Many small brooks – about the Kawa Project
The Project Group’s Own Testing
“He who travels has always something to relate”
A shared journey of discovery in the possibilities of the Kawa model
A project inspired by a Japanese occupational therapy practice model
Latest news:
The KAWA model is now translated into Danish – August 2009
http://www.gyldendal-akademisk.dk/Books/9788762808799.aspx
25. may 2009 - Michael visits UCN, Aalborg - talking about Kawa in the future in Denmark
Kawa’s official homepage with discussion groupwww.kawamodel.com/
Experiences
The beginning of the account of the Kawa group’s experiences of trying out the model follows – it is intended as headings/topics which we will fill in as we become wiser.
Painting under time pressure
Painting under time pressure was OK. I don’t think I would achieve much more if I had double the time.
Writing on/ about the river
It was OK to write, a little difficult I think, but I’m absolutely not a writing nerd. On the other hand, I found that I’d “forgotten” the beginning of a large rock, when I should tell about my drawing. I could see what it meant when it was written down.
The river therapeutically
I think that the river and the course of events that the patient had shown on their river, gave a really good starting point for a dialogue. I found out many things and the river created a form for structure. This patient is usually good at giving a detailed account of things, so it’s difficult to know if the river made a difference. It would have been interesting to find out if it gave the same result at the point of hospitalization.
The client had difficulty with abstract and symbolic thinking – but said “there is a current/flow in my river – my life”.
Therapist’s reflections on introduction
I experienced that many words need be used in instructing the patient, to give them the basis to enable them to paint their river, using the assigned symbols.
Therapist’s reflections on the drawing
It’s a dilemma that a person with brain injury can’t always grasp too much information at one time, and painting a kawa river requires some introduction with a description of the basic elements such as rocks, driftwood, bottom and sides. Even the sentence “paint your life as a river” can seem long for a person with brain injury. I therefore decided to give a short and concrete introduction by giving a simple example of a river and it’s elements.
Motivation for participation
I have a patient, with whom I am carrying out a course of treatment, but he is “more for talk therapy”, as he puts it! Not even strong motivation was of use…
About the process
….it was really good that we tried the model out ourselves. We agreed to draw a cross-section of the river. We only had time to tell each other about our drawings and our experiences of drawing. There wasn’t time to ask questions and look at individual drawings in greater detail. We found out that it’s good to have the opportunity to place words on the drawing and/or put into words the process/ the thoughts that the drawing generated.
That time we drew a river cross-section, we also used time to write things down afterwards. In my world it’s called “intermodality” and is going from an artistic expression to the other. We could develop this, e.g. if we wrote it like a poem and not just some thoughts written down. As a rule, this gives even more vitamins to the subject/problem.
- and so to my long-standing dilemma: when one tackles drawing/painting, one shall also think about translating one’s world to river-language which is understandable (it almost becomes an illustration) - or shall one “not-think” and just cast oneself into the creative process and later examine, what happened during the process and what the picture actually says/means.
Isn’t there a difference? Do you understand what I mean, do you also experience a difference?
We discussed the opportunities there were with using another language/form of expression.
The symbolic meaning of the elements in Kawa
The movement of the water “there is current/flow in the water” was named as an element.
Bend in the river.
As something new, there were plants drawn in the water – this made an impression, amongst other things, because rocks and driftwood are dead things and plants are living things.
The dead things and plants as living things.
That the therapist is present when the other person is drawing.
It was good that when some other personnel suddenly came into the room – they could be shepherded out again.
Future possibilities
It could be possible to see how the river/stream is considered within the field of art: music, poetry, books, paintings
Finally, we discussed the possibilities of drawing a future river (which hopes, dreams and expectations bind themselves to the future).
When referring to a future river, it makes me think “goals and plans of action.” Can Kawa be used here?
It was suggested that as part of our work with the model, that at some point we take an excursion on the water, with “KAWA-eyes,” with the purpose of coming closer to the model’s possibilities.
Lifelines and KAWA
We discussed the differences and similarities between “lifelines” and KAWA; Kawa also takes movement into account (bend in the river, different widths and illustrates concrete life events with the help of rocks and driftwood), whereas lifelines can be seen as something linear.
Further experiences
Target group:
Everyone in principle, but experience has shown that it is difficult to use with people admitted to acute psychiatric wards (also because of institutional reasons).
Age, physical and mental capacity, language, ethnic background etc are important considerations, but mostly in connection with HOW.
Purpose/ Context
One can draw individually, followed by a discussion between the illustrator and occupational therapist, or in a group, where experiences are shared with the group.
A river can be drawn at the start of a course of treatment to “get to know”, or at the end, to sum up.
A river can be drawn to create an overview over a whole life course – or a momentary picture.
A river drawing can be used as something concrete to relate to during a dialogue – precisely the picture, which can be produced over and over again.
Time:
Approx. 1 hour. 5-10 minutes for the introduction, 20-30 minutes to paint, approx. 20 minutes for discussion of the drawing and process.
We have experienced that a slightly tight timescale doesn’t do any harm.
