It is and privileges have been given to me and in in that way. I think probably my work in the field of Occupational Therapy has been in in some people have called it all listed in that, you know, I’ve never wanted to profit from this. I wanted to give back and constantly get back and maybe that’s been the secret to whatever successes I’ve experienced wage is that you know, you just go forward with the sense of gratitude and do as much good as you can and the rest is sort of takes care of itself. So yeah, that was how we got to where we are today. So you did you work in Voc Rehab sort of the whole time until you went into Academia or had you tried a few other areas or was that your thought was your passion? Well that you know, it was what happened. Was that small hospital where I was doing my clinical placements that knew that I had a background in, New Jersey. Size physiology and they were developing a new approach to Vocational Rehabilitation sort of a kind of a a separate entity from the hospital self sort of a free-standing vocational rehabilitation service and work hardening ergonomics Consulting and and evaluations of people work capacity to help lawyers make decisions about whether somebody was able to return back to their former jobs or not following an injury or an illness. Yep. And and so when they started that program a fresh read like me, they invited me to come and be the coordinator of that new and took yeah, you know, you grab, you know experience but they I guess they they saw that I had a background in exercise physiology and that that you know, I’d probably be a good person to be able Go ahead and do it. So I was flying by the seat of my pants. And before I knew it I was being asked to be an expert witness and the Supreme Court and and then I started working privately as a consultant and it was just really really unbelievable times for a new grad who was like pumped full of testosterone. And you know, I had my red Triumph TR6 sports car. I was living in a in a penthouse suite in a high-rise apartment building with sweeping views Victoria Harbor and I would take a helicopter from Victoria to Vancouver to the to the Supreme Court in order to give testimony off and then later on when Chuck Christensen invited me to come and teach Vocational Rehabilitation. You know, I I was yeah, I was traveling across the streets and wage. Going. Yeah, I mean it was just crazy crazy times that you’re a rockstar back then as well. Yeah, but you know, there’s a story. Well, I should say a rockstar. But but what I say though is that I turned away from it. I threw it all the way and it’s where I had an experience and I’ve shared this story with some people wage war, but it’s one that really changed my whole life and changed my whole outlook toward occupational therapy and its future and that is that I had a client that I was just doing a legal evaluation for and the lawyers then took that report and used it to basically get this person cut off from all of their wages ability to benefit payments and you know young father of three small children and this person suicided And it was it it talked about rocking ones world.
00:15:16 – 00:20:03
Yeah through me right on onto my back home. That’s when I did some soul-searching and I thought what the heck am I doing? And so going from the red sports car and the penthouse apartment. So on I disappeared I went I went to Japan and the excuse that I used at that time was that I was going to Thursday how Japanese companies handle their employee health programs and so on. So I went and studied how Nissan and Toyota and Hitachi and all of these companies, you know managed all of that and taught English on the side in Japan. And so that was my first experience of going back to Japan as an adult and then later on I would go back. You helped establish. One of the first bachelor’s programs in occupational therapy there. So so that was a so when people ask me what is my clinical specialty area? It’s it’s Vocational Rehabilitation. But embedded in there are some real lessons that have really shaped who I am today and wearing the other thing that I’ll say about that to Brock is that other than that that one in stock that really really affected me vocational rehabilitation in the work that I was doing was a perfect merger between physical medicine and um and social and environmental aspects of of well being so it was really truly biopsychosocial in nature because when you’re helping somebody to return back to work again, you’re not just getting them physically able to meet the capacity that’s required for their for the job that they’re going to but they also have to make the transition. Socially and emotionally spiritually from being a chronic patient to see themselves as an able employee and worker and off after having lost their regular routines of daily life of a well person of not engaging in the song So activities not engaging in work losing having losing confidence in one’s own abilities not even knowing what what’s cheaper bilities are anyone, you know, the OT that I was practicing at the time was seemed to be Innovative because I was I recognized those those those challenges. Yeah, and I’m working with them more on a physical and environmental level than I was physically like I found out that you can get a person physically. Well, you can get ten people with the same soft tissue back injury dead. Then you’ll see ten different levels of function and you’ll see 10 different levels of recovery and return to work potential. So that’s what I thought. Well occupational therapy. It’s just like it’s incredible. It’s just so Broad in its scope in it and Incredibly useful. It’s it’s essential, you know, we spend with our lives gaining competencies and abilities, but we don’t quite know what to do when catastrophe interrupts that yeah and turns it all apart. Right? We’re not so good at putting all the pieces of the puzzle back together again for ourselves and we need professionals who understand a whole landscape to come in and help us. That’s what I’m original there appears to me. Yeah. I see i t is kind of when people aren’t able to still sort of see that big picture like we’re able to stand back and see you know how their soldiers weixin and how their experiences and all of that sort of stuff fits into the big picture so that we can kind of help them Stitch things back together and get back on on onto that that track Yeah, yeah, absolutely. So so yeah, I mean Talk about serendipity or Karma, you know, it was really important that I I went and studied Sports Sciences or exercise physiology first, you know that I I happen to meet some incredibly influential people that then I would go and practice in the field of Vocational Rehabilitation and had the kind of experiences that I have. Yep. And that’s really what clued me into the incredible potential of occupational therapy.
