Cultural Adaptions: Part 1
I work with diverse clients from various cultural, religious, social, economic and ethnic backgrounds. Due to this, I've been reading articles, attending talks and training around cultural competency, cultural adaptions to therapy and anti-racist practice to ensure better relationships with the clients I work with. This will
Ensure that clients feel respected and cared for throughout their time at the service.
Build a richer formulation of clients' needs and make sure their voices are heard throughout their time at the service.
Ensure that intervention best fits the client's needs, expectations and values.
I am also curious about cultural adaptations from assessment and intervention and how they may differ across different cultures. In this blog series, I will be summarising the talks and training I have attended during my work experience and reflecting on how these have enhanced my knowledge and skill set to work culturally sensitively.
Culturally Sensitive Assessment
This talk discussed how culture shapes mental health issues and the importance of cultural sensitivity in assessments. I was also trained in the Cultural Formulation Interview (CFI), a DSM5 tool traditionally used to ensure mental health diagnoses and interventions are more culturally sensitive. The Key Components of the CFI are below:
Cultural Definition of the Problem
In this section of the CFI, we will be trying to look for the following:
A person's way of understanding the problem.
How an individual frames their current problems to other members of the social network, i.e. families and friends.
Example Questions
People often understand their problems in their way, which may be like or different from how doctors describe the problem. How would you describe your problem?
Sometimes, people describe their problems differently to their family, friends, or community members. How would you describe your problem to them?
Cultural Perceptions of Cause, Context, and Support
In this section of the CFI, we will be trying to look for the following:
What the individual identifies is the cause of their problems.
For example, in some cultures, mental health is the result of bad things that happen in their life, problems with others, a physical illness or a spiritual reason.
The individual's life context focuses on resources, social support, and resilience.
I.e. from co-workers, from participation in religion or spirituality
Example Questions
What do you think are the causes of your problem? Is there any support that improves your situation, such as support from family, friends, or others?
What do others in your family, friends, or community think is causing your problem?
Do any aspects of your background or identity affect your problem?
Cultural Factors Affecting Self-Coping and Past Help-Seeking
In this section of the CFI, we will be trying to look for the following:
How does a person cope with their problem? What was/wasn't helpful? And why?
Either by medical care, mental health treatment, support groups, work-based counselling, folk healing, religious or spiritual counselling, or other forms of traditional or alternative healing
The role of social barriers to help-seeking, access to care, and problems engaging in previous treatment. (basically, what got in the way of them accessing help?)
For example, lack of money, work or family commitments, stigma or discrimination, or lack of services that understand your language or background?
Cultural Factors Affecting Current Help-Seeking
In this section of the CFI, we will be trying to look for the following:
An individual's current perceived needs and expectations of help.
The views of the social network regarding help-seeking.
Example Questions
What kind of help would be most helpful to you with your current problem?
Are there other kinds of help that your family, friends, or other people have suggested would be helpful for you now?
Cultural Factors in the Therapeutic Relationship.
In this section of the CFI, we will be trying to look for the following:
Any possible concerns about the clinician-patient relationship, including perceived racism, language barriers, or cultural differences that may undermine goodwill, communication, or care delivery.
Example Questions
Sometimes, doctors and patients misunderstand each other because they come from different backgrounds or have different expectations.
Have you been concerned about this, and can we do anything to provide you with the care you need?
How will this information influence my practice:
The CFI questions can easily be integrated into any initial assessment. The information from these questions could be used alongside any formulation model (such as the 5P's model) to develop a deeper understanding of a person's current concerns from an individual's and their network's social and cultural perspective. It will allow us to work holistically and identify areas of need.
Lastly, Whilst reading this article, do any reflections or viewpoints come to mind?
Comment your views below.