Materials:
Free choice between “wet” paints, used to paint with, and crayons, used to draw with. Or watercolour-crayons (eg. Caran d’Ache), which can be used for both.
It’s a good idea to offer large sheets of paper – which can always be cut into smaller pieces, and have extra sheets to hand if there is a need for extension.
It’s a good idea to give the options of hanging the paper on a wall, laying it on a table or on the floor.
Remember tape, plastic or a bottom sheet, scissors, a water container, brushes and sponges.
Introduction:
Begin with telling about the KAWA-model’s origins (Michael Iwama, occupational therapy in the East/West, individual/collective, metaphors).
Instruct in the terminology – driftwood is for example, resources, strengths and weaknesses, which the person has acquired throughout their life. Show the KAWA-illustrations from the theory or draw a river as an illustration.
Show pictures or photos of different rivers.
Play river/water music, e.g., Smetana’s “Mouldau” or Celtic music such as Loreena McKinnitt’s “Books of Secrets”.
Exchange:
Depends upon the target group and purpose.
The advantage of having the KAWA-drawing is that a concrete illustration is available, it doesn’t change and can work as a memory aid. A picture is more organic than for example, a lifeline, and is therefore more “like a person.”
When a group compares drawings, life’s diversity becomes evident, leading to a reduction in stigmatising and narrow-mindedness.
With people in crisis (which many patients/users are when they meet an occupational therapist in the treatment world) one shall show humility, care and real interest.
- So long, so good! Additions and corrections are welcome.
From a lecturer’s logbook
It is been a gift to have the opportunity to introduce KAWA.
I have gained a fantastic insight into my students’ lives – sorrow, joy, strength, uncertainty etc. – these students become distinct carriers of a narrative/story. I have previously encountered a great interest for narratives and life histories – it’s overwhelming how strongly KAWA stands out for me as a method for unfolding a story. The symbolic language which unfolds in reflections, stands out strongly – I am once again inclined to work with metaphors.
Project Description
Many small brooks
KAWA - development project
Pre-project
Participants:
Participants in the pre-project are Lone Kolding / Vendsyssel Hospital, Lise Nørby Frey / Psychiatry in Nordjylland County, Sanne Brocks, Kristina Frank, Gertrud Qvist Lauritzen and Ole Mygind. As there are fewer commitments from participants in practice than originally expected, it is also our intention to evaluate the experiences we have gained in introducing KAWA at SCVUN, ie 1st semester and optional subject in autumn 2006, and let these evaluations form part of the project.
Evaluation of the introduction to KAWA on the Occupational Therapy Course at SCVUN (1st semester and optional subject), can be in the form of focus group interviews, answers to questions or written reflections from students, which describe their experiences in encountering KAWA.
Project Framework
We will hold 4 all day meetings in total - in autumn 2006 and spring 2007 from 9-15 at SCVUN.
1st Meeting – Sept 06:
Orientation, teaching and discussion of KAWA – to be prepared for trying KAWA out at “home”.
Orientation about the KAWA-interest group
In-between phase:
Try out KAWA on one or more patients/clients/users/class at CVU.
2nd Meeting – Nov 06:
Exchange of experiences during the trial period, via presentation to the rest of the group.
In-between phase:
Further trials and reflection of significance in therapeutic intervention.
3rd Meeting – March 07:
Presentation to the rest of the group, together with the students have been introduced to KAWA and participated in the CVU part of the project. Opportunity for the project participants to receive feedback.
A draft proposal of the contents of the final presentation shall be decided at the latest, at the date of this meeting, eventually already at the time of the 2nd meeting.
4th Meeting – June 07:
Presentation of results at a KAWA seminar, to all interested parties – students, therapists in practice, from teaching establishments.
There will be an agenda for each meeting from the interest group. There is opportunity for guidance from the principal group, extent depends upon the number of groups/ project locations.
Presentation of information
It is proposed that there will be continuous verbal transmission of information to the network and others (students and those in practice).
We envisage that the final presentation will have a layout rather like an illustrated cookery book, recipes and reviews of restaurant visits or a la “Greek Travel Guide” or a la “postcard from life”.
It is envisaged that the individual descriptions of experiences will not be difficult to write, but the principle “many small brooks – become a large river” (every little helps), will be the project’s strength.
There will be a total presentation of the project in the “Occupational Therapist”.
It is thought that this overall casebook could form the basis for analysis and future bachelor projects.
There could be a project within the main project to describe and evaluate the course of events – but not within the scope of this presentation.
Presentations, en route and final, as well as the project’s network organisation, are principal elements.
1st and 2nd meetings are only for the network.
3rd meeting is divided. 1st part just for the network and 2nd part for the classes at CVU that have been involved, are invited to hear about the project and give constructive feedback.
4th meeting is a KAWA seminar, where invitations are sent out to 1st, 2nd and 3rd semesters (classes introduced to KAWA) and the practice field.
Decision on the final presentation form, will be decided at the 2nd and 3rd meetings.
There is the opportunity for 10 hours supervision/guidance from the principal group.
