Aspects of Cultural Formulation

A consideration of culture is essential in the process of the interview, case formulation, diagnosis, and treatment of culturally diverse indi­viduals. The evaluation of these individuals raises many issues that clinicians need to address to formulate an accurate diagnosis and treatment plan that will be acceptable to the patient. A consideration of culture is essential in the process of the interview, case formulation, diagnosis, and treatment of culturally diverse indi­viduals. The evaluation of these individuals raises many issues that clinicians need to address to formulate an accurate diagnosis and treatment plan that will be acceptable to the patient The American Psychological Association (1993) guidelines acknowledge the necessity of assessing individuals in the context of their ethnicity and culture, respecting their indigenous beliefs and practices (including those involving religion and spirituality), assessing the patients’ support systems, evaluating the patients in their primary language, and taking a history that accounts for immigration and acculturation stresses.

In summary, the consideration of cultural factors in the assessment, diagnosis, and treatment of culturally diverse individuals has gained recognition in a variety of disciplines in the last decade.

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In this chapter, we present a brief history of psychiatric case formulation; define culture, ethnicity, and race; and focus on an explication and elaboration of the DSM-IV outline for cultural formulation.

Aspects of cultural formulation include assessing a patient’s cultural identity and understanding how culture affects the explanation of the individual’s illness, support system, and the clinician-patient relation­ship as well as understanding how culture affects the assessment and diagnosis of culturally diverse individuals From a clinical point of view, understanding the patient’s view of his or her illness helps determine our assessment and our treatment plan.

Different cultures express their symptoms differently (Kleinman 1988), and concepts of illness also vary with culture. For example, for the Chinese in Hong Kong, Cheung (1987) found that patients had three explanatory models for mental disorders. They could explain their illness as based on psychological, somatic, or mixed factors. Their explana­tion of the illness influenced how they went about getting help. The patients who had purely psychological explanations were the least likely to seek help. Because of this, Cheung recommended that clinicians specifically inquire about psychological symptoms, because these patients were not likely to volunteer them. Special Issues in Assessment Professionals working in systems that link treatment and corrections must be aware of a broad range of special issues in assessment related to clients' gender, culture, ethnicity, sexual orientation, educational level, religious affiliation or spirituality, and other such sociocultural characteristics. Issues related to a number of these characteristics are discussed below.

Language It may be necessary to perform the assessment in the primary language of the individual, which may not be English. Assessors should avoid the assumption that a speaker of any given language can also read that language. The client may not be functionally literate in any language. Another part of the staff member's sensitivity to language should be an awareness that the client may need to communicate in "street language." The assessor should be attentive to the kind of vocabulary that the individual client feels most comfortable using. To the extent possible, concepts should be stated in lay language, even street language, if appropriate, but not professional or clinical jargon. Using appropriate language is an essential part of making a true connection with the individual, so that he or she becomes engaged in the assessment process. While good assessment may be largely an intuitive process, specific assessment skills can be taught. Training can be provided in nonjudgmental interviewing techniques, rapport building, sensitive probing, and multicultural sensitivity. Cultural Identity and Ethnicity For appropriate assessment, it is critical that culturally and linguistically competent staff are available.

The assessor must be aware of the importance of the client's cultural identity and the extent of his or her acculturation into the dominant culture. Some programs attempt to draw on traditional cultural http://www.wikihow.com/Write-a-Mental-Health-Assessment strengths of the individual in specific ways; these may be appropriate for the individual who has a strong identification with his or her culture of origin, but it may be inappropriate for other individuals of the same group. It is necessary to gain some sense of the meaning that the individual's culture holds for him or her personally, rather than relying on presuppositions. The client's culture has many potential implications for the process of the assessment. Some cultures view direct questioning as inappropriate. Therefore, individuals from this type of culture may view the assessment process as highly intrusive. A goal of the assessment process is to understand the client's world from his or her own cultural perspective.

The importance of making appropriate inferences from information about an individual's culture makes it imperative that programs involved in assessment exert a strong effort in good faith to hire assessors representative of the populations they serve. When qualified professionals from these cultural groups are not on staff, treatment programs can seek to employ counselors or support staff from these groups, in order to create a diverse multicultural program environment. For effective assessment and placement, it is necessary to recognize that institutional and individual discrimination may exist in the criminal justice system and other institutions, and that bias can negatively affect classification, screening, and assessment.