Content area
Full Text
The Cultural Formulation Interview (CFI) was included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (DSM-5)1 to guide clinicians on how to conduct a cultural assessment in routine mental health settings.2,3 The CFI operationalizes the Outline for Cultural Formulation (OCF), a conceptual framework introduced in DSM-IV4 describing the content of a cultural evaluation.5 As a semi-structured instrument, the CFI includes instructions and open-ended questions for clinicians, a pragmatic definition of culture, and clear guidelines for its implementation.1,6 Use of the CFI is recommended during the initial evaluation of any patient, in all mental health settings, by any provider.
The basis for this recommendation derives from a substantial and growing literature that describes how culture shapes every aspect of psychiatric care, influencing patients' experience of illness and distress, the patterning of symptoms, and the models clinicians use to interpret symptoms through psychiatric diagnoses.3 Culture also shapes patients' perceptions of care, including what types of treatment are acceptable and for how long. Even when patients and clinicians share similar ethnic or linguistic backgrounds, culture affects care through other influences on identity, such as those due to gender, age, class, race, occupation, sexual orientation, and religion/spirituality.
A Definition of Culture
A multifactorial definition of culture that includes all these elements is a cornerstone of the development and implementation of the CFI.7 For the CFI, culture is not merely a set of group characteristics that are relevant for mental health care only when patients are considered “other” —different in critical ways from the clinician or from a dominant social group—such as due to their minority background, whether racial/ethnic, sexual, religious, linguistic, or otherwise.5 Instead, culture patterns the very process of meaning-making that every person engages in, as noted in the DSM-5 definition of culture:
Culture refers to systems of knowledge, concepts, rules, and practices that are learned and transmitted across generations. Culture includes language, religion and spirituality, family structures, life-cycle stages, ceremonial rituals, and customs, as well as moral and legal systems. Cultures are open, dynamic systems that undergo continuous change over time; in the contemporary world, most individuals and groups are exposed to multiple cultures, which they use to fashion their own identities and make sense of experience.1
Such meanings can be...