00:20:04 – 00:25:07
And so that’s always been my vision. Yeah that that, you know of OT and its possibilities and I still believe that it is the greatest idea. In fact now 21st century health and medicine. So what we’re along that Journey or what made you I guess make the the relatively Conventional leap into Academia. Well, I mentioned that Chuck Christensen, you know gave me my first job and so therefore an introduction to the academic home life and that’s where I discovered that I really enjoyed teaching, you know, and my students told me that I was really good at it. So it’s something that I’ve I’ve always stayed close to is is education in in occupational therapy. So I I then really started to think about how about going down the path of becoming a teacher instead of a practitioner exam. So I went back to graduate school and did a master’s degree in Rehabilitation scientists. And and so I thought at that point that I would embark on a career of teaching and doing research Now the the experience in in graduate school was one in which I was really studying the getting gaining the rudiments of how bout to do quantitative research. And a couple of people in on on my committee happened to be social scientists. I caught us psychologists and sociologists and they my interaction them turned me onto the social and and and intrigued with the social so that would then lead me to then pursue the PHD in the sociology and then later on with a medical anthropology. Still talk about certain events and experiences that are really shaped where I’ve gone. That’s how I I developed but the other thing that I want to say and I think that this will probably lead into may be a question that you might want to ask later. This session is about how the Kawa model got its origins in how I got to the point of creating the column odd. Well in in the midst of all of this I mentioned earlier that I had opportunities to go back to my native Japan, you know first to to escape educational Rehabilitation and to you know, study how Japanese companies did Occupational Health But I went back and had the opportunity then to teach occupational therapy in Japan and this whole experience of me being born and raised in Japan. acculturating into North American Life going back to my native Japan re acculturate and back to to Japanese life and going back and forth between these geographical and cultural locations. In my own life, I was experiencing this phenomena of how ways of knowing and doing and being in one place don’t necessarily need the same thing or configured differently in another cultural location. And so here I was teaching occupational therapy in Japan and trying to teach Theory, you know T. That’s what they had me teaching because that was the thing back then. Yeah, you know what Canadian bottle of Aram Aram what you was in the woods in the mid-1990s? Okay, so, you know the really big push on sort of models and Frameworks and stuff at the time. Yeah. Oh teeth were leading the whole field of Rehabilitation. Yep. They were well away ahead of the the physiotherapists in terms of developing Theory and models and Frameworks to guide our processes wage. Guide are practiced. So here I was teaching trying to teach models that were made in North America. And in Australia thought there’d be more models like the lotto and apma that sort of Australia. Yep. And and so but my Japanese students and colleagues were not yet. They couldn’t understand and I clued into the fact that even in my own personal life.
00:25:07 – 00:30:01
I was having trouble adjusting back into a Japanese society and I realize oh my goodness, you know, it’s not that you guys are lacking the right kind of instruction or even in the level of intelligence required to understand models in OT cuz here I am, you know, I’m Japanese. I’ve got Japanese DNA Yeah a hundred percent, you know, and and and I can understand mod. And so why can’t my computer it’s also it’s because the ideas could not be anchored. The ideas run occupation could not be anchored to anything tangible and practical in in in how Japanese people constructed their activities of daily living wage experience of everyday life. In fact, the Japanese don’t have a word in their lexicon in their language their actually captures the definition of occupation as we know it and celebrate it within our profession and in English-speaking places, right? So that’s so that’s why we needed it dawned on me that we needed new models and we needed models that were culturally relevant. Cuz so last time you when you were in Australia like we hung out a bit. I came down to Brisbane and did you workshop and we went out to dinner and all that stuff and you explained it to me then cuz obviously I’m not of Japanese Heritage. I’ve never even been there. So I didn’t have I couldn’t initially get my head around I guess what it’s like to not like I guess see the world differently to how I am currently see it and the way you explained it to me then was in a a western world. We look at the person and we look at the environment and occupation is the bit that in between with the person acts their influence over the environment. Whereas in a Japanese culture and I believe at the time you you said it’s similar in Australian indigenous culture as well. They don’t well they they they don’t conceptualize them as separate. Everything is sort of joined together everything influences everything. So there’s no space in between for occupation as a khong. Step to actually fit is that when am I am I still remembering that correctly like bang on you say I still remember the diagram? Yeah, and the thing that I would say is that really what it is is that those of us in a rationally thinking Western world where the individual is celebrated as being the center of the universe that the self and the environment are two separate distinct entities. And so in that particular worldview, you need something to be able to connect the two months then it happens to be through our agency through our action on the environment and unbend and unwittingly really. It’s a quest to control our environment, you know, the early stages of the model of human occupation of you go back and do those readings they were basically postulating that that your job Ability to control the environment was an indication of adaptation and that that was a optimal place to be and that once you lost control of your environment and and aspects of the environment where then controlling you that that was synonymous with disability. Okay, but when you go into a place where people have grown up and they’ve learned the world differently, you know that we’re we’re we’re in interconnected with everybody and everything in the world. Yeah, and that it’s everything is in flux and always changing. They’re Inseparable. Nothing happens isolated that everything has its its influences and its impact and reactions as two-way two-way influence as well. I think that’s the important thing as well. Like, you know, we impact the environment change something in the environment that impacts us change. Our that impacts the environment and everything sort of influences everything. So there are oties around the world like in places like in Japan where when they hear about this about the basic of Occupational Therapy Theory which is always the self is for the individual is is a distinct entity that is separate very very close next to the environment but yet separate and you need to have this off some kind of an an agent or vehicle of communication between the two and that is what we in in Western occupational therapy call occupation.
