The Cultural Context of Clinical Assessment

Careful evaluation of the cultural context of psychiatric problems must form a central part of any clinical assessment. The outline for a cultural formulation in DSM-IV-TR provides a useful checklist of basic issues to address, including the cultural, ethnic, religious, and linguistic identity of the patient; illness explanations and healing practices; social stress, support, and functioning; and models of the roles and relationship of doctor and patient. Psychiatric theory and practice reflect cultural assumptions that patients and clinicians may not share. Lack of awareness of important differences between patients and clinicians on any of these dimensions can undermine the development of a therapeutic alliance and the negotiation and delivery of effective treatment. Mainstream care cannot respond adequately to the needs of a diverse population unless it gives explicit attention to cultural issues. The ethnocultural diversity of mental health professionals itself represents an invaluable resource. The training programs must recognize this, and make it safe for clinicians to explore their own ethnocultural background and assumptions as a path to more sensitive and responsive work with others. Ultimately, cultural competence involves knowing one's own assumptions, biases, and limitations, and working collaboratively with patients, their families, and community as well as with trained interpreters and culture-brokers, toward goals that have been negotiated through open dialogues.