skills of cultural competence: DSM-5 Cultural Formulation Interview
|GUIDE TO INTERVIEWER||INSTRUCTIONS TO THE INTERVIEWER ARE ITALICIZED.|
The following questions
aim to clarify key aspects of the presenting clinical problem from
the point of view of the individual and other members of the individual’s
social network (i.e., family, friends, or others involved in current problem).
This includes the problem’s meaning, potential sources of help,
and expectations for services.
INTRODUCTION FOR THE
I would like to understand the problems that bring you here
so that I can help you more effectively. I want to know about your experience
and ideas. I will ask some questions about what is going on and
how you are dealing with it. Please remember there are no right
or wrong answers.
OF THE PROBLEM|
Definition of the Problem
Elicit the individual’s
view of core problems and key concerns.
Focus on the individual’s own way of understanding
Use the term, expression, or brief description
elicited in question 1 to identify the problem in subsequent questions
(e.g., “your conflict with your son”).
brings you here today?
INDIVIDUAL GIVES FEW DETAILS OR ONLY MENTIONS SYMPTOMS OR A MEDICAL
People often understand
their problems in their own way, which may be similar to or different
from how doctors describe the problem. How would you describe
Ask how individual frames
the problem for members of the social network.
people have different ways of describing their problem to their
family, friends, or others in their community. How would you describe
your problem to them?
Focus on the aspects
of the problem that matter most to the individual.
troubles you most about your problem?
OF CAUSE, CONTEXT, AND SUPPORT|
This question indicates
the meaning of the condition for the individual, which may be relevant
for clinical care.
do you think this is happening to you? What do you think are the
causes of your [PROBLEM]?
Note that individuals
may identify multiple causes, depending on the facet of the problem
they are considering.
FURTHER IF REQUIRED:
Some people may explain
their problem as the result of bad things that happen in their life,
problems with others, a physical illness, a spiritual reason, or
many other causes.
Focus on the views of
members of the individual’s social network. These may be diverse
and vary from the individual’s.
do others in your family, your friends, or others in your community
think is causing your [PROBLEM]?
Elicit information on
the individual’s life context, focusing on resources, social supports,
and resilience. May also probe other supports (e.g., from co‑workers,
from participation in religion or spirituality).
there any kinds of support that make your [PROBLEM] better, such
as support from family, friends, or others?
Focus on stressful aspects
of the indi-vidual’s environment. Can also probe, e.g., relationship
problems, difficulties at work or school, or discrimination.
there any kinds of stresses that make your [PROBLEM] worse, such
as difficulties with money, or family problems?
of Cultural Identity
aspects of people’s background or identity can make their [PROBLEM]
better or worse. By background or identity, I
mean, for example, the communities you belong to, the languages
you speak, where you or your family are from, your race or ethnic background,
your gender or sexual orientation, or your faith or religion.
Ask the individual to
reflect on the most salient elements of his or her cultural identity.
Use this information to tailor questions 9–10 as needed.
you, what are the most important aspects of your background or identity?
Elicit aspects of identity
that make the problem better or worse.
Probe as needed (e.g., clinical worsening as
a result of discrimination due to migration status, race/ethnicity,
or sexual orientation).
there any aspects of your background or identity that make a difference
to your [PROBLEM]?
Probe as needed (e.g.,
migration-related problems; conflict across generations or due to
there any aspects of your background or identity that are causing
other concerns or difficulties for you?
|CULTURAL FACTORS AFFECTING
SELF-COPING AND PAST HELP SEEKING|
Clarify self-coping for
people have various ways of dealing with problems like [PROBLEM].
What have you done on your own to cope with your [PROBLEM]?
Elicit various sources
of help (e.g., medical care, mental health treatment, support groups,
work-based counseling, folk healing, religious or spiritual counseling,
other forms of traditional or alternative healing).
Probe as needed (e.g., “What other sources
of help have you used?”).
Clarify the individual’s experience and regard
for previous help.
people look for help from many different sources, including different
kinds of doctors, helpers, or healers. In the past, what kinds of
treatment, help, advice, or healing have you sought for your [PROBLEM]?
IF DOES NOT DESCRIBE USEFULNESS OF HELP RECEIVED:
What types of help
or treatment were most useful? Not useful?
Clarify the role of social
barriers to help seeking, access to care, and problems engaging
in previous treatment.
Probe details as needed (e.g., “What got in
anything prevented you from getting the help you need?
For example, money,
work or family commitments, stigma or discrimination, or lack of
services that understand your language or background?
|CULTURAL FACTORS AFFECTING
CURRENT HELP SEEKING|
current perceived needs and expectations of help, broadly defined.
Probe if individual lists only one source of
help (e.g., “What other kinds of help would be useful to you at
let’s talk some more about the help you need.
14. What kinds of
help do you think would be most useful to you at this time for your
Focus on the views of
the social network regarding help seeking.
there other kinds of help that your family, friends, or other people
have suggested would be helpful for you now?
concerns about the clinic or the clinician-patient relationship,
including perceived racism, language barriers, or cultural differences
that may undermine goodwill, communication, or care delivery.
Probe details as needed (e.g., “In what way?”).
Address possible barriers to care or concerns
about the clinic and the clinician-patient relationship raised previously.
and patients misunderstand each other because they come from different
backgrounds or have different expectations.
16. Have you been
concerned about this and is there anything that we can do to provide
you with the care you need?
modules (available online at www.psychiatry.org/dsm5) have been
developed that expand on each domain of the CFI and guide clinicians
who wish to explore these domains in greater depth.
(excluding referencing of supplementary modules) from the Diagnostic
and Statistical Manual of Mental Disorders, 5th
Edition. Washington, DC, American Psychiatric Association, 2013,
pp. 752–754. Copyright 2013, American Psychiatric Association. Used
with permission. Please refer to DSM-5 for the full CFI including
referencing of supplementary modules under pertinent subheadings.