00:30:01 – 00:35:17
Yeah wage, but the Japanese person and others would say hold it if the environment is in me as I am in the environment. Why do I need this thing that you call Accu patient? You know, once the instrumental value of that like we don’t know what you’re talking about. Yeah, Sensei, you know, they’re like, what is that? Okay if you say so so, okay. Well this memorized definition of occupation. We don’t really quite know how to explain it for ourselves. But because the leaders of OT have said that this is what it is, we’re going to say you respect that and we’re going to also repeat the same definition, even though we can’t quite make sense of that ourselves. So it was a teaching in in Japan house that point in time. I’m assuming then that a lot of the like it would have been viewed as a very Western profession and a lot of the theory all of the theory up until that point was you know them learning like it’s just Western Way this Western health profession. Was there any sort of other like research or Theory or anything going on over there at that point in time before you started birth? Helping, no there there wasn’t in fact the very fact that the very notion that that theory e or models could be built in Japan. Was just like that wasn’t on anybody’s Consciousness. It was like well theories and models are made by more learned people in those countries were occupational therapy has been around for a lot longer. They’re the ones who are able to make the theory and it’s our job to learn those theories thousand learn them well and execute those theories and and models as closely to the original as possible. You know, Japanese people over time Sears typically have been lauded as copiers, you know, we’ll take Automobiles and cameras and how to grind lenses and you know, we’ll take all of these Technologies from the very busy places around the world and then we Jetta and even make them better so but what’s what’s hidden dead? What’s hidden in in all of the in in this is that the Japanese social structure is built quite distinctively. And that is that everything is is seen through collectives through through groups of people and each of those bodies of dead. People are always arranged in a hierarchy. Okay. So this whole notion of everybody being equal and democracy as a concept is a very difficult thing for a Japanese people to get their heads around because they’ve learned the world in a different way that that everything is stratified in a hierarchy and so when when we then translate that over to a larger macro level it means that occupational therapy and especially American Occupational Therapy is at the top of the pyramid okay wage. So they’re they’re the authority and it’s up to us to I guess respect that and to follow that lead. Yep, um to the point where if we were to go and make a new model like the column model. Made by people clinicians and practitioners that collaborated with clinicians and practitioners in Japan who are seen to be at the lower echelons of the occupational therapy Kermit. Yep. It would be seen as offensive in a and an affront to the venerated leaders of OT wage in America or wherever to downgrade to sort of indirectly downgrade the value and importance of their work by creating something about ourselves to use for ourselves interesting. So yeah, I mean this is this is why even though the color model was made in Japan decided that most often push back there was there was there was a ban on on publications of the, model. I mean that was an unspoken log. That that was whispered to me by somebody who was on the the editorial board. Yep. And and and so there were there was all kinds of opposition off the there is no way that that Japanese OT is could possibly make anything that would come anywhere close to the Perfection of models that were made in place like America and Canada.
00:35:17 – 00:40:11
So I was so frustrated in in that alone that I decided. Okay. Well if that’s the way that this is I’m not going to be able to change it. I’m going to now take this model and take it outside of Japan and propagate it out into the world and off that’s when in two thousand and two at the wfo team meetings in Stockholm the Congress there. That’s where I took my Cadre of dead. Of my my my group of practitioners who were already being browbeaten by wage superiors for participating in the development of this. Sin, ya this model, they they work very hard and trained for this. We had a great number of papers that were accepted for 4 or oral presentation and posters and we went to Stockholm Sweden and I’m so proud of these practitioners who practically memorized their presentation in English. Yeah and and presented the work across the world and and I went to work at that time. I left Japan left my profile position there and I went to work with Elizabeth Townsend at Dalhousie University in the eastern part of Canada and wage. That’s where I started writing about cross-cultural epistemology issues as well as practice issues and really it come back. All from my own experience of having a culture rated into these different spheres of shared experience. Yep, right that’s really been the impetus to the development of the column model. You know, why? Why did we need a model? Yeah. Yeah and let me just really One More Story to you about this church. That was at at Stockholm one of the most amazing things happened. And that was that I was scheduled to give a presentation on the column model at you know, 1020 rooms that at that time people were presenting on aspects of theory. And when I got there I found out that there was a conflict and that somebody else had my life on it. And so we were arguing as to who’s who’s presentation should be allowed to be given Well, it was given to the other person and then they came to the organizers of the of the conference came back to me and they said we’ve got an opening tomorrow in the keynote theater and you can give your presentation their house that and I said well, okay, that’s something that you can give me for this appointment. Well, you know what? I followed Gary kielhofner Gary kill after gave a presentation. A keynote address. Yep, and then there were a couple of other ones that came after and I then gave mine and I think that I was talking about Kang eastern and western from the the about occupational therapist cultural relevance. Yep, and and and so forth. Um, if people are interested in what I talked about it is captured in my publication in the American Journal of Occupational Therapy the September 2093 issue, I believe that’s where my article called toward. The title is toward culturally-relevant epistemology in occupational therapy. And so what I basically postulated in in that serendipitous presentation was the need for Ooty wage now to grow up and to now develop more models that would that people in other places could relate to yeah the wage Western countries. Yeah. Yeah, you know individual Centric sort of biased toward middle-class and affluent patterns of of living and just all kinds of other Norms that are embedded in our models.
