Occupational Therapy Models and Life Between The Trails

I believe that meaningful change doesn’t happen in isolation. It happens in relationship with our environment, our routines, our values, and the people around us. This is something I really connected with whilst training.

Occupational therapy (OT) gives us powerful frameworks to understand how we change, grow and adapt.

Two models that resonated with me during my training — and continue to drive my practice and life, are the Model of Human Occupation (MOHO) and the Kawa Model. While they come from different cultural and theoretical backgrounds, both provide valuable insights into how people live, adapt, and find meaning, especially when life feels blocked, overwhelming, or out of balance.

The Model of Human Occupation (MOHO):

The Model of Human Occupation (MOHO) focuses on how people choose, organise, and perform everyday activities (occupations). MOHO helps us understand why we do what we do and how the patterns of our lives develop over time.

MOHO looks at three key areas:

• Volition – our motivation, values, interests, and the reasons behind this.

• Habituation – our routines, roles, and habits that structure daily life

• Performance capacity – our physical, cognitive, and emotional abilities, and how we experience using them

All of this occurs within an environment—physical, social, cultural, and natural—which can either support or restrict participation.

From a MOHO perspective, challenges arise when there are differences or mismatch between these areas. For example, a person may value movement and connection (volition) but feel stuck in the same routines (habituation) or limited by stress, pain, or burnout (performance capacity), within an environment that offers limited opportunity to reset.

MOHO fits so well with Life Between the Trails because it focuses on:

• Individual values and lived experience

• The importance of rhythm and routine

• The idea that change rarely happens in a straight line

• Like a trail system, our lives are shaped by repeated paths, but those paths can always be redirected.

Pause & Reflect (MOHO)

When spending time outdoors, you could ask yourself:

What activities in nature feel meaningful or motivating to me right now?

Which daily routines support my wellbeing, and which feel misaligned?

How does my body respond to movement, rest, or challenge in natural spaces?

What environments help me feel capable and grounded rather than pressured?

Nature often makes these patterns easier to notice, without judgement or speed.

The Kawa Model: Life as a River

The Kawa Model i feel is more metaphorical but can be easily related to to understand life.

It originates in Japan, kawa means river, and the model represents a person’s life as the flow of a river moving toward the sea.

In the Kawa Model:

• Water represents life flow and wellbeing

• River banks represent the physical, social, cultural, and natural environment

• Rocks symbolise life challenges and obstacles

• Driftwood represents personal attributes, values, skills, and resources

Rather than focusing on fixing the person, the Kawa Model focuses on: What is blocking the flow of life, and how can we make more space for it to move?

This model really links beautifully with outdoor, nature-based, and reflective practice. Being alongside an actual river, trail, or landscape demonstrates how we can identify with this metaphor the metaphor. Nature reminds us that obstacles are part of every life and that flow can change.

We often see people who feel like their river is stagnant or rough. The Kawa Model lets us explore what’s in the way and what strengths we already have to help the flow.

Pause & Reflect (Kawa Model)

While walking, sitting, or observing nature, take some time to think about:

If my life were a river right now, how would it be flowing?

What rocks feel most heavy at this point in time?

What strengths, supports, or values might be acting as driftwood, either helping or hindering flow?

How does my environment help or hinder me?

Where These Models Meet Our Ethos

Life Between the Trails is believed that life is lived in the spaces between milestones, the quiet stretches, the detours, the pauses. Both MOHO and the Kawa Model reflect this too.

They share similar themes:

Connection to environment

MOHO emphasises environmental influence, and the Kawa Model embeds the person within their environment. We look at the natural world as being powerful to support regulation, reflection, and reconnection.

Strengths

MOHO highlights values and interests; the Kawa Model highlights driftwood. We focus on what is already there, not just what feels broken.

Change

Like walking a trail or following a river, progress isn’t always predictable. The models support growth that adapts over time, not instant answers.

Meaning over productivity

Both models prioritise meaningful occupation and life flow over performance for performance’s sake. This is a key part of our ethos.

Walking the Trail, Shaping the River

Whether we are exploring habits and routines through MOHO or reflecting on life flow through the Kawa Model, the goal is the same: to help people reconnect with what matters and move forward with purpose.

Yes, I may be biased as a passionate OT, but I don't just see OT as a clinical approach, but as a way of understanding life. How we get stuck, how we adapt, and how we keep moving.

Sometimes that means finding a new trail.

Sometimes it means clearing space in the river.

Often, it means learning to walk alongside ourselves with more curiosity and compassion.

References

Kielhofner, G. (2008). Model of Human Occupation: Theory and Application (4th ed.). Lippincott Williams & Wilkins.

Taylor, R. R. (2020). Kielhofner’s Model of Human Occupation: Theory and Application (5th ed.). Wolters Kluwer.

Iwama, M. K. (2006). The Kawa Model: Culturally Relevant Occupational Therapy. Elsevier.

Iwama, M. K., Thomson, N. A., & Macdonald, R. M. (2009). The Kawa Model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31(14), 1125–1135.