Testing in practice
The river is drawn by a person with depression in their 50’s, at a time when the depression is easing. It describes the course of events from birth to the present time.
40 minutes are used to draw the river and a further 40 minutes are used for discussion.
The accumulation of black rocks is the point at which the depression seriously breaks out.
It is difficult to see on the drawing in this format, but where the river is in the present (bottom right corner), a piece of driftwood is drawn among the small rocks, which have also become smaller.
This person had difficulty in talking about/ “remembering” their life.
The drawing was a good medium for the person to find the right words to put on their life history.
The piece of driftwood in the bottom right hand corner clearly shows an improvement which the person had difficulty in noticing themselves, but here she could see it existed, which generated a smile.
The patient is a 56 year old man, who has been hospitalized in a rehabilitation centre for approx. 2 months, following a blood clot in the right side of the brain. As a result of the blood clot, he has paralysis of the left side of the body and is very concrete in his train of thought.
He is willing to draw his life as a river, but does this mainly for my sake as he can’t really see the meaning of it. He would rather train his walking function, which is more concrete for him.
He uses 10 minutes to draw his river, whilst I sit outside of his line of vision. He draws the river first, and then adds events and dates. We subsequently discuss the river for 40 minutes, where the river gives good structure to the discussion. He describes many things about his life and I think, that I get a good picture of the type of person he is, and which events have had the most influence on his life. He places rocks in 3 places in his river. Representing the death of a close family member, his divorce, and draws a whole row of rocks to represent his present situation. It is clear from our discussion that his present situation is difficult. He is a very active person who has always had many projects on the go, and this lifestyle may be difficult to resume at present. His comment on the piece of driftwood he initially draws in the river is “there has always been course in my river” – an impressive comment from a very concrete thinking person.
The Kawa drawing was on the face of it, a very simple drawing, and yet formed the basis for a very detailed discussion and understanding of the patient’s situation.
A drawing produced by a 47 year old woman, suffering with chronic pain.
She was asked to draw a cross-section which showed her present situation. We agreed to produce a corresponding drawing when her 3 months training period was over.
She draws for 20 minutes, and we use a following 20 minutes to discuss it.
The surroundings around the drawing describe that she is very fond of nature, but is restricted in using it (illustrated by uneven, impassable hills). The river contains a number of rocks. The large ones are the chronic pain, the small ones are the restrictions in her daily activities. For example, when she starts something she can’t finish. Pieces of driftwood are herself and the resources she is aware of when she can deflect the pain (e.g. when she bakes, something which she is good at).
The sand is a soft bottom which the pains rest upon. (Is it a hope for alleviation?)
The choppy waves indicate when she has a day filled with pain, resulting in a day which is difficult to get through.
On a good day the water will be calm.
There isn’t much flow in the river, due to rocks and sand.
It’s been a tiresome Easter with illness, and conflicts in the family. The person has still got influenza when she draws. It’s agreed that 10 minutes will be set aside for drawing.
The drawing resembles the first drawing in it’s layout. However the content of the river is different, it only contains rocks which lie on hard and uncomfortable sand.
When she is confronted with the fact that she has drawn a sun, she smiles and says: “That is what one draws when it is shining outside”.
We discuss that her two drawings are momentary pictures (drawn with 3 weeks interval) and that they don’t reflect the process in her course of training, but how her days are different and unpredictable when she suffers with chronic pain.
We compare the scorings from the 1st and 2nd COPM (carried out with 7 weeks interval). Here one can see progress in both performance and satisfaction of the chosen activity problems.
In this case, I see KAWA as a good supplement to examine activity problems more closely in a positive way, to refer to further areas within the creative field, and gain a more rapid build up of knowledge of the person, as well as building up their trust more quickly.
Sabina (anonymized)
A 29 year old woman, who suffers from depression and general anxiety.
½ a year ago, Sabina started a course together with other young people, and she has profited greatly from participation. In many ways, she functions well socially, arranges for example, joint leisure time amusements. Sabina has opted for expressive subjects such as drawing, painting, writing workshop, photography, and she writes diligently for the in-house magazine. In this context she gave a cheerful YES to draw her life as a river.
Sabina draws seated on the floor, on a soft mat – draws on a 2 metre long piece of paper.
Sabina draws her life as a river, starting on the right hand side of the paper.
The problems start during puberty. Stones and rocks symbolise bullying, sexual assault as well as a lack of help – letdown.
Life flow increases when Sabrina gets a place on a course, and becomes a mother. She lives alone with the child.
The river grows narrower again when a good friend commits suicide. She enters into a bad relationship, becomes pregnant and has an abortion. All this results in new depression and anxiety.
The river widens vigorously when Sabrina starts the course, in connection with this, she ends the relationship with her partner, who she has been together with for 1 year.
The drawing ends with visions and ambitions for the future.
Sabina looks at it afterwards and says “Still, it’s different to see the whole, there on the paper”.
Sabina is thoughtful when we discuss the picture of the river afterwards, and I get the feeling that she both distances herself from, and gathers together her life course. She looks and looks, doesn’t use so many words but says, it was good to draw and I would like to draw again.
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