00:40:11 – 00:45:05
Yeah models are really culture. They are actually cultural artifacts. They’re made by human beings wage if they’re located in a particular sphere of experiences. Yep and view of the world, right? So in that presentation, At the end it was a question-and-answer period and the first person who shot her hand up and asked the question was none other than dr. Gail Whiteford of of Australia also been a guest on the podcast. Yeah, right. You got you got all of the Heavy Hitters they’re trying to collect the whole set. Yeah, and she asked a poignant question. And and that was are you you know, how many new like are you thinking that we need one another model or do you think we need many more and I said as many models that that will allow people in different. Walks of life to be able to relate to occupational therapy and what it has to offer. And so I think that really the 2002 wfot Congress was also another turning point in the model. That’s when the model went International. Yep, and I’m happy to say to just sort of close the loop that decades later at the World Federation wfot Congress in Yokohama, Japan in 2014. I believe this When ya want him in that one, that was a later than that was Or it could have been yeah, I had twenty-four chairman money. Whatever 2016. Yeah, like six things about that. Yeah. Yeah that that the The Color Purple was translated and published in in Japanese launched. It was launched at that that W 14 and life. So it’s been back imported back into Japan and now slowly but surely it’s gaining some traction there but during but at the time which Tacoma model was developed, there’s just no way that that it had any kind of a chance of propagating in Japan. Yeah, that’s really cool. So going back to you just like that was sort of I guess the why it was necessary. But so you got a group of practitioners and yourself, and I’m assuming probably a couple of other people too easy. Sort of I guess collaborate and work on developing it. So how what was that process? Like how did you get obviously most people have heard of even if they don’t fully understand the different components of the the model itself of the metaphor. How did you come up with those particular components? Like what was the the process or the how did you how did it Courtney you come about? Well, it’s interesting. Well, one of the first things that I did when one of the first things that I was asked to do when I went to Japan to teach OT month was that many people there recognized that I was of Japanese descent that I practiced occupational therapy in North America, and I was actually teaching at at the you know at a university there. So they they were having difficulties understanding theory in OT and like I said, they’re often they look at the world. They see things in a hierarchy and they wanted so desperately to to to to to run alongside the American o t s and the Canadian. Oh teenage, but one thing that was hampering their their progression was their ability to understand and use occupational therapy Theory, so they asked me to give a workshop. I believe I think it was a two-day workshop and people from all over Japan came OT teachers, especially in practitioners to learn how to do understand and apply the model of human occupation. And I proceeded to teach over two days what I would normally cover in two hours in a theory lecture. Yeah, and in North America, right? I thought it was a piece of cake there and then I knew that I was in a lot of trouble just by the first morning of people were confused.
00:45:05 – 00:50:03
They were dejected discouraged here. They thought finally we’ve got a Japanese guy who’s able to teach here explain it to us. Yeah month and we can get it. And so afterwards there were a number of people who expressed how saddened they were many people were thinking about maybe even abandoning OT and going to work elsewhere like maybe as you know work in a supermarket or whatever job that they can get. Yeah, they were that discouraged and so I I thought you know wage was going through my own transition of a culture reading back in the Japanese life as an adult and I thought no, you know, what we need is we need to develop a new model. And so I gathered these people that kind of met with me afterwards and I said, I think what we need to do here is that we need to develop an a unique model of Occupational Therapy. That would be understandable by Japanese clients. Especially Roti Japanese students and Japanese practitioners so long, I mean later on I find out that that this model that we created was not just relevant to Japanese or tedious process that yeah, the metaphor that this based on the one of a river depicting a person’s life journey is a metaphor that a lot of people in many different places around the world can relate to As a metaphor. Yep, that’s why it’s been the utility of the car, model has been really quite impressive in terms of where it’s gone around the world and did just for people that might not knock off a means River. Doesn’t it? It means River and that’s what you know, what is the Japanese word for River? Yeah. So what I did was that I gathered these people together and you know, they were saying we can’t make models. That’s something that’s really intelligent people on the other side of the ocean do and I said no this is you know, the the The American Canadian and Australian OTS, but especially the the the the leaders of OT in America have the luxury of building their model and theory on their own historically and culturally located experiences. And what we’re going to do what I think that we should do is that we should do the same. We should go right back to the basics and start to ask the the basic questions. What is the definition of Health? What is the definition of well-being? What is the definition of disability to us Japanese? And and so we need to start at the very basic places not take models from other places and translate them trying to make for your language wage. So I gathered a group of people to undergo a process of qualitative research. We met at another University in the evening and we had OT teachers. We had OT students. We had OT practitioners from mental health practice Pediatrics adult physical rehabilitation to name a few as well as a couple of clients and yeah to gather together on a weekly basis and I remember that inspiring these meetings where we’d go from like 7 in the evening until 2 or 3:00 in the morning. Wow. Yeah, you know and it’s really something because in Japan The universities of being buildings, they usually shut off their their electricity their lights and air conditioning at like 8 in the evening and when it’s the summertime when air conditioning cuts out. Yeah and it gets hot in Japan, you know, and so people would be sweating. We should be doing our focus groups and so on way into the night under these conditions and in the wintertime, you know, just the opposite we’d have to bundle up and we’d be kind of have freezing and having Arthur’s or oceans, but it was just really quite inspiring and so at the time I had implored this group of people that if we’re going to develop a model wage, it’s going to have to be kind of in a systems theory kind of format. Like boxes connected by plus signs with an equal sign and then a box of the end. Yeah, baby plus b plus C equals D found very prescriptive way of doing it.
00:50:04 – 00:55:09
Yeah, and it’s a very rational. Yeah modernistic North American Australian way of office building. Yeah, cuz the area is is a rational exercise. Yep. So these Japanese oties, you know, we talked together and and off go the first model that they put up was quite incredible. It was four boxes in a circle with arrows not plus signs, but arrows connect each box to every other box inside the circle. Four boxes inside of a circle and that and when I asked well what what does this mean? What is it explain? It means that these four elements off water the river walls and and and floor insides the sides of the the River Rocks and Driftwood those four elements were in a constant interplay and that if you change one box and make it bigger than it would affect the relative sizes of the other boxes, that would be all of these adjustments being made kind of like an an amoeba. Okay always in flux always changing always moving and so just to make sure my explanation water was the concept that we used for life or life flow. Well being the river walls Inside Job. It’s were symbolic of the physical and social environment that if there were problems in any of those areas. It would be seen in this metaphor as a thickening of the Riverwalk hotels there for constraining the channel of water of flow of Life water is life. Yep, like flow and then there would be rocks of different sizes and shapes that would appear and these were symbolic of problems difficulties and challenges and then Driftwood are these elements that can have a positive negative or neutral effect on the flow of the river these Driftwood can get stuck between the hard structures and the river walk and create even a greater obstruction to flow or they can actually move rocks out of the way as they Flow by or erode the side of the the the wage. Four walls a bit to increase greater flow. So these are what I call personal factors abilities and personality Tendencies and whatever it is training and schooling the person has has received whatever it is, those are personal facts or so here, you know, we have at the time this round circle with four boxes and then finally in our discussions, you know, we developed we said what are some easier ways to explain this is one of the first images that came forward was one of a river. And with a digger of heavy equipment Digger on the banks of the river that was also in sort of digging out holes and things and that was supposed to be what medical intervention was about surgery and the use of prescription drugs, you know to kind of effect a an effect where you would expand that I have to change that to be a very deep metaphor that one loading the sides of my river, right? So so, you know an artificially yeah, but however, so then it was like no let’s get rid of the bigger all together. This is a much better much more unrelated understandable way. And and so that’s how the river metaphor came to be the Kawa model so is using metaphor to cuz this is something I’ve always wanted and I’ve never actually asked you about wage is using metaphor to explain a concept like that. Is that something that’s like common in Japanese culture or is that something that you just sort of amongst you decided like this might be a better way to like where did that idea of using cuz there’s not so in OT most people can name a handful of 18 models. There’s none that use metaphor to actually get their their message across other than this one really. Well, and and and there’s a lot of people who don’t understand the models because it’s you know written in a in a cultural language. The concepts are things that that we don’t normally relate to on a daily basis and and and they’re very narrow in their application believe it or not.
00:55:09 – 01:00:12
You know, it’s only OTS that can really fully understand the concept of occupation as we’ve learned it. Yeah in our possession, but however, Brock getting back to what you just said metaphor is something that we all use and relate to like forget about just models just think about our conversations if you were to have a conversation with anybody and you reported it and then transcribed it word for word you’d be astonished at how dependent we are on metaphor. You know, I know I definitely even when somebody swears and says oh shit, you know, and and so when you think about that as a metaphor you get a very clear I did not do this is not good. Yeah, you know that right or your patience says the pain It Feels Like a Knife that or the pain is a knife. Yeah feels like I’ve been stabbed. Yeah. Yeah, so it’s an interesting thing right? But it is a part of how we communicate to one another and not relate to one another. Yeah. And so what I say about the koe model is that it is just a metaphor. It is just a metaphor and and it is not a universal prescriptive model really it gives the occupational therapist using it the freedom to be able to use the metaphor in the most advantageous ways to communicate with your client and to help them move toward their potential cuz I remember when you’re in Australia last and we were we went out to dinner with a whole group of our T’s and there was a discussion. I can’t remember who wrote it up but there was a discussion of from one of the eighties around them essentially using the same Concepts, but using a different metaphor in that from memory, and I could be butchering this but from memory it was they used the metaphor of a football field and so like the opposition players were like dog Equivalent to the the rocks in the car why the size of the width of the field was obviously like the banks your team was the the Driftwood and obviously had to try to you know, get through Thursday score try obviously. Most Americans probably don’t understand this sport that I’ve just described but it’s an Australian. Yeah an Australian version of football, which is yeah quite I guess like I thought you probably couldn’t translate it to American football as well. But that was just even that was like a thirty-second conversation during that dinner that clicked in me. Like it really is just packed full Concepts and the river explains to me because obviously understand what a river is and how it works and what’s in it and that sort of thing I get how all those four things into relate and you can do and started and the reason that that was using that is cuz the the population that are working with yes that population understood River without you working with from memory like young and teenage Aboriginal Straight on the people in Australia. They relate really really well to playing football. It’s a really big part of you know, that particular town or that that region that our in of their culture so long to get by in I guess from the kids. They had it set up so that they were doing this the the cob with a football field instead of a river. I’m not to say that the river wouldn’t work, but just a little bit essentially to that particular region and I remember that like it was it was yesterday? Cuz that was when it was clicked that this is a metaphor and you can use it. However, you know, however you see fit really and and and really the goal of of you know, I would want people who are using the column model to have as an objective to understand and empathize as much as you can to the clients experience of everyday life. It’s like an error If that is waiting to be discovered and appreciated and respected and so each of our clients have got their own experience with their particular wage illness or injury or whatever the issue is and it really instead of Us coming in with these preconceived ideas about what their reality should be. That’s what we do when we take models and universally apply that model to everyone everywhere like the same Shoe Fits everybody when really what we’re doing is that we’re forcing our narrative on the part of the client and really missing what is essential to occupational therapy.
01:00:12 – 01:05:11
I want to believe and that is it’s the client’s experience of everyday life that should be at the center of the universe. We should first be able to appreciate that first and then step back and then think about ways that wage. Ways the occupational therapy can make a difference or has to offer right? So that’s why I say there is no correct way to use the Kawa model we can suggest ways, you know in terms of how it was conceived in Japan and how it was first used but really the essence of client-centered Occupational Therapy was really about putting your client on top of everything in the Centre of everything right and that that means that we should not be unwittingly forcing. The person’s narrative to fit into our narrative. Mmm. Okay. Yeah. So if it’s an AFL football field or a rugby game or the the Autobahn in Germany, which which is a road without speed limits with on-ramps and off-ramps and Ed. Access photos and traffic and folgen, right? Yeah, right. Yeah. I mean whatever it is, you know, if the client can relate to it in a meaningful way and effectively than that’s the right metaphor or that’s the right pathway. So you may start off with using the river metaphor because you can relate to it. But if you find out that your client can’t relate to it as effectively as something else then my change it my recommendation has thrown the Kawa model away from now. Yeah, go to something else. That’s much more safe to use. Yep, and and and then others will start off with a color model and then it will morph into something really awful different and that is okay because the the essence of the color model is that It’s the client’s explanation of what they’ve drawn or what they have put forward in the metaphor. That is the most precious most important job. They don’t even have to follow the rules. You know, like, oh gosh, I think you’re wrong water is supposed to mean this and rocks are supposed to mean this. I think this should be a Driftwood instead of Rock all just let it go. Yeah and encourage them to if they’re drawing skull and crossbones or flowers or fish in there River let it go because the home then it’s going to you’re going to be treated to some insight into what this person’s experience of everyday life is like when they begin to tell you what the fish are or you know, what the snake is off. What what what these things are what is flowers represent. So I just hope that the cover model draws OTS to be able to do them. Educational therapy better. Yeah, you know, yeah and more effectively and effective means as helpful as possible to your client Bots who’s trying to move toward their potential. Yeah, that that brings me to something. I definitely want to talk about. I got a couple of questions from other people that I think will lead into that home and and I’ve actually heard this question a few times myself. Someone sent me a question asking whether you believe that the car off its more as a conceptual practice model or a paradigm. Or I will getting into semantics when we start looking at things like that the answer to it is and I think maybe it’s an extension of what we just been talking about is that it can be it’s it’s it can be all of those things and it has been so there are some that will use the color model as a conceptual model. They use it as a mental framework to ensure that they are keeping the client in the center of all of their their their thinking and in their planning so it can be used instrumentally like that. Right? I mean from that Viewpoint it has all of the qualities of a conceptual model, you know that it’s effective and good when it can describe the phenomena of Interest. Well if it can expect Being processes in a systematic way if they can if it’s good enough to be even predict outcomes and future outcomes.
01:05:11 – 01:10:01
Yeah, those dead zones of the benchmarks that we would use but in terms of a paradigm it is all of it is also that in that the model really when you compare it with contemporary models and our own personal therapy or contemporary Theory. What is fundamentally different is whether you see the self you construct the self as a separate and distinct entity from the environment. Or whether you see the two as interconnected in separately and influx in a complex relationship. And so so in terms of Paradigm, we can also reflect it back to the larger social paradigms that that many of us in the industrial world are are going through you know that we’ve gone through the modernist. We’re you know, we had Universal singular Grand theories to explain all phenomena. It’s what gave birth to the scientific method and how we can reduce complexities down to its Elemental smaller bits to be able to able to explain that those realities now we are in the postmodern a condition in which understandings of Truth and knowledge is power. Much more relative. Yep. Okay, like you ask a question and the person will answer. It depends. Yeah off and ever since the we’ve had these advances in digital technology and especially social media. You know, we’re we’re now recognizing that oh my goodness. My view of reality is not necessarily the same as your view of reality or understanding of the same phenomena, even right you can you can right now I’m talking I’m located off the east coast of the United States and I’m speaking to you on the on the East Coast of Australia. Yeah and faith in this real-time conversation. I mean, we haven’t gone to sleep but we haven’t if we were in some kind of an argument we would know right away. Oh my goodness, maybe you know in fact Of what I’ve experienced in my life and how I’ve made sense of reality you you’ve got your own unique and equally valid different way of experiencing and looking at things. Yeah, right. And and so that’s to me that’s what social media has really accelerated is the awareness that there are multiple realities. Yep. It’s much more relational. It’s not as cohesive and simple and square as as the as modernist thinking I feel like to this is a preface that as well. Like I said, I a hundred percent agree with you. I it’s definitely made it more aware. I still think there’s a ways to go before the majority of the world is more accepting that there’s other factors influence, but there’s definitely more aware that there’s people all over the world with the same and different opinions to myself and yeah that kind of thing I’m getting a wage With both barrels here in the United States. I mean look at what has been happening politically here over the last couple of months. Yeah, you know, like what is qanon and and all these conspiracy theories, you know, I mean everything from you know, the shootings at Sandy Hook of those children. Yeah as being a false flag to you know, in other I mean people actually bought all this stuff, right? So it is that’s what the underscores for me the reality that no, we have all we all each developed our own uniqueness of reality faith and we decide what is believable or what isn’t and and we have our ways of being able to validate those things for ourselves to some people it’s whatever people talk about and reinforce through conversation with two others. It’s about using some kind of a scientific measure to be able to determine that Right. So now I think the amount way off on a tangent can’t even I think I think to build on that too. And this this could be a very loaded question cuz I feel like you know what the answer is going to be but where do you in my experience in using the car? Like we’ve talked about how a lot of our westernized developed models work very well understood if off.
01:10:01 – 01:15:01
All in the Japanese culture, but in my experience going the other way, there’s a little Western people from a western world that I’ve worked with our Western culture that I’ve worked with understand the car wash the wires at all. It’s really easy. I wonder whether firstly that’s your experience but where you feel Or if you feel even the car wash fits within say occupational science, who is I guess promoted as the underpinnings of our whole profession from a Western World. Anyway, where do you feel they do they oppose each other like or do they fit somehow together? Like, where do you see that sort of relationship? Well, yeah, it depends on I’ve got to be really careful about how I answered this question. That’s what I thought. Yeah, and it’s good that you’re asking this because I think that this is something that that we as a profession should also reflect on if we want our profession to be truly relevant and helpful to people in different locations different places different experience sets around the world wherever you are. I think that really dead we we need to reflect upon our own understandings of our own Concepts and and really come to terms with either off with we’ve got a graph grapple with a very same issues of whether the concepts that we put forward are truly relevant and applicable to everyone everywhere else. Given the growing sense or awareness of diversity that we’re gaining. I think that that occupational scientists, especially in the early days, so and they still have the very best intentions at heart. They really really want to give something of Great Value to the world revolutionary, you know of being able to really highlight the benefits of this thing that we call occupation, but I will say and this will be maybe metaphorically wage quite crude and maybe a little bit over-the-top but you know, the colonization of many of the Southern countries of the world was propagated and justified by Good intentions, you know when Northern countries would go into the African continent and basically say we’re going to save these people from themselves. We’re going to teach them how to behave how to act and how to speak our language and so on and so forth. So really, you know, I mean, I thought we were to just think openly we’d realized that that we also need to be careful with in our profession in terms of what we not just wittingly but unwittingly communicate to the other the the kinds of assumptions that were making about the other and about really what we think they’re reality should be with very much consideration for how they might see it from their viewpoint. So I have you know, I’ve been I’ve supported occupational science from a distance, but I’ve always rejected or resisted the label of being called an occupational scientist. And that is because I really do feel that the the core concept occupation is culturally bound and that it’s going to suck resonate with a lot of people who abide in shared experiences as with the authors of these Concepts and thoughts. However, it does disadvantaged people who can’t relate to the concept because they can’t anchor it to the same social conditions of individual centrality of human agency and so on and so forth. So I I just think that you know with best intentions. I mean, you know occupational science was launched as dead. As a new discipline and one that you know was not limited to occupational therapy. Um, but you know was certainly a growing body of knowledge that. Oh jeez could refer to to support their their fledgling growth, you know, so it it started off with yeah with Renee really good good intentions.
01:15:01 – 01:20:04
Yeah. I think that really what it’s suffering from and this is evidenced in the fact that there hasn’t been the kind of buy-in from other disciplines from other act from academics and other fields. Yeah to come over to the to this and and I think that that, you know, they’re it’s it’s indicative of how just like our contemporary models and occupational therapy were developed with a modernist mindset. You know where you want to create a grand theory that is going to explain this phenomena for everyone everywhere regardless of their differences in experiences of the world and not reality it is I believe that occupational signs at least in its original form is a Vestige of worldviews that that way we’re very Central to the modernist. And now that we are into the postmodern arm some of these Notions and assumptions that are based on a rational view of the world in which Grand theories are adequate to explain a phenomenon for everyone everywhere it it it’s not going to hold off and so occupational scientists have two in my opinion. They’ve got to do some Major rejigging and that is eating Humble Pie stepping back and saying okay, let’s start from the very beginning again. And let’s ask the essential questions page is instead of making statements. Like all people are occupational beings. Or occupation is essential for health and well-being or occupation is doing being belonging doing being becomes doing becoming bologna becoming belonging. Yep. Okay, instead of making those statements with a great deal of confidence. Let’s go back life. All of these other many other disciplines have done and let’s ask the essential questions that’s formulated reformulated into a question is occupation. You are actually required for health and Is occupation doing being becoming and belonging? Are we all occupational beings and and if if that would have been in the equation from the very beginning I think that we would have seen occupational science grow into a much broader much more eclectic, uh discipline of thinking and I think the Palm now occupational scientists, especially those that are more trained in the social sciences are trying to make those exceptions. They’re trying to backpedal and they’re trying to get into office everything from uh, disability Theory to the field of science where we we look at text and we offer we analyzed text and draw understanding from it. It’s called critical. It starts with a d Theory. Anyway, it’s got a Long Hill ahead of it. I so damn long and short of it is that I’m not opposed to occupational science, but I do most certainly have some cautionary issues about it. And that’s what I have been participating in occupational science because I don’t want to participate in any kind of activity. That would maybe be seen to be actually excluding. Yeah. Yeah. Yep. Okay, and that’s a that’s a strong and hard possibly unfair thing to say, but really when you look at the effect of it if you’re taking a set of ideas and you’re just assuming that this is the way that everybody around the world. Sees reality and and you know with the best intentions you’re trying to get that vehicle moving in that direction it there are going to be people who can’t relate to it who don’t see it as part of their own understandings of reality and therefore don’t value it as as as essentially and fundamentally as many of us might change. It actually is excluding. It’s actually rewarding the people who abide in that view of reality and that that fits with something of thought for a very long time in that job as a whole. And again, this is a very generalized statement as a profession.
01:20:04 – 01:25:04
We don’t I don’t feel we have enough critical thinking we don’t question enough things even right down to the the little things of like why am I doing this assessment with this person? Like what is What benefit is it going to be to them? I hear so many OTS that and I used to be the same one. I used to get referrals that I’d get a referral for a baseline assessment on my okay Baseline for what expecting them to come back? How about we just do a really good job now and then they went after come back. So yeah, I just on every level I feel like OT as a profession Mondays in general could do with a million, including myself in this could do with more critical thinking or at least even more space to to be critical and think about some of these Concepts that we work under that we use some of the assessments some of the some of the places that we even see the profession actually situated. I I I mean, I’m fairly opinionated as you know, how long I feel probably aren’t the best spot for our profession and might be better suited to other professions. Whereas there’s other places where you know, we could put more eighties because we’re able to have a bigger influence. In that that particular area but I do feel I’m always wary of people that talk in absolutes cuz I’m like if you’re talking an absolute or absolute truths or you know, this is the way in the most that Star Wars thing that Mandalorian this is the way I feel like then you’re already negating some other options, Yes, any any any other options one more thing that I wanted to cover before you go? Cuz I know I’ve taken up a lot of your time is I’ve had someone Tom asked about the application of the car were two individuals but also to community-level cuz I know like I can speak from my experience as a mental health clinician. That’s usually, Peru pretty much since I learned about it right through my my clinical Korea. I’ve used it as similar to what you were speaking to before we were talking about whether it was a paradigm or a model home. Drop I’ve used the Car Wise a number of different users an initial assessment. I’ve used as an outcome measure. I’
